方韡

【摘要】目的：通过集束化护理措施预防血液透析中后期低血压发生，从而降低非计划下概率，提高血液透析充分性。方法：选择2021年6月—2021年12月血液透析期间反复发生低血压的维持性血液透析患者55例，对其实施集束化护理措施，比较实施前后低血压致非计划下概率与患者满意度。结果：实施前低血压致非计划下概率为3.09%，实施后为1.45%，比较具有统计学意义（P<0.05）。实施前患者满意度为80.00%，实施后为96.36%，比较具有统计学意义（P<0.05）。结论：通过集束化护理达到持续质量改进，可有效减少透析中后期低血压发生，从而降低非计划下概率，保证透析充分性，提高患者透析满意度。

【关键词】血液透析；非计划下机；集束化护理；低血压

Application of cluster nursing measures in reducing the probability of unplanned hemodialysis

FANG Wei

Jiangsu Province Hospital of Chinese Medicine， Nanjing， Jiangsu 210029， China

【Abstract】Objective： To prevent the occurrence of hypotension in the middle and late stages of hemodialysis through cluster nursing measures， thereby reducing the probability of unplanned events and improving the adequacy of hemodialysis. Methods： A total of 55 maintenance hemodialysis patients who experienced recurrent hypotension during hemodialysis from June 2021 to December 2021 were selected and subjected to cluster nursing measures. The probability of unplanned hypotension before and after implementation and patient satisfaction were compared. Results： The probability of unplanned hypotension before implementation was 3.09%， and after implementation was 1.45%， which was statistically significant （P<0.05）. The patient satisfaction rate before implementation was 80.00%， and after implementation was 96.36%， which was statistically significant （P<0.05）. Conclusion： Continuous quality improvement through cluster nursing can effectively reduce the occurrence of hypotension in the middle and late stages of dialysis， thereby reducing the probability of unplanned events， ensuring dialysis adequacy， and improving patient satisfaction with dialysis.

【Key Words】Hemodialysis； Unplanned events； Cluster nursing； Hypotension

血液透析是目前终末期肾病安全有效的替代疗法。据报道，至2017年我国终末期肾病患者接近300万，近45万接受血液透析治疗，且还在逐年增加[1]。随之而来的是，庞大数量的血液透析患者对护理服务的高需求，提高透析质量、减少不良事件、持续质量改进是血液净化中心护理人员的首要责任。目前血液净化敏感指标的研究尚处于探索阶段，尚缺乏血液净化护理质量统一的质量评价指标。我科室持续质量改进小组以“血液透析”和“质量评价”“血液透析”和“敏感指标”“血液净化敏感指标”为关键词搜索中国知网、万方数据库、维普中文期刊科技数据库文献共58篇，参考文献中以德尔菲的结构-过程-结果模式为基础拟定的血液净化护理敏感指标，结合省拟定的血液净化护理敏感指标，遴选出通过“降低血液透析非计划下概率”作为此次推动血液透析护理质量改进的敏感指标，并实施集束化护理措施来降低非计划下概率，報道如下。

1 对象与方法