脓毒性休克1小时集束化治疗的质量改进策略及效果评价

doi:10.3761/j.issn.2096-7446.2026.02.015

中华急危重症护理杂志 ›› 2026, Vol. 7 ›› Issue (2): 210-215.doi: 10.3761/j.issn.2096-7446.2026.02.015

脓毒性休克1小时集束化治疗的质量改进策略及效果评价

崔梦影¹(), 肖琦¹^,^*(), 邹灯秀¹, 谭昆², 邓娟¹, 商薇薇¹

1.华中科技大学同济医学院附属同济医院护理部武汉市 430030
2.华中科技大学同济医学院附属同济医院感染管理科武汉市 430030

收稿日期:2025-03-04 出版日期:2026-02-10 发布日期:2026-02-02
通讯作者: 肖琦 E-mail:2679729515@qq.com;68186187@qq.com
作者简介:崔梦影：女，硕士，护师，E-mail：2679729515@qq.com
基金资助:
华中科技大学同济医学院附属同济医院院基金(2022D25)

Quality improvement strategy and effect evaluation of 1-h bundle for septic shock

CUI Mengying¹(), XIAO Qi¹^,^*(), ZOU Dengxiu¹, TAN Kun², DENG Juan¹, SHANG Weiwei¹

1. Department of Nursing， Tongji Hospital，Tongji Medical College，Huazhong University of Science and Technology， Wuhan 430030， China
2. Department of Infection Management， Tongji Hospital，Tongji Medical College，Huazhong University of Science and Technology， Wuhan 430030， China

Received:2025-03-04 Online:2026-02-10 Published:2026-02-02
Contact: XIAO Qi E-mail:2679729515@qq.com;68186187@qq.com
Supported by:
The Nursing Research Fund of Tongji Hospital，Tongji Medical College，Huazhong University of Science and Technology(2022D25)

摘要/Abstract

摘要：

目的探讨基于“分析—设计—开发—实施—评估”模型的持续质量改进策略对提升ICU医护人员1 h集束化治疗执行率的影响，以及其对脓毒性休克患者临床结局的改善作用。方法以湖北省某三级甲等医院ICU为研究场所，研究对象为2021年6月—2024年5月收治的脓毒性休克患者。研究采用持续质量改进的设计，按照“分析—设计—开发—实施—评估”模型实施质量改进，分为4个阶段：2021年6月—2022年5月为前期准备及基线资料收集阶段；2022年6月为方案集中培训阶段；2022年7月—2023年5月为第1个质量改进周期，2023年6月—2024年5月为第2个质量改进周期。收集ICU医护人员1 h集束化治疗执行率、患者住院时间及病死率等指标，使用Kruskal-Wallis H检验比较住院时间，采用χ²检验比较各阶段执行率及病死率。结果共纳入396例患者，其中基线期87例，第1个质量改进周期151例，第2个质量改进周期158例。1 h集束化治疗执行率呈增长趋势，统计学分析显示，除平均动脉压≥ 65 mmHg（1 mmHg=0.133 kPa）执行率在3个时间点的组间差异无统计学差异（P>0.05）外，其余条目执行率与基线期、第1个质量改进周期相比，差异均有统计学意义（P<0.05）。第2个质量改进周期患者病死率（18.35%）低于基线期（28.74%）（P<0.05）。结论基于“分析—设计—开发—实施—评估”模型的持续质量改进策略有助于提升ICU医护人员1 h集束化治疗执行率，并通过优化关键环节实施质量，降低了脓毒症休克患者病死率。

关键词: ADDIE模型, 质量改进, 脓毒性休克, 1 h集束化治疗策略, 依从性

Abstract:

Objective To investigate the impact of a continuous quality improvement strategy based on the Analysis-Design-Development-Implementation-Evaluation（ADDIE） model on enhancing the compliance of intensive care unit（ICU） medical staff with the 1-hour bundle therapy for septic shock，and its effect on septic shock patients’ clinical outcomes. Methods This study was conducted in the ICU of a tertiary class A hospital in Hubei Province. The study population included patients diagnosed with septic shock and admitted between June 2021 and May 2024. The study adopted a continuous quality improvement design and implemented interventions based on the ADDIE model. It was divided into four phases：baseline data collection and preparation（June 2021 to May 2022），intensive training （June 2022），and two quality improvement cycles（July 2022 to May 2023 and June 2023 to May 2024）. Data were collected on ICU medical staff compliance with the 1-hour bundle，patient ICU length of stay，and in-hospital mortality. The Kruskal-Wallis H test was used to compare length of stay，and the chi-square test was used to compare compliance rates and mortality across phases. Results A total of 396 patients were included，with 87 in the baseline phase，151 in the first quality improvement cycle，and 158 in the second quality improvement cycle. Compliance with each component of the 1-hour bundle showed an overall increasing trend. Statistical analysis revealed significant improvements in all measures across the three time points，except for maintenance of mean arterial pressure≥65 mmHg（1 mmHg=0.133 kPa）（P>0.05）. The in-hospital mortality rate in the second quality improvement cycle（18.35%） was significantly lower than that in the baseline phase（28.74%）（P<0.05）. Conclusion The continuous quality improvement strategy based on the ADDIE model significantly improved compliance of ICU staff with the 1-hour bundle therapy and effectively reduced in-hospital mortality by enhancing the implementation quality of key interventions.

Key words: ADDIE Model, Quality Improvement, Sepsis Shock, 1 Hour Bundle Strategy, Compliance

崔梦影, 肖琦, 邹灯秀, 谭昆, 邓娟, 商薇薇. 脓毒性休克1小时集束化治疗的质量改进策略及效果评价[J]. 中华急危重症护理杂志, 2026, 7(2): 210-215.

CUI Mengying, XIAO Qi, ZOU Dengxiu, TAN Kun, DENG Juan, SHANG Weiwei. Quality improvement strategy and effect evaluation of 1-h bundle for septic shock[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(2): 210-215.

图/表 3

参考文献 22

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脓毒性休克1小时集束化治疗的质量改进策略及效果评价

Quality improvement strategy and effect evaluation of 1-h bundle for septic shock

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