社区-医院分级管理模式管理腹膜透析患者的效果  

Effect of Community hospital grading management model in managing patients with peritoneal dialysis

作　　者：姜燕[1] 臧秀娟[1] 吴水 

机构地区：[1]上海市松江区中心医院肾内科,上海201600

出　　处：《上海医学》2016年第5期301-305,共5页Shanghai Medical Journal

基　　金：上海市科学技术委员会科技引导类资助项目(15411971200)

摘　　要：目的 探讨腹膜透析技术社区-医院分级管理模式管理腹膜透析患者的效果。方法选取2014年1月-2015年1月在上海市松江区中心医院行腹膜透析的患者82例，按照数字随机法将患者分人随访组（38例）和非随访组（44例）。借助腹膜透析信息管理软件对所有患者进行分组管理，仅对随访组患者进行分级定期随访，随访时间为1年，随访结束时以自设问卷形式对所有患者进行考核。比较两组患者无菌操作（操作前洗手、操作时戴口罩、每天按要求进行出口消毒、每次更换碘液帽）、容量控制（每天进行透析记录、自觉控制水分摄入）、按时检测（每1～2个月检测1次血液指标）、按时服药的患者比例和平均治疗时间（TOT）。比较两组患者腹膜透析后的腹膜炎发生率和透析充分性指标（血压达标，尿素清除指数达标，血清白蛋白水平达标，钙、磷代谢平衡）达标的患者比例。结果随访组的无菌操作、容量控制、按时检测、按时服药的患者比例均显著高于非随访组（P值分N〈0．05、0．01）。随访组1～12个月的TOT显著长于非随访组（P〈0．05），腹膜炎发生率显著低于非随访组（P〈0．05），透析充分性指标达标的患者比例均显著高于非随访组（P值均〈0．05）。结论社区一医院分级管理模式是在中国医疗体制下管理腹膜透析患者的有效方式。Objective To study the effect of community hospital grading management model in managing patients with peritoneal dialysis. Methods A total of 82 patients undergoing peritoneal dialysis in Central Hospital of Shanghai Songjiang District from January 2014 to January 2015 were selected and randomly divided into followup group （38 cases） and non follow-up group （44 cases）. With the aid of peritoneal dialysis information management software, grouping management was performed in all patients, but only the patients in the follow-up group were followed up regularly for one year. All patients were assessed by self-designed questionnaire after follow-up. Sterile operation （washing hands before operation, wearing masks during operation, daily export disinfection, and replacement of iodine solution cap）, capacity control （daily dialysis records and conscious control of water intake）, time to blood index detection （1 - 2 months）, timely medication and the average treatment time （TOT） were compared between two groups. The incidence of peritonitis and parameters related to dialysis adequacy （blood pressure compliance rate, urea clearance index compliance rate, serum albumin level, and metabolic balance of calcium and phosphorus） were compared after peritoneal dialysis. Results The proportions of patients in the follow-up group were significantly higher than those of the non follow-up group in terms of the sterile operation, capacity control, timely detection, and timely taking medicine （P〈0.05, 0.01）. The average treatment time in the follow-up group was significantly longer than that in the non follow-up group （P〈0.05）. The incidence of peritonitis in the follow-up group was significantly lower than that in the non follow-up group （P〈 0.05）. The dialysis adequacy in the follow-up group were significantly better than that in the non follow-up group （all P〈0.05）. Conclusion Community hospital management model is an effective way to manage peritoneal dialysis patients in Chines

关 键 词：社区-医院分级管理模式 腹膜透析患者 透析充分性 无菌操作 

分 类 号：R692.5[医药卫生—泌尿科学]