持续质量改进在纠正血液透析患者钙磷代谢紊乱中的应用  

Application of continuous quality improvement in remedying calcium-phosphorus metabolism disorder of patients with maintenance hemodialysis

作　　者：牟爱华[1] 赵建明[1] 庞玉洪[1] 张小翠[1] 

机构地区：[1]重庆市涪陵中心医院肾内科,重庆408099

出　　处：《中国医药导报》2015年第32期104-107,共4页China Medical Herald

基　　金：重庆市卫生局医学科研计划项目(2013-2-182);重庆市涪陵区科技计划项目(FLKJ;2015ABB1082)

摘　　要：目的探讨持续质量改进对纠正维持性血液透析(MHD)患者钙磷代谢紊乱及甲状旁腺功能异常的作用。方法横断面调查了解2013年12月重庆市涪陵中心医院(以下简称"我院")221例MHD患者血清钙、磷、钙磷乘积、全段甲状旁腺激素(iPTH)的情况,应用PDCA的方法[即计划(plan)、实施(do)、检验(check)、应用(act)],实施持续质量改进,为期6个月,观察经过持续质量改进后,MHD患者2014年6月的血钙、磷、钙磷乘积、iPTH指标,并与改进前对比。结果经过持续质量改进后,我院血透中心MHD患者血钙、磷、钙磷乘积、iPTH等各项指标的达标率均超过改进前。血钙平均水平由(2.13±0.23)mmol/L升至(2.22±0.23)mmol/L;血磷平均水平由(1.96±0.71)mmol/L降至(1.70±0.58)mmol/L;钙磷乘积平均水平由(51.58±18.49)mg2/d L2降至(46.65±16.20)mg2/d L2,iPTH平均水平由(440.82±427.00)ng/m L降至(361.40±340.70)ng/m L,差异均有统计学意义(P<0.05或P<0.01)。结论持续质量改进的方法可以改善维持性血液透析患者的钙磷代谢紊乱。Objective To discuss the function of continuous quality improvement in remedying calcium-phosphorus metabolism disorder of patients with maintenance hemodialysis（MHD） and parathyroid dysfunction. Methods Conditions of serum calcium, serum phosphorus, calcium-phosphorus product and intact parathyroid hormone（i PTH） of 221 cases of patients with MHD treated at Fuling Central Hospital（＂our hospital＂ for short） in December 2013 were crosssectionally studied. Method of PDCA namely plan, do, check and act was applied in a period of 6 months in order to proceed continuous quality improvement. After continuous quality improvement, the contrast of serum calcium, serum phosphorus, calcium-phosphorus product and i PTH of these MHD patients between the former and latter conditions was observed. Results After continuous quality improvement, the indexes of serum calcium, serum phosphorus, calcium-phosphorus product and i PTH of MHD patients at our hospital exceeded the former conditions. The average of serum calcium raised from（2.13±0.23） mmol/L to（2.22±0.23） mmol/L; The average of serum phosphorus dropped from（1.96±0.71） mmol/L to（1.70±0.58） mmol/L; The average of the calcium-phosphorus product dropped from（51.58±18.49） mg^2/d L^2to（46.65±16.20） mg^2/d L^2; The average of i PTH dropped from（440.82±427.00） ng/m L to（361.40±340.70） ng/m L, all with statistical significance（P〈0.05 or P〈0.01）. Conclusion Continuous quality improvement can remedy calciumphosphorus metabolism disorder of patients with MHD.

关 键 词：钙磷代谢 血液透析 持续质量改进 达标率 

分 类 号：R692[医药卫生—泌尿科学]