持续质量改进降低人工血管动静脉内瘘并发症及提高透析患者生存质量的临床研究

Clinical Study on Continuous Quality Improvement to Reduce Complications of Artificial Vascular Arteriovenous Fistula and Improve Quality of Life of Hemodialysis Patients

目的:探究持续质量改进(CQI)降低人工血管动静脉内瘘并发症的临床效果,并分析其对提高透析患者生存质量的影响。方法:选取2018年1-12月笔者所在医院收治的行规律性维持性血液透析患者22例,2018年1-6月采用常规护理,2018年7-12月采用CQI护理。统计CQI实施前后人工血管动静脉内瘘并发症发生率、患者对临床护理质量满意度、生存质量评分及液体平衡管理相关指标变化情况。结果:CQI实施后,人工血管动静脉内瘘并发症发生率均显著低于实施前,临床护理质量满意度显著高于实施前(P<0.05);CQI实施后,患者生理领域、环境领域、社会关系领域、心理领域评分及总分均显著高于实施前(P<0.05);CQI实施后,患者DBP、SBP、HR、心胸比、NT-proBNP水平均显著低于实施前(P<0.05)。结论:实施CQI后,可有效降低维持性血液透析患者人工血管动静脉内瘘并发症发生率,提升患者对临床护理质量满意度及生存质量,值得临床推广应用。

Objective:To explore the clinical effect of continuous quality improvement(CQI)on reducing complications of artificial vascular arteriovenous fistula and to analyze its effect on improving the quality of life of hemodialysis patients.Method:Twenty-two patients with regular maintenance hemodialysis admitted to our hospital from January to December 2018 were selected.The patients received routine nursing from January to June 2018,and CQI nursing from July to December 2018.The incidences of complications of artificial vascular arteriovenous fistula,patients’satisfaction with clinical nursing quality,scores of quality of life and related indicators of fluid balance management before and after the implementation of CQI were compared.Result:After the implementation of CQI,the incidences of complications of artificial vascular arteriovenous fistula were significantly lower than those before the implementation,and the satisfaction with clinical nursing quality was significantly higher than that before the implementation(P<0.05).After the implementation of CQI,the scores of physiological field,environmental field,social relationship field and psychological fields and total score were significantly higher than those before the implementation(P<0.05).After the implementation of CQI,the levels of DBP,SBP,HR,heart-chest ratio,NT-proBNP were significantly lower than those before the implementation(P<0.05).Conclusion:After the implementation of CQI,it can effectively reduce the complications of artificial vascular arteriovenous fistula in maintenance hemodialysis patients,improve the patients’satisfaction with clinical nursing quality and quality of life,which is worthy of clinical application.