2018年度武汉地区血液透析临床质控数据分析  

Analysis of clinical quality control data of hemodialysis in Wuhan in 2018

作　　者：费世枝[1,2] 陈靖 李红兵 吴爱纯[1] 熊飞[1,3] FEI Shi-zhi;CHEN Jing;LI Hongbing;WU Ai-chun;XIONG Fei(Blood Purification Center,Wuhan No.1 Hospital,Wuhan 430022,Hubei,China;College of Health Science Nursing,Wuhan Polytechnic University,Wuhan 430023,Hubei,China;Hemodialysis Quality Control Center of Wuhan,Wuhan 430022,Hubei,China)

机构地区：[1]武汉市第一医院血液净化中心,湖北武汉430022 [2]武汉轻工大学医学技术与护理学院,湖北武汉430023 [3]武汉市血液透析质量控制中心,湖北武汉430022

出　　处：《生物医学工程与临床》2020年第4期441-445,共5页Biomedical Engineering and Clinical Medicine

基　　金：武汉市卫生和计划生育委员会基金资助项目(公共卫生及卫生政策类)。

摘　　要：目的分析2018年度武汉地区维持性血液透析(MHD)患者的临床质控数据,了解MHD患者的治疗现状。方法从武汉市血液透析质量控制系统(下称质控系统)下载武汉地区2018年度44个血液透析单位的MHD患者一般临床资料及各质量核心数据(KPI),比较2018年与2017年的KPI,一般临床资料包括患者的年龄、性别、透析龄、血管通路情况等,KPI包括血红蛋白(Hb)、血清钙(Ca)、血清磷(P)、血清全段甲状旁腺素(iPTH)、血浆白蛋白(ALB)。结果44个血液透析单位2018年度共有MHD患者4011例,其中男性2413例,女性1598例;年龄16~92岁,平均年龄59.55岁(标准差13.48岁);老年患者占54%。透析龄3个月~30年,透析龄中位数2.8年。血管通路中自体动静脉内瘘(AVF)占74.89%。KPI与2017年相比,检查率均有显著提高,差异有显著统计学意义(P<0.01);Hb、iPTH和Ca的达标率均有提高,差异有统计学意义(χ^2=20.266、23.696、4.573;P<0.01或P<0.05);ALB达标率有提高,但差异无统计学意义(χ^2=1.274,P>0.05);而P达标率有所降低,差异无统计学意义(χ^2=0.381,P>0.05);平均值的比较,Hb和Ca水平较2017年有所提高,差异有统计学意义(t=-5.095、-2.247,P<0.01或P<0.05);ALB和P水平均有改善,但差异无统计学意义(t=-0.970、1.885,P>0.05);iPTH水平较2017年差,差异有显著统计学差意义(t=-3.640,P<0.01)。结论武汉地区老年MHD患者较多,血管通路指标有待改善,KPI较2017年大多有不同程度的提高,iPTH的控制应引起各血液透析单位的重视。Objective To analyze clinical quality control data of maintenance hemodialysis(MHD)patients in Wuhan in 2018,and detect treatment status of MHD patients.Methods The general clinical data and key performance indicators(KPI)of MHD patients in 44 hemodialysis units of Wuhan in 2018 were downloaded from Wuhan Hemodialysis Quality Control System(QCS),the KPI between 2018 and 2017 was compared.The general clinical data including age,gender,dialysis time and vascular access,and KPI including hemoglobin(Hb),serum calcium(Ca),serum phosphorus(P),and serum intact parathyroid hormone(iPTH)and plasma albumin(ALB).Results There were 4011 MHD patients in 44 hemodialysis units,which included 2413 males and 1598 females,aged 16-92 years old with mean age of 59.55 years old(standard deviation 13.48 years old);54%of elderly patients,and dialysis time was 3-month to 30-year with median of 2.8-year.The autovascular arteriovenous fistula(AVF)accounted for 74.89%of vascular access.Compared with 2017,the inspection rate of KPI statistically signifi-cantly improved in 2018(P<0.01);The compliance rates of Hb,iPTH and Ca in 2018 were all statistically significantly increased(χ^2=20.266,23.696,4.573;P<0.01 or P<0.05).In 2018,the ALB compliance rate was improved(χ^2=1.274,P>0.05)and the P compliance rate was decreased(χ^2=0.381,P>0.05),there was no statistically significant difference.Compared with 2017,the mean Hb and Ca levels in 2018 were statistically significantly increased(t=-5.095,-2.247,P<0.01 or P<0.05);ALB and P levels were improved,but difference was no statistically significant(t=-0.970,1.885,P>0.05);The iPTH level in 2018 was statistically significantly worse than that in 2017(t=-3.640,P<0.01).Conclusion It is demonstrated that there are many elderly MHD patients in Wuhan,which is necessary to improve vascular access index.The KPI level in 2018 is more than that in 2017,so should be paid attention to control of iPTH.

关 键 词：终末期肾病 维持性血液透析 血液透析 血管通路 质量控制 

分 类 号：R692.5[医药卫生—泌尿科学] R459.5[医药卫生—外科学]