PDCA循环在初发脑梗死患者出院后行为管理中的应用效果

The application effects of PDCA circulation on behavior management in discharged patients with first cerebral infarction

目的 探讨PDCA循环在初发脑梗死患者出院后行为管理中的应用效果.方法 选取2013年4月至2015年3月入住安徽医科大学第一附属医院的初发脑梗死患者,根据住院号单双号分为观察组94例和对照组80例.对观察组患者在采用常规个性化二级预防措施的基础上,实施为期9个月的PDCA循环管理方案.采用脑卒中行为改变问卷评估2组患者出院后1年的生活方式和遵医服药行为改变情况.结果 出院后1年,观察组抽烟戒除、定期血压监测、定期血糖监测、适当锻炼身体、压力控制5项行为改变程度分别为0.00（0.00,3.00）、1.68（1.00,3.00）、1.00（0.00,2.00）、1.20（0.75,2.00）、1.00（0.00,1.00）分,对照组分别为0.00（0.00,1.00）、1.00（0.00,2.00）、0.00（0.00,1.00）、1.00（1.00,2.00）、0.00（0.00,1.00）分,2组比较观察组高于对照组,差异有统计学意义（Z=-3.166^-2.419,均P〈0.05）,观察组遵医服用降血糖、降血压、心房颤动、心血管病、脑卒中药物行为改变的程度分别为0.00（0.00,0.00）、0.00（0.00,2.00）、0.00（0.00,0.00）、0.00（0.00,0.00）、3.00（3.00,3.00）分,对照组分别为0.00（0.00,0.00）、0.00（0.00,0.79）、0.00（0.00,0.00）、0.00（0.00,0.80）、0.00（0.00,1.50）分,2组比较观察组也高于对照组,差异有统计学意义（Z=-8.081^-2.595,均P〈0.05）.结论 应用PDCA循环质量管理干预脑梗死患者出院后行为,能够较好地帮助患者纠正不良生活方式,增加患者遵医服药依从性,使脑梗死二级预防工作落到实处.

Objective To explore the application effects of PDCA circulation on behavior management in discharged patients with first cerebral infarction. Methods Patients with first attack of cerebral infarction were enrolled from the department of neurology of the First Hospital of Anhui Medical University from April 2013 to March 2015. According to their admission numbers, patients were divided into the observation group （94 cases） and the control group （80 cases）. Besides of the regular personalized secondary prevention, the observation group was also applied for the PDCA cycle for nine months. Stroke Behavior Change Inventory was used to evaluate the changes of their lifestyle and medication compliance one year after discharge for two groups. Results After the observed patients were discharged one year, the changed extent of these five behaviors including quitting smoking, regular monitoring blood pressure and sugar, appropriate exercise, pressure control in the observation group were 0.00 （0.00, 3.00）, 1.68 （1.00, 3.00）, 1.00 （0.00, 2.00）, 1.20 （0.75, 2.00）, 1.00 （0.00, 1.00） points, and these in the control group were 0.00 （0.00, 1.0）0, 1.00 （0.00, 2.00）, 0.00 （0.00, 1.00）, 1.00 （1.00, 2.00）, 0.00（0.00, 1.00） points. The observation group in these parameters had significantly higher than the control group （Z=-3.166--2.419, P 〈 0.05）. The changed extent of these behaviors in the medication compliance such as reducing blood glucose, blood pressure, atrial fibrillation, cardiovascular disease, and stroke prevention in the observed group were 0.00 （0.00, 0.00）, 0.00 （0.00, 2.00）, 0.00 （0.00, 0.00）, 0.00 （0.00, 0.00）, 3.00 （3.00, 3.00） points, and these in the control group were 0.00 （0.00, 0.00）, 0.00 （0.00, 0.79）, 0.00 （0.00, 0.00）, 0.00 （0.00, 0.80）, 0.00 （0.00, 1.50） points. The observation group in these parameters had significantly higher the above parameters than the control group （Z=-8.081--2.595, P〈0.05）. Conclusions Application of the PDCA circulation in the patients with first attack of cerebral infarction after their discharge can help them correct lifestyle and increase their medical treatment compliance, which is beneficial for secondary prevention of cerebral infarction.