基于QCC的链式质控护理管...施在急诊PCI患者中的应用_答秀维.pdf

海南医学2023年2月第34卷第4期Hainan Med J,Feb.2023.Vol.34,No.4基于QCC的链式质控护理管理措施在急诊PCI患者中的应用答秀维1，朱芳芳1，刘丹1，常莎莎1，刘国晨1，袁鹏1，张俊2空军军医大学第二附属医院介入疼痛科1、门诊部2，陕西西安710038【摘要】目的观察基于品管圈(QCC)的链式质控护理管理措施在急诊经皮冠状动脉介入术(PCI)患者中的应用效果。方法选取2020年7月至2021年6月于空军军医大学第二附属医院行急诊PCI的128例患者为研究对象。按照随机数表法分研究组和对照组各64例。对照组患者行常规护理，研究组患者在对照组的基础上行基于QCC的链式质控护理。比较两组患者急诊室进出时间、住院时间、急诊到球囊扩张时间与随访6个月生活质量健康调查简表(SF-36)评分、心功能指标包括N末端B型利钠肽原(NT-proBNP)、6min步行距离、左心射血分数、不良事件发生情况。结果研究组患者的急诊室进出时间、住院时间、急诊到球囊扩张时间分别为(48.659.87)min、(8.851.93)d、(47.5010.32)min，明显短于对照组的(60.3611.24)min、(13.103.52)d、(66.0911.21)min，差异均有统计学意义(P0.05)；随访6个月，研究组患者的总体健康、躯体健康、躯体疼痛、情绪角色、躯体角色、社会功能、精力、精神健康评分分别为(51.048.26)分、(76.9218.37)分、(77.2613.29)分、(75.1518.24)分、(61.3316.31)分、(72.268.42)分、(77.158.93)分、(70.356.74)分，明显高于对照组的(43.287.31)分、(55.8316.14)分、(67.9110.37)分、(64.2517.49)分、(50.0215.09)分、(60.567.25)分、(65.819.46)分、(60.775.01)分，差异均有统计学意义(P0.05)；研究组患者的NT-proBNP为(357.1428.54)ng/mL，明显低于对照组的(392.7130.26)ng/mL，左心射血分数、6 min步行距离为(59.266.37)%、(420.7358.41)m，明显高于对照组的(53.085.96)%、(363.9651.85)m，差异均具有统计学意义(P0.05)；研究组患者的不良事件发生率为25.00%，明显低于对照组的48.44%，差异有统计学意义(P0.05)。结论基于QCC的链式质控护理管理措施应用于急诊PCI中可缩短患者的住院时间，有效改善心功能及生存质量，同时还能降低不良事件发生率，值得推广应用。【关键词】经皮冠状动脉介入术；品管圈；链式质控护理；急诊；心功能；不良事件【中图分类号】R47【文献标识码】A【文章编号】10036350（2023）04057405Application of chain quality control nursing management measures based on QCC in patients undergoingemergency PCI.DA Xiu-wei1,ZHU Fang-fang1,LIU Dan1,CHANG Sha-sha1,LIU Guo-chen1,YUAN Peng1,ZHANGJun2.Department of Interventional Pain1,Outpatient Department2,Second Affiliated Hospital of Air Force Military MedicalUniversity,Xian 710038,Shaanxi,CHINA【Abstract】ObjectiveTo observe the application effect of quality control circle(QCC)-based chain qualitycontrol nursing management measures in patients undergoing emergency percutaneous coronary intervention(PCI).MethodsA total of 128 patients who underwent emergency PCI in Second Affiliated Hospital of Air Force MilitaryMedical University from July 2020 to June 2021 were selected as the research subjects.According to the random numbertable method,they were divided into the study group and the control group,with 64 cases in each group.The control groupreceived routine nursing care,and the study group received chain quality control nursing based on QCC on the basis of thecontrol group.After 6 months of follow-up,the time of entering and leaving the emergency room,length of hospital stay,time from emergency to balloon dilation,and 36-item Short-Form(SF-36)Health Survey score at follow-up of 6 months,cardiac function indicators including N-terminal pro-B-type natriuretic peptide(NT-proBNP),6-min walking distance,left ventricular ejection fraction,and incidence of adverse events were compared between the two groups.ResultsThetime of entering and leaving the emergency room,length of hospital stay,and time from emergency to balloon dilationwere(48.659.87)min,(8.851.93)d,and(47.5010.32)min in the study group,which were significantly shorter than(60.3610.32)min,(13.103.52)d,(66.0911.21)min in the control group(P0.05).At follow-up of 6 months,the gener-al health,physical health,physical pain,emotional role,physical role,social function,energy,and mental health scores ofthe patients in the study group were(51.048.26)points,(76.9218.37)points,(77.2613.29)points,(75.1518.24)points,(61.3316.31)points,(72.268.42)points,(77.158.93)points,(70.356.74)points,significantly higher than(43.287.31)points,(55.8316.14)points,(67.9110.37)points,(64.2517.49)points,(50.0215.09)points,(60.567.25)points,(65.819.46)points,(60.775.01)points in the control group(P0.05)，具有可比性。本研究经医院医学伦理委员会批准，且患者及其家属均知情并签署知情同意书。1.2护理方法对照组患者行常规护理。入院后严密监测患者生命体征，同时严格按医嘱用药，并为患者讲解疾病基本内容及注意事项等。研究组患者在对照组的基础上行基于QCC的链式质控护理。(1)组建QCC团队：于心内科培训QCC知识后，按照自愿原则，组建QCC团队。本次研究共纳入11名成员，之中包括QCC圈长1名、心脏专科护士1名、心内科医生1名及8名主管护师。(2)主题确定：经护理质量分析反馈、头脑风暴法及医生讨论，确定亟需改进的护理措施，然后按照迫切性、重要性、上级政策、圈能力等维度。选择“531评价法”选定改善急诊PCI患者心功能及生存质量为主题。(3)拟订活动计划：按照品管圈步骤，明确活动日期、任务分配，确定团队活动计划表。QCC团队每个月进行一次线下会议，平时使用微信群、企业微信等开展线上会议，沟通护理措施进展情况及面对的问题等。(4)现状把握：分析PCI患者状况及术后心功能、生存质量状况，得出PCI患者术后心功能、生存质量同患者心理状况、术后康复指导、对疾病的了解程度息息相关。(5)对策制定、实施：接触到患者时就需开展心理护理，选择健康宣教、沟通交流等方法减轻患者的抑郁、害怕、紧张、焦虑等不良情绪，同时与患者家属沟通，了解患者过敏史，且使其了解介入干预的意义与重要性。手术完成后患者进入重症监护室，且实施连续心电监测，定时询问患者有无心悸、胸闷、胸痛症状，并对血压变化进行观察，若出现异常确保第一时间进行对症干预。实施心电图监测，同术前心电图比较，分析心肌供血差异，为复诊提供相关依据，若患者开展支架手术，需使患者了解术侧身体24 h内不能挤压、伸屈，建议患者选择侧卧位(另一侧)或平卧位，若患者实施股动脉穿刺，需使患者术侧身体保持平伸，同时选择沙袋止血(超过5 h)，并身体制动大于10 h。定时检查患者穿刺部位有无皮下肿胀、渗血等状况，确保穿刺部位的辅料干燥、干净，同时按照医嘱使用抗生素，防止感染，叮嘱患者术后多喝水，使造影剂加快排出。术后7 d给患者设计有针对性的康复计划，以提升患者的生存质量，增加患者战胜疾病的信心，同时让患者食用低热量、低盐、28.54)ng/mL,which was significantly lower than(392.7130.26)ng/mL of the control group,and left cardiac ejectionfraction and 6-min walking distance were(59.266.37)%and(420.7358.41)m,which were significantly higher than(53.085.96)%and(363.9651.85)m in the control group,with statistically significant differences(P0.05).The inci-dence of adverse events in the study group was 25.00%,which was significantly lower than 48.44%in the control group(P0.05).ConclusionThe application of QCC-based chain quality control nursing managemen