节假日对腹膜透析患者的影响  

Influence of holidays on peritoneal dialysis patients： an observational study

作　　者：马莹[1] 雷蕾[2] 王海云[1] 周紫娟[1] 李阳[1] 王颖[1] 杨薇[1] 黄宝延[3] 李雪梅[1] 陈丽萌[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院肾内科,100730 [2]重庆市中医院肾病科,400011 [3]中国医学科学院北京协和医学院护理学院,100730

出　　处：《中华临床营养杂志》2017年第4期233-239,共7页Chinese Journal of Clinical Nutrition

基　　金：中国医学科学院医学与健康科技创新工程（2016-12M-2-004）;中国医学科学院协和学者基金

摘　　要：目的观察腹膜透析患者春节期间与春节前临床指标、自我管理及依从性的变化，了解节假日对腹膜透析患者的影响。方法选取北京协和医院腹膜透析中心长期腹膜透析、规律随诊，且病情平稳的130例患者为研究对象，通过腹透预约门诊面对面调查的方式，随访其春节前（2016年1月8日至2016年2月7日）、春节期间（2016年2月8日至2016年3月8日）临床指标、自我管理及依从性的变化。结果130例腹透患者平均年龄（58.5±15.4）岁，女性69例（53.1%），中位透析龄34个月。32.3%的患者原发病诊断为糖尿病肾病，其次为慢性肾小球肾炎（26.2%）。透析方式为持续不卧床腹膜透析占73.8%，14例（10.8%）患者接受自动化腹膜透析治疗。随访1个月期间患者食欲无变化，血磷、血前白蛋白水平升高[（1.5±0.4）mmol/L比（1.6±0.4）mmol/L, P＝0.025; 325.3（272.2，355.1）mmol/L比326.0（284.2，376.5）mmol/L, P〈0.001]。水肿、憋气、夜间平卧症状差异无统计学意义，体质量增加[（61.3±13.9）kg比（63.4±13.0）kg, P＝0.002]，中位腹膜透析超滤量由783.3 ml增加至900.0 ml（P＝0.005）。节假日期间患者腹膜透析相关感染发病率无改变，而消化道不适的发生比率增加（5.4%比13.8%, P＝0.021）。治疗依从性方面，节假日期间发生腹膜透析次数减少8例，较前增加（P＝0.018）；转换透析模式1例，未遵医嘱用药6例。性别、年龄等人口学特征以及透析龄、透析方式、操作者等透析相关因素均不是影响节假日期间腹膜透析患者依从性的危险因素。结论节假日期间腹膜透析患者水分、血磷等负荷增加，依从性下降，节假日期间患者的容量、饮食、依从性管理不良及影响患者自我管理的因素亟需关注。ObjectiveTo observe the clinical parameters, self-management, and compliance in peritoneal dialysis （PD） patients before and during Spring Festival, and to describe holiday syndrome in PD patients.MethodsWe prospectively observed PD patients with regular follow-up in our center before Chinese Spring Festival （January 8-February 7, 2016） and during Chinese Spring Festival （February 8- March 8, 2016）. Demographic and clinical characteristics, self-management, and compliance with its influencing factors were collected by face-to-face method in outpatient care.ResultsTotally 130 PD patients were enrolled. The average age was （58.5±15.4） years, and women accounted for 53.1%. The primary diagnosis was diabetic kidney disease （32.3%）, followed by primary glomerulonephritis （26.2%）. Fourteen patients （10.8%） received automated peritoneal dialysis （APD）, and most of the remaining patients chose continuous ambulatory peritoneal dialysis （CAPD, 73.8%）, with a median dialysis age of 34 months. During the 4-week followed-up, the appetite was stable, while the serum phosphate and pre-albumin increased [（1.5±0.4）mmol/L vs. （1.6±0.4）mmol/L, P=0.025; 325.3 （272.2, 355.1）mmol/L vs. 326.0（284.2, 376.5）mmol/L, P〈0.01, respectively]. No difference was observed in edema, dyspnea, and nighttime lying flat. However, the weight elevated significantly [（61.3±13.9）kg vs. （63.4±13.0）kg, P=0.002], with the median peritoneal ultrafiltration volume increased from 783.3 ml to 900.0 ml （P=0.005）. During the holiday, the incidences of dialysis-related infections were unchanged, while the incidences of digestive system comorbidities increased significantly （5.4% vs. 13.8%, P=0.021）. As for the compliance, 8 patients reduced their PD cycles during the holiday, which was more frequent than before holiday （P=0.018）. One patient changed his PD pattern, and 6 patients did not follow the medication orders. Demographic characteristics such as gender, age, and marriage conditio

关 键 词：腹膜透析 病人依从 自我管理 

分 类 号：R459.5[医药卫生—治疗学]