PDCA循环在降低CT增强检查中对比剂渗漏不良事件的应用研究

Effect of plan-do-check-act cycle in reducing contrast agent leakage in contrast-enhanced computed tomography

摘要:

目的：探讨计划—实施—检查—处理（plan-do-check-act，PDCA）循环管理程序在计算机断层扫描（computed tomogra－phy，CT）增强检查对比剂渗漏管理中的效果。方法：分析我院2015年3月至2017年2月行CT增强检查患者的临床资料。分别将2015年3月至2016年2月进行增强CT检查采用常规护理程序的40 223例患者作为对照组，2016年3月至2017年2月进行增强CT检查采用PDCA循环管理程序进行护理干预的44 831例患者作为观察组。使用卡方检验分析比较2组患者对比剂渗漏发生率及渗漏的程度。结果：2组患者共发生76例对比剂渗漏事件，发生率为0.08%。其中观察组28例（0.06%），对照组48例（0.11%）。相比于常规增强CT检查护理程序，PDCA循环管理护理程序可以明显降低对比剂渗漏发生率（28/44 831 vs. 48/40 223， X2=7.638，P=0.006）。此外，PDCA循环管理护理程序可以明显降低中度渗漏（7/44 831 vs. 16/40 223， X2=4.579，P=0.032），而不能降低轻度渗漏（19/44 831 vs. 27/40 223， X2=2.402，P=0.121）及重度渗漏（2/44 831 vs. 5/40 223， X2=0.811，P=0.368）。结论：CT增强检查中运用PDCA循环管理程序进行护理干预有利于降低对比剂渗漏不良事件的发生率，从而提高护理质量。

Abstract:

Objective：To investigate the clinical effect of plan-do-check-act（PDCA） cycle management procedure in the management of contrast agent leakage in contrast-enhanced computed tomography（CT）. Methods：A retrospective analysis was performed for the clinical data of patients who underwent contrast-enhanced CT in our hospital from March 2015 to February 2017. A total of 40 223 patients who underwent conventional nursing in contrast-enhanced CT from March 2015 to February 2016 were enrolled as control group，and 44 831 patients who underwent PDCA cycle management in contrast-enhanced CT from March 2016 to February 2017 were enrolled as observation group. The chi-square test was used to compare the incidence rate and degree of contrast agent leakage between the two groups. Results：A total of 76 patients experienced contrast agent leakage，resulting in an incidence rate of 0.08%，with 28 patients（0.06%） from the observation group and 48（0.11%） from the control group. Compared with conventional nursing，PDCA cycle management significantly reduced the incidence rate of contrast agent leakage（28/44 831 vs. 48/40 223， X2=7.638，P= 0.006）. In addition，PDCA cycle management significantly reduced moderate contrast agent leakage（7/44 831 vs. 16/40 223， X2= 4.579，P=0.032），but it did not reduce mild contrast agent leakage（19/44 831 vs. 27/40 223，X2 =2.402，P=0.121） and severe contrast agent leakage（2/44 831 vs. 5/40 223，X2=0.811，P=0.368）. Conclusion：PDCA cycle management for nursing intervention in contrast-en－hanced CT can reduce the incidence rate of contrast agent leakage and improve the quality of nursing.