标题：PDCA循环结合智能化网络管理在血液透析患者自我管理模式中的应用

      作者：苏惠娟，莫秀飞，关淑兴    (佛山市第五人民医院血液净化中心，广东 佛山 528211)

      卷次： 2018年29卷11期

      【摘要】 目的 探讨PDCA循环结合智能化网络管理在维持性血液透析(MHD)患者自我管理模式中的应用价值。方法 选择2016年1月至2017年5月佛山市第五人民医院血液透析室治疗的90例MHD患者为研究对象，根据随机数表法分为A组、B组和C组，每组30例，分别给予常规护理管理、智能化网络管理及PDCA循环结合智能化网络管理，干预时间为 6个月，比较干预后三组患者自我管理能力、并发症发生率和饮食控制依从性，采用SF-36量表评价患者的生活质量，分为心理健康总评分(MCS)和生理健康总评分(PCS)两个方面；同时使用改良定量主观整体评估表(MQSGA)评价患者的营养状态。结果 干预后，C组患者自我管理行为问卷得分为(73.2±6.4)分，饮食依从率为80.00%，明显高于B组的(67.1±5.7)分和56.67%以及A组的(61.2±4.2)分和33.33%，而B组的上述指标也明显高于A组，差异均有统计学意义(P<0.05)；C组患者的急性透析及导管感染发生率分别为 6.67%和3.33%，明显低于A组的26.67%和23.33%，也低于B组的23.33%和20.00%，差异均有统计学意义(P<0.05)；C组患者的MQSGA评分为(11.2±1.9)，PCS和MCS评分分别为(64.6±7.5)分、(63.6±6.2)分，与B组的(13.6±2.8)分、(58.1±6.3)分、(57.8±5.8)分及A组的(15.7±3.6)分、(53.2±5.4)分、(52.4±4.9)分比较，差异均有统计学意义(P<0.05)；B组的上述指标与A组比较，差异均有统计学意义(P<0.05)。结论 PDCA循环结合智能化网络管理可以有效提高MHD患者自我管理能力及饮食控制依从性，降低透析导管感染发生率，改善营养状态，提高生活质量。
      【关键词】 维持性血液透析；PDCA循环；智能网络化；自我管理；营养状态；生活质量
      【中图分类号】 R473.6 【文献标识码】 A 【文章编号】 1003—6350（2018）11—1626—03

Application of plan-do-check-act cycle combined with intelligent network management in self-managementmode of hemodialysis patients.
SU Hui-juan, MO Xiu-fei, GUAN Shu-xing. Department of Blood Purification Center, theFifth People's Hospital of Foshan City, Foshan 528211, Guangdong, CHINA
【Abstract】 Objective To explore the application value of plan-do-check-act (PDCA) cycle combined with in-telligent network management in self-management of patients with maintenance hemodialysis (MHD). Methods Dur-ing January 2016 to May 2017, 90 MHD patients in Department of Blood Purification Center, the Fifth People's Hospitalof Foshan City were slected as the research objects. According to random number table method, they were divided intogroup A, group B, group C, with 30 patients in each group, which were given routine nursing management, intelligentnetwork management, and PDCA cycle combined with intelligent network management, respectively. The interventiontime was 6 months. The self-management ability, complication rate and diet control compliance between the three groupsafter intervention were compared. The quality of life (QOL) of the patients was evaluated by SF-36, which was dividedinto two aspects: mental health score (MCS) and physiological health scale (GPS). The Modified Quantitative SubjectiveGlobal Assessment (MQSGA) was used to evaluate the nutritional status of the patients. Results After the intervention,self-management behavior questionnaire scores and diet compliance rate in group C were (73.2±6.4), 80.00%, respec-tively, which were significantly higher than (67.1±5.7), 56.67% in group B and (61.2±4.2), 33.33% in group A, withthe indexes in group B significantly higher than those in group A (P<0.05). Acute dialysis and catheter infection rate ingroup C was 6.67% and 3.33% , respectively, which was significantly lower than 26.67% , 23.33% in group A, and23.33%, 20.00% in group B (P<0.05). The score of MQSGA in group C was (11.2±1.9), and PCS and MCS scores were(64.6±7.5) and (63.6±6.2), compared with (13.6±2.8), (58.1±6.3), (57.8±5.8) in group B, and (15.7±3.6), (53.2±5.4),(52.4±4.9) in group A, with statistically significant differences (P<0.05). The above indexes in group B were significant-ly different from those in group A (P<0.05). Conclusion PDCA cycle combined with intelligent network managementcan effectively improve the self-management ability and dietary control compliance of MHD patients, which can reducethe incidence of dialysis catheter infection, and improve the nutritional status and enhance the quality of life.
      【Key words】 Maintenance hemodialysis (MHD); Plan-do-check-act (PDCA) cycle; Intelligent network;Self-management; Nutritional status; Quality of life·护 理·doi:10.3969/j.issn.1003-6350.2018.11.046基金项目：广东省佛山市卫生和计生局医学科研课题(编号：20180140)