质量持续改进对腹膜透析患者透析充分性和心血管事件的影响  

Effect of continuous quality improvement on dialysis adequacy and cardiovascular events in peritoneal dialysis patients

作　　者：张燕[1] 刘昌华[1] 卜玲[1] 李婷[1] ZHANG Yan;LIU Changhua;BU Ling;LI Ting(Subei People＇s Hospital of Jiangsu Province, Yangzhou , Jiangsu , 225001)

机构地区：[1]江苏省苏北人民医院,江苏扬州225001

出　　处：《实用临床医药杂志》2018年第10期21-24,31,共5页Journal of Clinical Medicine in Practice

基　　金：江苏省扬州市科技局项目(SQZ201430047)

摘　　要：目的探讨应用质量持续改进(CQI)方法对腹膜透析患者透析充分性和心血管事件的影响。方法本研究为前瞻自身前后对照研究,选择本院病情稳定的维持性腹膜透析患者98例,运用设计、实施、检验和应用(PDCA)四步法,针对腹膜透析各项指标和工作环节进行改进,分析比较CQI前后透析充分性、营养、炎症和心血管事件等各项指标的变化。结果CQI前后比较,每周总尿素清除指数(Kt/V)达标率增加(P<0.05),Kt/V水平升高(P<0.05);血清学指标白蛋白(ALB)、前白蛋白(PAB)升高(P<0.05);标准化的总氮呈现率改善(P<0.05);腹膜炎发生率降低(P<0.05);因心血管事件住院率下降(P<0.05)。结论 CQI措施能够改善老年腹膜透析患者的营养、炎症和透析充分性,从而降低心血管事件住院率。Objective To investigate the effect of continous quality improvement（CQI） on dialysis adequacy and cardiovascular events in peritoneal dialysis patients. Methods This study was a prospective controlled study,and 98 patients with stable peritoneal dialysis in our hospital were recruited in the study. Plan,do,check,action（PDCA） was applied for improvement of peritoneal dialysis and working steps. Changes in the dialysis adequacy,nutrition,inflammation and cardiovascular events after CQI were compared. Results After CQI,standardization-reaching rate of weekly total urea clearance index（Kt/V） was increased（P〈0. 05）,Kt/V level was increased（P〈0. 05）,serum albumin（ALB） and prealbumin（PAB） were significantly elevated（P〈0. 05）. The standardized rate of total nitrogen was significantly improved（P〈0. 05）; The incidence of peritonitis was reduced（P〈0. 05）,and hospitalization rate due to cardiovascular events decreased（P〈0. 05）.Conclusion CQI can improve nutrition,inflammation and dialysis adequacy for peritoneal dialysis elderly patients,thereby reducing the incidence of cardiovascular events.

关 键 词：腹膜透析 质量控制 透析充分性 心血管疾病 

分 类 号：R473.5[医药卫生—护理学]