PDCA循环管理在急诊科动物咬伤伤口处理中的应用研究

doi:10.3760/cma.j.issn.1007-1245.2023.23.041

摘要/Abstract

摘要：

目的　探讨计划（plan）、实施（do）、检查（check）、处理（action）（PDCA）循环管理在急诊科动物咬伤伤口处理中的应用效果。方法　回顾性分析2023年1月至6月厦门大学附属第一医院急诊科收治的200例动物咬伤患者临床资料，将2023年1月至3月采取常规急诊管理期间收治的100例患者设为对照组，其中男56例，女44例，年龄（40.29±6.43）岁；2023年4月至6月采取PDCA循环管理期间收治的100例患者设为观察组，其中男59例，女41例，年龄（39.63±6.89）岁。对比两组急诊管理质量、伤口愈合等级、伤口愈合情况、伤口疼痛程度。采用t检验、χ²检验、秩和检验。结果　观察组的不易清洗易滑倒发生率低于对照组［0比6.00%（6/100）］；伤口冲洗依从率［98.00%（98/100）］、座椅舒适度［97.00%（97/100）］、伤口处理规范率［99.00%（99/100）］，高于对照组［89.00%（89/100）、85.00%（85/100）、91.00%（91/100）］，差异均有统计学意义（χ²=4.296、6.664、8.791、6.737，P=0.038、0.010、0.003、0.009）；观察组伤口愈合效果优于对照组，伤口疼痛程度轻于对照组，差异有统计学意义（Z=4.521、3.443，均P<0.05）；观察组伤口愈合时间（9.63±2.11）d、瘢痕宽度（35.36±4.05）mm，均短于对照组的（12.47±3.48）d、（43.31±5.64）mm，就诊次数少于对照组［（4.35±0.58）次比（5.11±0.76）次］，差异均有统计学意义（t=6.978、11.594、7.950，均P<0.001）。结论　PDCA循环管理能提高急诊管理质量、动物伤口处理规范率，加快伤口愈合。

关键词:

动物咬伤, 伤口处理, 伤口愈合, 疼痛, PDCA循环管理

Abstract:

Objective　To explore the application effect of PDCA (plan-do-check-action) cycle management in animal bite wound management in emergency department. Methods　A retrospective analysis was conducted on the clinical data of 200 animal bite patients admitted to the emergency department of the First Affiliated Hospital of Xiamen University from January to June 2023. From January to March 2023, 100 patients admitted during the routine emergency management period were set as the control group; from April to June 2023, 100 patients admitted during the PDCA cycle management were set as the observation group. The control group included 56 males and 44 females, aged (40.29±6.43) years; the observation group included 59 males and 41 females, aged (39.63±6.89) years. The quality of emergency management, wound healing level, wound healing status, and degree of wound pain were compared between the two groups. t test, χ² test, and rank sum test were used. Results　The incidence of difficult to clean and easy to slip in the observation group was lower than that in the control group [0 vs. 6.00% (6/100)], and the compliance rate for wound flushing [98.00% (98/100)], seat comfort rate [97.00% (97/100)], and wound management standardization rate [99.00% (99/100)] were higher than those in the control group [89.00% (89/100), 85.00% (85/100), and 91.00% (91/100)], with statistically significant differences (χ²=4.296, 6.664, 8.791, and 6.737; P=0.038, 0.010, 0.003, and 0.009). The wound healing effect of the observation group was better than that of the control group, and the degree of wound pain was less than that of the control group, with statistically significant differences (Z=4.521 and 3.443, both P<0.05). The wound healing time and scar width in the observation group were (9.63±2.11) d and (35.36±4.05) mm, which were shorter than those in the control group [(12.47±3.48) d and (43.31±5.64) mm], and the number of visits was less than that in the control group [(4.35±0.58) vs. (5.11±0.76)], with statistically significant differences (t=6.978, 11.594, and 7.950, all P<0.001). Conclusion　PDCA cycle management can improve the quality of emergency management, standardize the animal wound management, and accelerate the wound healing.

Key words:

Animal bites, Wound treatment, Wound healing, Pain, PDCA cycle management

许锦云.

PDCA循环管理在急诊科动物咬伤伤口处理中的应用研究 [J]. 国际医药卫生导报, 2023, 29(23): 3507-3510.

Xu Jinyun.

Application of PDCA cycle management in animal bite wound management in emergency department [J]. International Medicine and Health Guidance News, 2023, 29(23): 3507-3510.

参考文献

[1] 杜剑,左永波,陈庆军. "优拓"引流条在手部猫咬伤狂犬病暴露Ⅲ级伤口患者治疗中的应用效果[J]. 中国急救复苏与灾害医学杂志,2021,16(9):1060-1062. DOI: 10.3969/j.issn.1673-6966.2021.09.026.
[2] 李曾,李金强,唐臻,等. 不同干预措施控制狂犬病暴露后伤口处置中疼痛的策略探讨[J]. 医学动物防制,2021,37(7):663-666. DOI: 10.7629/yxdwfz202107013.
[3] 王烽,王旭东,黄立嵩. 一期缝合与持续封闭负压引流后延期缝合对儿童犬咬伤患者瘢痕及感染的影响[J]. 中国临床医生杂志,2021,49(8):914-916. DOI: 10.3969/j.issn.2095-8552.2021.08.010.
[4] 付超,王寅,李冉,等. 蒙药嘎木朱尔在动物咬伤伤口愈合中的疗效及优势[J]. 科技导报,2023,41(3):66-71.
[5] 曾少颜,谢丽萍,彭淑梅,等. PDCA循环在持续改进住院病房高危药品管理质量的效果分析[J]. 国际医药卫生导报,2022,28(9):1231-1234. DOI: 10.3760/cma.j.issn.1007- 1245.2022.09.011.
[6] 刘晓庆,严育忠,赵江霞. PDCA循环在医院安全事件管理中的应用[J]. 解放军医院管理杂志,2021,28(12):1128-1129,1132. DOI: 10.16770/J.cnki.1008-9985.2021.12.011.
[7] 殷文武,王传林,陈秋兰,等. 狂犬病暴露预防处置专家共识[J]. 中华预防医学杂志,2019,53(7):668-679. DOI: 10.3760/cma.j.issn.0253?9624.2019.07.004.
[8] 王军. 狂犬病暴露预防处置工作规范(2009年版)[J]. 中国工作犬业, 2010(2):60-61.
[9] 孙兵,车晓明. 视觉模拟评分法(VAS)[J]. 中华神经外科杂志,2012,28(6):645.
[10] 邢瑞婷,吴涛,高舒. 2014-2018年北京市房山区狂犬病暴露人群流行病学特征分析[J]. 预防医学情报杂志,2020,36(5):503-507.
[11] 刘敏,刘铮然,陶晓燕,等. 2020年中国狂犬病流行特征分析[J]. 疾病监测,2022,37(5):609-612. DOI: 10.3784/jbjc.202109080483.
[12] 甘晓虹,李明,刘晖,等. 2011—2020年中国狂犬病暴露人群流行病学与临床防治特征的系统评价[J]. 中国急救复苏与灾害医学杂志,2022,17(10):1261-1267,1277. DOI: 10.3969/j.issn.1673-6966.2022.10.003.
[13] 杨宠,张硕,蒙晓宇,等. 广西某地农村初中学生狂犬病风险认知和预防知识现状分析[J]. 中国健康教育,2022,38(1):44-47. DOI: 10.16168/j.cnki.issn.1002-9982.2022.01.009.
[14] 张艳波,魏亚梅,韩占英,等. 河北省2014-2018年狂犬病流行特征及其暴露处置分析[J]. 中国媒介生物学及控制杂志,2020,31(1):96-99. DOI: 10.11853/j.issn.1003.8280.2020. 01.020.
[15] 陈庆军. 狂犬病暴露后预防处置中被动免疫制剂的规范使用[J]. 中华医学杂志,2021,101(17):1284-1286. DOI: 10.3760/cma.j.cn112137-20210201-00313.
[16] 张舒曼,袁博丽. 常见伤口换药要点和注意事项[J]. 空军医学杂志,2021,37(3):272-274. DOI: 10.3969/j.issn.2095- 3402.2021.03.024.
[17] 冯妙林,谭彩霞. PDCA循环在急性心肌梗死患者院前急救护理中的应用[J]. 武警后勤学院学报(医学版),2021,30(4):48-51.
[18] 经惠薪,袁萍,胡璟雯. P DCA循环模式在脑卒中事件相关紧急备用药品管理中的应用研究[J]. 东南国防医药,2022,24(6):658-660. DOI: 10.3969/j.issn.1672- 271X.2022.06.020.
[19] Fan Y,Zhou X. The clinical evaluation of PDCA management model for acute myocardial infarction with percutaneous coronary intervention: a single-center experience[J]. Asian J Surg, 2022, 45(12): 3034-3035. DOI: 10.1016/j.asjsur.2022.06.172.
[20] Nakazawa Y, Sakashita A, Kaizu M, et al. A self-check program targeting quality improvement in a hospital-based palliative care consultation team, japanese society for palliative medicine: issues regarding team activities identified through the Plan-Do-Check-Act Cycle[J]. J Palliat Med, 2020, 23(3): 359-367. DOI: 10.1089/jpm.2019.0236.