目的

探讨品管圈活动在提高超声引导下甲状腺结节细针穿刺活检检出率中的应用效果。

方法

宁波市鄞州区第二医院超声科于2023年5月至2023年10月开展以“提高甲状腺结节细针穿刺活检检出率”为主题的品管圈活动。收集2023年5月15日至2023年5月26日50例甲状腺结节细针穿刺活检患者的资料（对7个观察点进行查验，共计查验350个观察点），分析影响超声引导下甲状腺结节细针穿刺活检检出率的主要原因，确定真因，讨论并制定相应对策，实施拟定对策；收集2023年9月18日至9月29日50例甲状腺结节细针穿刺活检患者的资料进行效果确认，计算不合格率、目标达成率和进步率，标准化持续实施。收集品管圈实施前（2023年4月1日至4月30日）和品管圈实施后（2023年11月1日至11月30日）1个月内甲状腺结节细针穿刺患者资料，计算甲状腺结节细针穿刺检出率，采用χ²检验比较品管圈活动前后甲状腺结节穿刺检出率的差异。并收集分析2023年12月至2024年4月每个月的甲状腺结节穿刺检出率。

结果

对策实施后（2023年9月18日至9月29日），不合格率由对策实施前的16.9%（59/350）降至5.71%（20/350），目标达成率为118.1%，进步率达66.1%。品管圈实施后1个月甲状腺结节穿刺检出率为93.1%（121/130），品管圈实施前1个月甲状腺结节穿刺检出率为81.6%（93/114），实施后检出率高于实施前，差异具有统计学意义（χ²=7.446，P=0.006）。2023年12月至2024年4月每个月的甲状腺结节穿刺检出率分别为94.2%、92.7%、94.9%、93.2%、92.8%。

结论

通过开展品管圈活动规范甲状腺结节细针穿刺活检操作流程，可有效提高甲状腺结节细针穿刺活检检出率，值得推广借鉴。

Objective

To explore the application of the quality control circle activity in improving the detection rate of thyroid nodules by fine-needle aspiration under the guidance of ultrasound.

Methods

From May to October 2023， the Ultrasound Department of No. 2 Hospital of Yinzhou District， Ningbo City， launched a quality control circle activity with the theme of “increasing the detection of thyroid nodules by fine-needle aspiration”.The information of 50 patients who underwent fine-needle aspiration of thyroid nodules from May 15 to 26，2023 （examination of 7 observation points per case， with a total of 350 observation points） to analyze the factors influencing the detection rate by fine-needle aspiration under ultrasound guidance. Corresponding countermeasures were then formulated and implemented， and 50 cases of thyroid nodules undergoing fine-needle aspiration from September 18 to 29， 2023 were tested for the non-conformity rate， the rate of goal achievement， and the rate of improvement， and the quality control circle activity continued to be implemented. Before （April 1 to 30， 2023）and after the implementation of the quality control circle activity （November 1 to 30， 2023）， the information of patients who underwent fine-needle aspiration of thyroid nodules Was collected to calculate the detection rate of thyroid nodule by fine-needle aspiration， and the χ² test was used to compare the difference in the detection rate between before and after the implementation of the quality control circle activity. The thyroid gland nodules were punctured every month from December 2023 to April 2024.

Results

After the implementation of the quality control circle activity （September 18 to 29， 2023）， the non-conformity rate decreased from 16.9% （59/350） before the implementation to 5.71% （20/350）， the rate of goal achievement was 118.1%， and the rate of improvement was 66.1%. Thyroid gland nodules were detected in 93.1% （121/130） of the patients after the implementation of quality control circle activity. The positive rate of thyroid gland nodules was 81.6% （93/114） before the implementation of quality control circle activity. The positive rate after implementation of quality control circle activity was significantly higher than that before implementation （χ²=7.446，P=0.006）. The detection rate of thyroid modules by fine-needle aspiration was 94.2%， 92.7%， 94.9%， 93.2%， and 92.8%， respectively， from December 2023 to April 2024.

Conclusion

The implementation of quality control circle activity can effectively improve the detection rate of thyroid nodules by fine-needle aspiration， which is worthy promotion.