应用六西格玛方法降低ERCP术后高淀粉酶血症发生率

Decreasing hyperamylasemia rate after ERCP surgery by six-sigma management

目的:降低胆总管结石ERCP术后高淀粉酶血症发生率,提高医疗质量。方法:应用六西格玛质量管理体系中的DMAIC模式,即定义、测量、分析、改进和控制五个步骤对胆总管结石ERCP术操作流程进行分析,找出影响术后高淀粉酶血症发生率的主要原因,制定相应的改进措施,并对改进前后的发生率进行比较。结果:高淀粉酶血症发生率从34%降至12.1%,短期Z值从1.908升至2.665。结论:建立术前风险评估制度、建立ERCP操作医生准入制度、推广应用预切开技术和ENBD、严格控制手术操作时间、避免胰管反复显影、改变术前用药方法和术后合理的预防性用药等改进措施是降低术后高淀粉酶血症发生率的有效办法。

Objectives： To decrease hyperamylasemia rate after ERCP surgery and improve medical quality. Methods： ERCP surgery process will be divided into 5 process names conception, measurement, analysis, promotion and control by framework of six-sigma management system. Main influence factors of causing hyperamylasemia after surgery were found and countermeasures were presented. The hyperamylasemia rate before and after surgery was compared. Results： Hyperamylasemia rate was decreased from 34% to 12.1%, short term Z value increased from 1.908 to 2.665. Conclusions： Establishing pre-operation risk evaluation system and ERCP admission system, popularizing pre-cut technique and ENBD, strict controlling operation time, avoiding repeated pancreatic magnetic resonance cholangiopancreatography, changing pro-operation drug use and rational using preventive drug after operation can all effectively decrease hyperamylasemia rate after ERCP.