品管圈在降低血液透析病人体外循环凝血发生率中的应用
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摘要
[目的]探讨应用品管圈活动降低血液透析病人体外循环凝血的效果。[方法]成立"肾生不息"品管圈小组,针对血液透析病人体外循环凝血发生率高的问题,通过把握现状、原因解析找出体外循环凝血发生率高的真因,针对真因共拟定三大对策群组:建立BDA(before-during-after)全程出凝血状态评估体系,精准确定抗凝剂剂量,全程规范抗凝剂使用。[结果]认真执行对策群组中各项措施,使血液透析病人体外循环凝血发生率由4.17%降低至1.60%(P<0.05)。[结论]品管圈活动有效改善了血液透析病人体外循环凝血现状,提高了病人远期生存率。提升了护理质量、凝聚团队精神。
引文
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[2] SUN L,ZOU L X,HAN Y C,et al.Forecast of the incidence,prevalence and burden of end-stage renal disease in Nanjing,China to the year 2025[J].BMC Nephrol,2016,17(1):60-67.
[3] SKAGERLIND M S E,STEGMAYR B G.An evaluation of four modes of low-dose anticoagulation during intermittent haemodialysis[J].Eur J Clin Pharmacol,2018,74(3):267-274.
[4] BERNIEH B,BOOBES Y,AL HAKIM M R,et al.Long-term use of low-molecular-weight heparin in hemodialysis patients:a 7-year experience[J].Blood Purif,2009,27(3):242-245.
[5] KESSLER M,MOUREAU F,NGUYEN P.Anticoagulation in chronic hemodialysis:progress toward an optimal approach[J].Semin Dial,2015,28(5):474-489.
[6] TANAKA M,MONIWA N,OHNISHI H,et al.Impact of the number of anti-thrombosis agents in hemodialysis patients:BOREAS-HD2 Study[J].Kidney Blood Press Res,2017,42(3):553-564.
[7] 中华人民共和国卫生部.血液净化标准操作规程(2010)[S].2010-01-25.
[8] 黄琪,孙雪峰.维持性血液透析的抗凝剂:选择普通肝素还是低分子肝素[J].中国血液净化,2015,14(1):60-62.
[9] 刘佳,赵君.阿加曲班与肝素类药物在血液透析抗凝治疗中的对比研究[J].军医进修学报,2012,33(1):47-49.
[10] 周春梅,任慧敏,全正利.不同抗凝法在血液透析中的应用效果观察[J].护理学杂志,2010,25(1):35-36.
[11] DAVENPORT A.What are the options for anticoagulation needs in dialysis for patients with heparin-induced thrombocytopenia[J]? Semin Dial,2011,24(4):382-385.
[12] HERRERO-CALVO J A,GONZALEZ-PARRA E,PEREZ-GARCIA R,et al.Spanish study of anticoagulation in haemodialysis[J].Nefrologia,2012,32(2):143-152.
[13] ZOCCALI C,ABRAMOWICZ D,CANNATA-ANDIA J B,et al.European best practice quo vadis? From European Best Practice Guidelines(EBPG) to European Renal Best Practice (ERBP)[J].Nephrol Dial Transplant,2008,23(7):2162-2166.
[14] KERR P,PERKOVIC V,PETRIE J,et al.Caring for Austra-lians with Renal Impairment (CARI):dialysis adequacy (HD)guidelines[J].Nephrology,2005,10(Suppl 4):S61-S80.
[15] K/DOQI Workgroup.K/DOQI Clinical practice guidelines for cardiovascular disease in dialysis patients[J].Am J Kidney Dis,2005,45(4 suppl 3):S1-S153.
[16] MACTIER R,HOENICH N,BREEN C,et al.Renal Association Clinical Practice Guideline on haemodialysis[J].Nephron Clin Pract,2011,118(Suppl 1):c241-c286.
[17] NESRALLAH G E,MUSTAFA R A,MACRAE J,et al.Canadian Society of Nephrology guidelines for the management of patients with ESRD treated with intensive hemodialysis[J].Am J Kidney Dis,2013,62(1):187-198.
[18] RICHTROVA P,RULCOVA K,MARES J,et al.Evaluation of three different methods to prevent dialyzer clotting without causing systemic anticoagulation effect[J].Artif Organs,2011,35(1):83-88.