持续质量改进在血液透析患者高磷血症管理中的应用  

Effectiveness of Continuous Quality Improvement in the Management of Hyperphosphatemia for Hemodialysis Patients

作　　者：郭军军[1] 吴禹池[1] 吴秀清[1] 伍施[1] 徐美宝[1] 刘敏华 邓丽丽[1] GUO Junjun;WU Yuchi;WU Xiuqing(The Second Affiliated Hospital of Guangzhou University of Chinese Medicine/ Guangdong Provincial Hospital of Chinese Medicine,Guangzhou（510120)

机构地区：[1]广州中医药大学第二附属医院/广东省中医院,广州510120

出　　处：《中国中西医结合肾病杂志》2018年第9期778-781,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：广东省科技厅立项项目(No.2014KT1513);广东省科技厅基金资助项目(No.2014KT1450)

摘　　要：目的:探讨持续质量改进(CQI)管理方法对维持性血液透析(MHD)患者高磷血症的影响。方法:以2017年03月~09月在广东省中医院透析科行维持性血液透析治疗的88例高磷血症(血磷> 1. 78 mmol/L)患者为研究对象,研究前横断面统计患者血清磷、钙、钙磷乘积、甲状旁腺激素(PTH)、血清白蛋白(ALB)及患者对高磷血症的认知情况,随后应用PDCA循环的方法对患者实施个体化3D(Diet、Dialysis、Drugs)综合管理,为期6个月,干预结束时再次统计上述指标,并进行前后自身对照统计分析。结果:干预后,患者血清磷、钙磷乘积与干预前比较均有明显下降(P <0. 01);血钙、PTH、Alb与干预前比较差异无统计学意义(P> 0. 05);患者对疾病的相关知识总分及各维度得分高于干预前(P <0. 01);磷结合剂服药依从率高于干预前(P <0. 01); CQI干预前后治疗方案有所改变,采用高通量透析和血液透析滤过治疗的患者人数均明显增加,差异有统计学意义(P <0. 01)。结论:CQI有利于优化透析方案,提高患者疾病认知能力,从而提高血磷达标率。Objective： To investigate the impact of continuous quality improvement（ CQI） management on hyperphosphatemia in maintenance hemodialysis（ MHD） patients. Methods：From March 2017 to September 2017,88 patients with hyperphosphatemia（ serum phosphorus 1. 78 mmol/L） who underwent maintenance hemodialysis in Department of Hemodialysis,Guangdong Provincial Hospital of Chinese Medicine,were enrolled in this study. Baseline serum phosphorus,calcium,calcium and phosphorus products,Parathyroid hormone（ PTH）,serum albumin（ Alb） and the patient＇s awareness of disease were evaluated. Then,a PDCA cycle of integrative 3 D（ Diet,Dialysis,Drugs） management was performed for 6 Months. After the intervention,all the above parameters were re-evaluated to compare with the baseline. Results：After intervention,the serum phosphorus,calcium and phosphorus products were significantly decreased compared with those before intervention（ P〈0. 01）. There was no significant difference in serum calcium,PTH and ALB before and after intervention（ P〈0. 05）. The compliance rate of using phosphate binders was higher than that before intervention（ P〈0. 01）. The treatment regimen was adjusted before and after the intervention of CQI,leading to an increase of patients undergoing high flux dialysis and hemoperfusion（ P〈0. 01）. Conclusion：CQI is beneficial to optimize dialysis program and improve patients＇ awareness of disease,resulting in higher rate of normal serum phosphate achievement.

关 键 词：持续质量改进 高磷血症 血液透析 

分 类 号：R692.5[医药卫生—泌尿科学]