中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (08): 542-546.doi: 10.3969/j.issn.1671-4091.2017.08.010

• 临床研究 • 上一篇    下一篇

PDCA管理对维持性血液透析患者矿物质代谢的影响

张娜1,冯文2   

  1. 1. 北京市回民医院 血液净化中心
    2. 北京大学公共卫生学院 卫生事业管理系
  • 收稿日期:2017-02-20 修回日期:2017-06-25 出版日期:2017-08-12 发布日期:2017-08-12
  • 通讯作者: 张娜 1903509095@qq.com E-mail:1903509095@qq.com

Effect of PDCA management on mineral metabolism disorder in maintenance hemodialysis patients

  • Received:2017-02-20 Revised:2017-06-25 Online:2017-08-12 Published:2017-08-12

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摘要： 目的分析PDCA 质量管理方法[即计划(plan)、实施(do)、检验(check)、应用(act)]对维持性血液透析(maintenance hemodialysis，MHD)患者矿物质代谢水平的作用与影响，完善血液透析患者的质量管理。方法本回顾性研究使用北京市某医院血液透析中心录入北京市血液净化质量控制和改进中心数据登记系统的数据进行分析。该中心于2013 年1 月始进行PDCA 循环管理流程，研究纳入2011 年1 月～2012 年12 月(对照组)及2014 年1 月～2015 年12 月(干预组)期间稳定(＞3 月)且之后具有连续12 个月完整临床数据MHD 患者。两组患者共90 例，记录一般情况(性别、年龄、透析龄、首透时间、原发病)，及矿物质代谢指标[钙(calcium,Ca)、磷(phosphorus,P)、全段甲状旁腺素(intact parathyroid hormone,iPTH)]。干预组应用PDCA 质量管理方法，对质量管理流程实施前后患者的矿物质代谢指标的变化进行分析和评价。采用描述性分析对数据进行统计分析。结果干预前后2 组患者血钙由(2.23 ± 0.19)mmol/L 升至(2.27 ± 0.14)mmol/L(t=1.347,P=0.178)、血磷由(1.90 ± 0.45)mmol/L 降至(1.71±0.35)mmol/L(t=-1.791,P=0.073)、iPTH 由(297.63±233.25)mmol/L 降至(293.46±227.44)mmol/L(t=0.049，P=0.961)，但均无统计学意义。干预前后2 组患者血磷波幅由(1.16±0.59)mmol/L 降至(0.98±0.48)mmol/L，差异有统计学意义(t=-2.089，P=0.037)。干预前后2 组患者iPTH 变异性由(0.47±0.23)%降至(0.35±0.20)%，差异有统计学意义(t=-2.528，P=0.011)。干预前后2 组间血钙变异性、血钙波幅、血磷变异性、iPTH 波幅、异常血钙占比、异常血磷占比、异常iPTH 占比无统计学差异。结论采用PDCA质量管理可改善MHD患者矿物质代谢水平，对于MHD 患者的医疗服务管理有重要意义。

关键词: PDCA管理, 血液透析, 矿物质代谢, 变异性

Abstract: Objective To explore the effect of PDCA (plan, do, check and act) management on the improvement of mineral metabolism disorder in maintenance hemodialysis (MHD) patients in order to improve quality management for hemodialysis patients. Methods Since Jan. 1st, 2013, the PDCA, a 4-step problemsolving irame work of continuous quality improvement (CQI), was carried out for the management of mineral metabolism disorder in MHD patients who were stable for more than 3 months in one hospital in Beijing. A total of 90 MHD patients treated in the hospital with complete clinical data within 12 months from Jan. 2011 to Dec. 2012 (control group) and from Jan. 2014 to Dec. 2015 (intervention group) were enrolled in this study. Clinical characteristics and mineral metabolism parameters including serum Ca, P and intact parathyroid hormone (iPTH) were extracted from digital clinical record system. Variability and mean of the parameters were calculated. Changes of mineral metabolism parameters were compared between the two groups. Results In intervention group and control group before PDCA management, serum Ca increased from 2.23±0.19 mmol/L to 2.27±0.14 mmol/L (t=1.347, P=0.178), serum P decreased from 1.90±0.45 mmol/L to 1.71±0.35 mmol/L (t=-1.791, P=0.073), and serum iPTH decreased from 297.63±233.25 mmol/L to 293.46±227.44 mmol/L (t= 0.049, P=0.961). These changes had no statistical significances. After the intervention, the variation of serum P between the two groups decreased from 1.16±0.59 mmol/L to 0.98±0.48 mmol/L (t=-2.089, P=0.037), the coefficient of variation (CV) of serum iPTH between the two groups decreased from 0.47±0.23% to 0.35± 0.20% (t=-2.528, P=0.011). The mean, range and CV of serum Ca, the mean and CV of serum P, the mean and range of serum iPTH, and the abnormal ratio of serum Ca, P and iPTH were similar between the two groups.Conclusions PDCA management improves mineral metabolism in MHD patients, and is thus useful for the management of MHD patients.

Key words: PDCA, Hemodialysis, Mineral metabolism, Variability