王月霞　　高丽媚

[摘要] 目的 研究優质护理和PDCA持续质量改进计划对血液透析患者中心静脉置管相关并发症的控制效果。 方法 选择2017年6月至2019年12月于我院进行血液透析的52例患者作为研究对象，随机分为观察组（实施优质护理和PDCA持续质量改进计划）和对照组（实施常规护理），每组各26例。比较两组患者依从率、依从性评分、中心静脉导管置管时间、心理情绪评分及并发症发生情况。 结果 观察组依从率、依从性评分均高于对照组，差异有统计学意义（P<0.05）。观察组中心静脉导管置管时间明显长于对照组，差异有统计学意义（P<0.05）。观察组并发症总发生率明显低于对照组，差异有统计学意义（P<0.05）。观察组护理后SAS评分、SDS评分均低于对照组，差异有统计学意义（P<0.05）。 结论 对血液透析患者实施优质护理和PDCA持续质量改进计划能提高中心静脉置管护理质量，提高自我管理能力，置管依从性更好，可延长置管时间，降低并发症发生风险，改善不良情绪，具有一定临床价值。

[关键词] 优质护理;持续质量改进;PDCA;中心静脉置管;并发症

[中图分类号] R473          [文献标识码] B          [文章编号] 1673-9701（2021）06-0174-04

Control effect of high-quality nursing and PDCA continuous quality improvement plan on complications related to central venous catheterization in hemodialysis patients

WANG Yuexia   GAO Limei

The Second Department of Internal Medicine， Yunfu Hospital of Traditional Chinese Medicine in Guangdong Province， Yunfu   527300， China

[Abstract] Objective To study the effect of high-quality nursing and PDCA continuous quality improvement plan on controlling complications related to central venous catheterization in hemodialysis patients. Methods A total of 52 patients who underwent hemodialysis in our hospital from June 2017 to December 2019 were selected as the research objects and randomly divided into the observation group（treated with high-quality care and PDCA continuous quality improvement plan） and the control group（treated with conventional nursing）， with 26 cases in each group. The compliance rate， compliance score， central venous catheterization time， psychological mood scores and complications were compared between the two groups. Results Tthe compliance rate and compliance score of the observation group were higher than those of the control group， and the difference was statistically significant（P<0.05）. The observation group′s central venous catheterization time was significantly longer than that of the control group， and the difference was statistically significant（P<0.05）. The total incidence of complications in the observation group was significantly lower than that in the control group， and the difference was statistically significant（P<0.05）. The observation group′s SAS scores and SDS scores were lower than those of the control group after nursing， and the difference was statistically significant（P<0.05）. Conclusion The high-quality nursing and PDCA continuous quality improvement plan for hemodialysis patients can improve the quality of central venous catheterization care， improve patient self-management ability， have better catheterization compliance， extend catheterization time， reduce the risk of complications， and improve a bad mood. It has a certain clinical value.

[Key words] High-quality nursing; Continuous quality improvement; PDCA; Central venous catheterization; Complications

血液透析是肾脏替代治疗三大方式之一，是普及率最高的治疗方法[1]。肾功能受损不可逆转，血液透析通过透析机清除血液中的代谢废物及多余水分，从而维持电解质和酸碱平衡[2]。该治疗方法普及率高，多数县级医院均具备血液透析医疗资源。血液透析每周需要去医院3次接受治疗，患者长时间居家带管，因此需强化中心静脉置管护理，降低并发症风险，延长导管寿命[3-4]。但鉴于患者长期在院外，与医护人员联系较弱，导致病患管理力度不足，患者因护理能力低下、对中心静脉置管了解不足等原因，会影响导管使用寿命[5]。为此本研究观察优质护理和PDCA持续质量改进计划的实施效果，探讨其在血液透析患者中心静脉置管护理中的应用价值，现报道如下。

1 资料与方法

1.1 一般资料

选择2017年6月至2019年12月于我院进行血液透析的52例患者作为研究对象，随机分为观察组与对照组，每组各26例。……