量化积分式血液透析质量控制体系策略的建立与临床实践成效初探  

Establishment and clinical practice of quantitative scoring strategy for hemodialysis quality control and improvement management in Beijing

作　　者：张月[1,3,4] 刁宗礼 郭王[1,3,4] 韦洮 刘文虎[1,3,4] ZHANG Yue;DIAO Zong-li;GUO Wang;WEI Tao;LIU Wen-hu(Department of Nephrology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Nephrology,Peking University People’s Hospital,Beijing 100044,China;Beijing Blood Purification Quality Control and Improvement Center,Beijing 100050,China;Faculty of Nephrology,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院肾内科血液净化中心,北京100050 [2]北京大学人民医院肾内科,北京100044 [3]北京市血液净化质量控制与改进中心,北京100050 [4]首都医科大学肾病学系,北京100050

出　　处：《中国血液净化》2023年第1期73-78,共6页Chinese Journal of Blood Purification

摘　　要：目的探讨血液透析质量控制核心策略与方法,增加血液透析室对质量控制工作的响应度,进一步提升血液透析质量控制效果。方法参照国内外指南,制定适合北京市血液透析质量的临床评估标准与方法,统计分析2014~2020年北京市血液净化质量控制与改进中心数据库,并结合现场抽样核对数据上传的准确性,计算全市及各透析中心相关临床指标的达标率与执行率,根据达标率与执行率进行得分计算,并进行排名与回馈。结果结合血液透析临床指南和北京市血液透析现状,将血红蛋白、白蛋白、铁蛋白、血钙、血磷、血全段甲状旁腺激素(iPTH)、尿素下降率(URR)、尿素清除指数(Kt/V)等8项指标纳入年度临床指标质量控制体系内。5年间,血红蛋白达标率(χ^(2)=18.339,P=0.005)、铁蛋白达标率(χ^(2)=8.935,P=0.003)、血钙达标率(χ^(2)=5.113,P=0.024)显著提升;血红蛋白平均水平从107.9g/L上升至110.3g/L;血白蛋白达标率从82.2%上升至85.6%,血白蛋白平均水平稳定于38.8g/L至38.6g/L;铁蛋白平均水平从405.1g/L下降至308.6g/L;血钙平均水平维持在2.2mmol/L;血磷达标率从41.7%上升至47.6%,血磷平均水平稳定于1.76mmol/L至1.79mmol/L;血iPTH达标率从28.2%上升至35.3%,血iPTH平均水平从336.4pg/ml下降至310.1pg/ml:URR与Kt/V达标率略有下降。结论量化后的积分式临床质量控制标准与方法可能更适合于当前血液透析质量控制管理体系,对不断提升血液透析质量与管理质量具有推动作用。Objectives To establish a practical method to improve compliance of the academic guidelines in dialysis units in Beijing.Methods Quantitative scoring strategy was built up based on the practicable clinical parameters and the guidelines from other countries.The rate of compliance with the guidelines and the rate of guideline performance during the period from 2014 to 2020 were calculated using the data from the database in Beijing Blood Purification Quality Control and Improvement Center.The dialysis units were then ranked according to the total scores of compliance rate and guideline performance rate.Results Eight clinical parameters were incorporated in the quantitative scoring strategy:hemoglobin,serum albumin,ferritin,calcium,phosphorus,iPTH,URR,and Kt/V.After implementation of the strategy for 5 years,the compliance and performance rates for hemoglobin(from 58.7%to 79.7%,χ^(2)=18.339,P=0.005),serum albumin(from 82.2%to 85.6%,χ^(2)=0.253,P=0.615),ferritin(from 47.5%to 63.4%,χ^(2)=8.935,P=0.003),calcium(χ^(2)=5.113,P=0.024),phosphorus(from 41.7%to 47.6%),and iPTH(from 28.2%to 35.3%,χ^(2)=2.037,P=0.153)increased steadily,but URR and Kt/V were slightly reduced in spite of their appropriate guideline performance.Conclusions The quantitative scoring strategy is a simple and practicable tool for administration and management of blood purification quality control and improvement.

关 键 词：血液透析 质量控制 临床实践 量化积分 

分 类 号：R19[医药卫生—卫生事业管理]