摘要
目的:探讨持续质量改进(CQI)管理模式在慢性肾脏病伴矿物质和骨代谢紊乱(CKDMBD)患者中的应用效果。方法:选取2019年4月1日-2021年4月1日川北医学院附属医院、南充东方医院、蓬安县人民医院血液净化中心收治的205例CKD-MBD维持性血液透析患者,根据患者意愿,分为观察组(采用CQI管理模式,154例)和对照组(采用常规管理模式,51例)。收集两组患者年龄、性别、体重指数、透析龄、每周透析次数、原发病等一般资料;比较两组干预前后血压、血红蛋白、白蛋白、血钙(矫正钙)、血磷、血清铁蛋白、甲状旁腺激素(PTH)、欧洲五维健康(EQ-5D)评分量和平均视觉模拟量表(EQ-VAS)评分。结果:观察组不良反应发生率和肺部感染发生率均低于对照组(P<0.05)。干预后,观察组血红蛋白、白蛋白、血磷和血清铁蛋白达标率均高于对照组,差异均有统计学意义(P<0.05)。观察组血红蛋白、血磷及血清铁蛋白达标率均高于干预前,对照组血红蛋白和白蛋白达标率均低于干预前,差异均有统计学意义(P<0.05)。干预后,观察组收缩压、舒张压、血红蛋白、血钙、血磷、血清铁蛋白、PTH、疼痛不适、焦虑沮丧、EQ-5D评分和EQ-VAS评分均优于干预前,对照组白蛋白、血磷、疼痛不适评分均优于干预前,但血红蛋白水平低于干预前(P<0.05)。观察组收缩压、舒张压、血红蛋白、白蛋白、血清铁蛋白、行动能力、自我照顾、日常活动、疼痛不适、焦虑沮丧、EQ-5D和EQ-VAS评分均优于对照组,血磷和PTH水平均低于对照组,差异均有统计学意义(P<0.05)。结论:CKD-MBD维持性血液透析患者采用CQI管理模式可改善患者血压、血红蛋白、血磷、血清铁蛋白、PTH、生活质量和健康状态,维持患者营养水平,降低患者不良事件发生率,对于改善维持性血液透析患者的CKD-MBD具有积极作用。
Objective:To investigate the application effect of continuous quality improvement(CQI)management mode in patients with chronic kidney disease with mineral and bone metabolism disorders(CKDMBD).Method:A total of 205 CKD-MBD patients with maintenance hemodialysis admitted to Affiliated Hospital of North Sichuan Medical College,Nanchong Oriental Hospital and Peng'an People's Hospital from April 1st,2019 to April 1st,2021 were selected,they were divided into observation group(154 cases used CQI management mode)and control group(51 cases used conventional management mode),based on personal willingness of each.General data such as age,sex,body mass index,dialysis age,weekly dialysis times and primary disease were collected;blood pressure,hemoglobin,albumin,blood calcium(corrective calcium),blood phosphorus,serum ferritin,parathyroid hormone(PTH),European five-dimension health(EQ-5D)scale and mean visual analog scale(EQ-VAS)scores were compared between the two groups before and after intervention.Result:The incidences of adverse reactions and pulmonary infection in the observation group were lower than those in the control group(P<0.05).After intervention,the compliance rates of hemoglobin,albumin,blood phosphorus and serum ferritin in the observation group were higher than those in the control group,the differences were statistically significant(P<0.05).The compliance rates of hemoglobin,blood phosphorus and serum ferritin in the observation group were higher than those before intervention,while the compliance rates of hemoglobin and albumin in the control group were lower than those before intervention,the differences were statistically significant(P<0.05).After intervention,systolic blood pressure,diastolic blood pressure,hemoglobin,calcium,phosphorus,serum ferritin,PTH,pain and discomfort,anxiety and depression,EQ-5D scores and EQ-VAS scores in the observation group were better than those before intervention,while albumin,blood phosphorus,pain and discomfort scores in the control group were better than those before intervention,but hemoglobin level was lower than that before intervention(P<0.05).Systolic blood pressure,diastolic blood pressure,hemoglobin,albumin,serum ferritin,mobility,self-care,daily activities,pain and discomfort,anxiety and depression,EQ-5D and EQ-VAS scores in observation group were better than those in control group,and blood phosphorus and PTH levels were lower than those in control group,the differences were statistically significant(P<0.05).Conclusion:CQI management mode can improve blood pressure,hemoglobin,blood phosphorus,serum ferritin,PTH,quality of life and health status of patients with CKD-MBD maintenance hemodialysis,maintain the nutritional level of patients,reduce the incidence of adverse events of patients,and play a positive role in improving CKD-MBD patients with maintenance hemodialysis.
作者
张燕妮
王只欣
秦丹
岳燕林
ZHANG Yanni;WANG Zhixin;QIN Dan;YUE Yanlin(Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;不详)
出处
《中国医学创新》
CAS
2023年第4期20-25,共6页
Medical Innovation of China
基金
四川省基层卫生事业发展研究中心资助项目(SWFZ19-Q-10)
南充市科技局项目(南市科发[2020]26号)。
关键词
持续质量改进
慢性肾脏病伴矿物质和骨代谢紊乱
维持性血液透析
慢性肾脏病
Continuous quality improvement
Chronic kidney disease with mineral and bone metabolism disorders
Maintenance hemodialysis
Chronic kidney disease
