QCC模式在降低血液透析患者高钾血症发生率中的应用

Application of QCC mode in reducing incidence of hyperkalemia in hemodialysis patients

目的观察分析品质管理圈（QCC）模式在降低血液透析（HD）患者高钾血症发生率中的应用效果。方法选择2015年10月至2016年3月期间在东莞市第八人民医院血液净化中心进行血液透析治疗的60例患者，2015年10月至2016年3月为Qcc活动前（没有开展品管圈活动），2016年4月至10月为QCC活动后（开展品管圈活动），比较QCC活动前后患者高钾血症的发生率、急诊透析例次和严重高钾血症引起的病死率。结果Qcc活动后患者血清钾浓度为（5．04±0．95）mmol／L，明显低于QCC活动前的（5．54±1．32）mmol／L（t=3．3746，P=0．0096）；QCC活动后高钾血症发生率为10．17％，明显低于QCC活动前的23．33％（χ2=2．5418，P〈0．05），Qcc活动后高钾血症急诊透析为0次，无患者因高钾血症而死亡，QcC活动后总满意度为100．00％，显著高于Qcc活动前的80．00％（χ2=13．1234，P〈0．05）。结论开展品管圈活动，有效提高了护理满意度，降低了血液透析患者高钾血症的发生率，减少患者因高钾血症而急诊透析的例次，降低了心跳骤停的发生，为延长HD患者生命周期提供新思路。

Objective To observe the effect of quality control activities （QCC） mode in reducing the incidence of hyperkalemia in hemodialysis patients （HD）. Methods 60 patients taking hemodialysis at our center from October, 2015 to October, 2016 were selected. QCC. was not carried out from October, 2015 to March,2016 and was from April to October, 2016. The incidence of hyperkalemia, case-time taking acute dialysis and mortality caused by severe hyperkalemia were compared between before and after QCC. Results The serum potassium concentration was （5.04±0.95） mmol / L after and （5.54±1.32） mmol/L before QCC （t=3.3746, P=0.0096）; the incidence of hyperkalemia was 10.17% after and 23.33% before QCC （χ 2=2.5418, P 〈 0.05）. After QCC, acute hemodialysis because of hyperthermia occurred 0 times and no patients died due to hyperkalemia. After QCC activity, the total satisfaction was 100.00%） after and 80.00% before QCC （χ 2=13.1234, P 〈 0.05）. Conclusions Carrying out QCC can effectively increase nursing satisfaction, decrease the incidences of hyperkalemia and cardiac arrest, and reduce acute hemodialysis because of hyperthermia, so it can extend the patients＇ life cycle.