【摘要】目的探讨PDCA[即计划(Plan)、实施(Do)、检查(Check)、处理(Aciton)]循环管理对基层医院维持性血液透析(maintenance hemodialysis,MHD)患者矿物质代谢及营养指标改善的作用及其认知的影响，提高MHD 患者的透析质量管理。方法研究选取苏州大学附属无锡市第九人民医院血液净化中心MHD患者98例，随机分为常规宣教组46 例，PDCA 循环管理组52 例。比较干预前后2 组矿物质代谢及营养指标达标率、营养不良-炎症评分(malnutrition inflammation score, MIS)及钙磷代谢与营养相关知识的掌握情况。结果干预18个月后，PDCA循环管理组患者血红蛋白、血磷、全段甲状旁腺素(intact parathyroid hormone, iPTH)达标率分别为71.15%、59.62%、53.85%，均高于常规宣教组的45.65%、34.78%、23.91%(c2=6.571、6.031、9.138,P=0.010、0.014、0.003)；PDCA 循环管理组患者MIS 评分明显下降(t=-2.926,P=0.005)，而常规宣教组无明显变化(t=1.284, P=0.206)，干预后2 组MIS 评分比较有统计学差异(t=- 3.226,P=0.002)；2 组患者钙磷代谢及营养相关知识调查问卷得分均提升(t=-11.395、-16.299, 均P＜0.001)，干预后PDCA 管理组调查问卷得分明显优于常规宣教组(t=4.906, P＜0.001)。结论PDCA 循环管理模式可有效改善基层医院MHD 患者的矿物质代谢水平及营养状况，提升患者自我管理意识，有利于改善预后，提高患者生活质量。
【Abstract】Objective To investigate the effect of PDCA (Plan, Do, Check and Action) cycle management on the improvement of mineral metabolism and nutritional indexes and cognition of the patients, in order to increase the hemodialysis quality management in maintenance hemodialysis (MHD) patients treated in the primary hospitals. Methods A total of 98 patients undergoing MHD in the Blood Purification Center of Wuxi Nineth People’s Hospital Affiliated to Soochow University were recruited and randomly divided into the routine health education group (n=46), and the PDCA cycle management group (n=52). The compliance rates of mineral metabolism and nutritional indexes, malnutrition-inflammation score (MIS), and knowledge of the patients about calcium and phosphorus metabolism and nutrition were compared before and after the intervention. Results After intervention for 18 months, the compliance rates of hemoglobin, serum phosphorus and parathyroid hormone were 71.15%, 59.62% and 53.85% respectively in the PDCA cycle management group, higher than those of 45.65%, 34.78% and 23.91% respectively in the routine health education group (c2=6.571, 6.031 and 9.138 respectively, P=0.010, 0.014 and 0.003 respectively). MIS score decreased significantly in the PDCA cycle management group (t=-2.926, P=0.005), but had no significant change in the routine health education group (t=1.284, P=0.206). MIS scores after the intervention were statistically different
between the two groups (t=-3.226, P=0.002). The scores of patients’knowledge about calcium and phosphorus metabolism and nutrition were improved in both groups (t=-11.395 and -16.299, P<0.001). After the intervention, the scores were significantly better in the PDCA cycle management group than in the routine health education group (t=4.906, P<0.001). Conclusion The PDCA cycle management mode can effectively improve the mineral metabolism and nutritional status, the awareness of selfmanagement, the quality of life and their prognosis in MHD patients treated in primary hospitals.
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