PDCA循环在提高急性心源性肺水肿患者无创正压辅助通气成功率中的应用

左汉恒 李银平 崔英华

[摘要] 目的 该研究将观察PDCA循环管理是否可以提高急性心源性肺水肿患者无创辅助通气使用成功率，从而降低气管插管率，缩短入住监护室时间。方法 方便选自2017年1月—2018年12月期间入住该院心内监护室符合ACPE诊断并行NIPPV治疗的患者74例作为研究对象，应用PDCA循环管理措施进行干预，按照循环实施的时间进行分期，主要分为基线期、PDCA第1周期、PDCA第2周期、PDCA第3周期以及维持期，观察不同时期内两组患者的气管插管成功率和入住监护室时间。结果 在3个月的基线期内，无创辅助通气成功率为56.76%。在第1个PDCA周期、第2个PDCA周期以及第3个PDCA周期，无创辅助通气成功率依次为65.96%、75.00%和77.36%。在维持期，无创辅助通气成功率为80.56%。维持期同基线其相比较，气管插管率降低、入住监护室时间缩短，差异有统计学意义（P<0.05）。结论 PDAC循环管理提高了急性心源性肺水肿患者无创呼吸机使用成功率，降低气管插管率，缩短入住监护室住院时间。

[关键词] 急性心源性肺水肿;无创正压辅助通气;PDCA

[Abstract] Objective This study will observe whether PDCA circulation management can improve the success rate of noninvasive assisted ventilation in patients with acute cardiogenic pulmonary edema， thereby reducing the rate of tracheal intubation and shortening the time of admission to the monitoring room. Methods A total of 74 patients who were admitted to our hospital's intracardial care room and were eligible for ACPE diagnosis and NIPPV treatment during the period from January 2017 to December 2018 were convenienty selected as the research subjects. PDCA cycle management measures were used to intervene and staged according to the cycle implementation time. It is mainly divided into baseline period， PDCA 1st cycle， PDCA 2nd cycle， PDCA 3rd cycle and maintenance period， and the success rate of tracheal intubation and the time of admission to the monitoring room of the two groups of patients were observed in different periods. Results During the 3-month baseline period， the success rate of noninvasive assisted ventilation was 56.76%. In the first PDCA cycle， the second PDCA cycle， and the third PDCA cycle， the success rates of noninvasive assisted ventilation were 65.96%， 75.00%， and 77.36%， respectively. During the maintenance period， the success rate of noninvasive assisted ventilation was 80.56%. Compared with the baseline during maintenance period， the tracheal intubation rate decreased and the time of admission to the monitoring room was shortened， and the differences were statistically significant （P<0.05）. Conclusion PDAC circulation management improves the success rate of noninvasive ventilator use in patients with acute cardiogenic pulmonary edema， reduces the rate of tracheal intubation， and shortens the length of stay in the monitoring room.

[Key words] Acute cardiogenic pulmonary edema; Noninvasive positive pressure assisted ventilation; PDCA

急性心源性肺水腫（acute cardiogenic pulmonaryedema ，ACPE）主要表现为严重呼吸衰竭，如果不紧急治疗，ACPE可能在几小时甚至分钟导致心肺衰竭，甚至死亡。常规氧疗常常不能完全代偿呼吸衰竭，需要呼吸机辅助通气支持治疗。无创正压通气（non-invasive positive pressure ventilation， NIPPV）可改善氧合和呼吸困难，减少气管插管辅助通气的需求[3]，降低呼吸机相关性肺炎的风险和病死率。然而，在实施NIPPV的过程中，许多患者不能耐受无创辅助通气，导致无创辅助通气失败。

PDCA（Plan-Do-Check-Act， PDCA）广泛应用于质量管理中，是质量持续改进的重要工具。PDCA近来被广泛用于医疗领域，提高医疗质量管理能力。该方便选自2017年1月—2018年12月期间入住该院心内监护室符合ACPE诊断[1]并行NIPPV治疗的患者74例作为研究对象，应用PDCA循环管理，提高了ACPE患者无创呼吸机使用成功率，取得了良好效果，报道如下。……