持续质量改进在减少腹膜透析患者腹膜炎发生中的作用

目的探讨应用持续质量改进(continuons quality improvement,CQI)的方法降低腹膜透析患者腹膜炎发生率的效果。方法选择北京大学人民医院腹膜透析中心CQI前(2008年)持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者63例,分析腹膜炎(29例次)的发生率及特征,采用设计、实施、检验和应用(plan,do,check and act,PDCA)四步法,设计并实施减少腹膜炎发生的防治措施,与CQI后2009年同期101例CAPD患者腹膜炎(14例次)发生情况比较。结果 CQI后,我中心CAPD患者腹膜炎发生率明显降低,由1次/22.2患者月降至1次/70.4患者月。其中,革兰氏阳性球菌所致腹膜炎发生率由1次/35.8患者月降至1次/197患者月;复发性腹膜炎发生率由1次/80.5患者月降至1次/985患者月。与CQI中主要采取的几项改进措施相一致。结论 CQI的方法可以降低腹膜透析中心腹膜炎发生率。

Effect of continuous quality improvement on the prevention of peritonitis in continuous ambulatory peritoneal dialysis patients

Objective To evaluate the effect of continuous quality improvement （CQI） on the prevention of peritonitis in CAPD patients. Methods 29 peritonitis cases in the 63 CAPD patients in 2008 were analysis. We adopted the four-step method （PDCA）, i.e., plan, do, check and act, to design and perform measures for reducing the prevalence of peritonitis, and then compared the peritonitis patients in 2008 with the 14 peritonitis patients in 101 CAPD patients in 2009. Results After CQI, peritonitis patients reduced obviously, from 1 case every 22.2 months to 1 case every 70.4 months. Gram-positive coccobacteria peritonitis patients reduced from 1 case every 35.8 months to 1 case every 197 months. Recurrent peritonitis reduced from 1 case every 80.5 months to 1 case every 985 months. The decrease of peritonitis cases coincided with the measures we adopted. Conclusion CQI can reduce he prevalence of peritonitis in CAPD patients.