基于终末期肾病患者共享决策下的自动腹膜透析治疗  

Automated peritoneal dialysis treatment based on end-stage kidney disease patient shared decision-making

作　　者：张涤华[1,2] ZHANG Dihua(Department of Nephrology,the First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China;Department of Nephrology/Rheumatology and Immunology,Guizhou Hospital of the First Affiliated Hospital,Sun Yat-sen University,Guiyang 550003,China)

机构地区：[1]中山大学附属第一医院肾内科,广州510080 [2]中山大学附属第一医院贵州医院肾脏/风湿免疫科,贵阳550003

出　　处：《实用医学杂志》2024年第12期1613-1618,共6页The Journal of Practical Medicine

基　　金：国家自然科学基金项目(编号:81970429);广东省自然科学基金项目(编号:2019A1515011956)。

摘　　要：近年来,我国终末期肾病(end-stage renal disease,ESRD)发病率逐年增长,透析患者常常伴随多种并发症,同时也是焦虑抑郁等心理疾病的高发人群。透析方式及透析过程与患者本人及家属的日常生活息息相关,这类患者更需要以人为本的治疗策略。进入ESRD准备接受肾脏替代治疗前,让患者及家属知晓每种肾脏替代治疗方式的特点,在充分考虑临床治疗需求基础上,结合患者生活环境、工作学习需求、社会回归、心理需求及个性化喜好共同决策选择合适的肾脏替代治疗方式。在此共享决策模式下,越来越多的患者希望进行居家透析治疗。目前鉴于设备技术、经济成本及人力资源等限制,居家血液透析短期内较难普及,作为居家透析主要方式的腹膜透析,也因操作培训及随访管理等问题,存在患者操作不规范、治疗依从性差、处方调整或并发症干预不及时等问题。本文着重就ESRD患者共享决策流程、自动腹膜透析治疗处方设置及患者远程随访管理进行阐述,以期共同提高居家腹透患者的治疗质量及社会回归。In recent years,the incidence of end-stage kidney disease(ESKD)in China has been increasing annually.Dialysis patients often experience various complications,and they are also a high-risk population for psychological disorders such as anxiety and depression.The choice of dialysis method and the dialysis process are closely related to the daily lives of the patients and their families.All these patients require a patient-centric treatment strategy.Before entering end-stage renal disease(ESRD)and preparing for renal replacement therapy,it is crucial for patients and their families to understand the characteristics of each renal replacement therapy.Considering clinical treatment needs,as well as the patient's living environment,work and study requirements,social reintegration,psychological needs,and personalized preferences,a collaborative decision-making approach is essential to choose an appropriate renal replacement therapy.With the growing preference for shared decision-making,more patients wish to undergo home dialysis treatment.Currently,due to limitations in equipment technology,economic costs,and human resources,home hemodialysis is challenging to widely adopt.Peritoneal dialysis,as a primary form of home dialysis,faces issues such as improper patient operation,poor treatment compliance,delayed prescription adjustments,and intervention for complications due to problems related to training and follow-up management.This article focuses on elucidating the shared decision-making process for ESRD patients,the prescription settings and remote patient follow-up management of automated peritoneal dialysis,which may help to collectively improve the treatment quality and social reintegration of home peritoneal dialysis patients.

关 键 词：终末期肾病 共享决策 自动腹膜透析 腹膜透析处方 远程患者管理 

分 类 号：R692[医药卫生—泌尿科学]