张玲芳 吴恒兰 姚娟霞 郁慧杰

[摘要] 目的 觀察腹膜透析患者不同门诊随访间隔对自我管理能力、透析质量的影响，分析原因并采取社区-医院协作等方式进行PDCA改进，观察改进效果。 方法 选取2009年8月至2018年12月在本院置管的腹膜透析患者122例，根据门诊随访间隔（≤1个月、>1个月）分为A、B两组，A组74例，B组48例。比较两组在自我管理能力、实验室检查、血压、常见并发症等方面的差异。分析B组间隔较长的主要原因，并成立PDCA小组，采取社区-医院协作随访等PDCA改进措施，观察改进前后随访间隔>1个月患者比例的变化。结果 A组患者换液技术操作、操作中异常情况处理、饮食管理、并发症监测、情绪管理与社会回归方面均明显高于B组（P<0.05），血红蛋白、白蛋白均明显高于B组（P<0.05），血钙、血磷均明显低于B组（P<0.05），腹膜炎发生率明显低于B组（P<0.05）。B组患者随访间隔较长的原因主要包括路程较远、年龄较大行动受限、与工作时间冲突、随访耗时较长等。采取改进措施后随访间隔>1个月患者的比例由39.34%下降至17.24%（χ2=14.20，P<0.05）。 结论 门诊随访间隔≤1个月患者的自我管理能力和透析质量均明显高于间隔>1个月的患者，采取社区-医院协作随访等改进措施，能有效解决部分患者随访间隔较长的问题。

[关键词] 腹膜透析患者;门诊随访间隔;透析质量;PDCA

[中图分类号] R543          [文献标识码] A          [文章编号] 1673-9701（2021）35-0005-04

The effect of follow-up interval of peritoneal dialysis patients on the quality of dialysis and the effect of improvement measures

ZHANG Lingfang   WU Henglan   YAO Juanxia   YU Huijie

Department of Nephrology， Jiaxing First Hospital in Zhejiang Province， Jiaxing   314000， China

[Abstract] Objective To observe the influence of different outpatient follow-up intervals for peritoneal dialysis patients on self-management ability and dialysis quality， analyze the reasons and adopt community-hospital collaboration to improve PDCA， and observe the improvement effect. Methods A total of 122 peritoneal dialysis patients who were intubated in our hospital from August 2009 to December 2018 were selected and divided into two groups A and B， There were 74 patients in group A and 48 patients in group B.according to the outpatient follow-up interval（≤1 month， >1 month）. The differences in self-management ability， laboratory tests， blood pressure， common symptoms， etc between the two groups were compared. The main reasons for the longer interval in group B were analyzed. A PDCA group was established， and PDCA improvement measures such as community-hospital collaborative follow-up were adopted. The changes in the proportion of patients with a follow-up interval> 1 month before and after the improvement were observed. Results Patients in group A were significantly higher than group B in terms of fluid exchange technique， handling of abnormal conditions， diet management， complication monitoring， emotional management， and social regression （P<0.05）. The hemoglobin and albumin in group A were significantly higher than group B （P<0.05）. The blood calcium and blood phosphorus in group A were significantly lower than group B （P<0.05）， and the incidence of peritonitis in group A was significantly lower than group B （P<0.05）. The main reasons for the longer follow-up intervals in group B included long distances， older age， restricted mobility， conflicts with working hours， and longer follow-up time. After improvement measures were taken， the proportion of patients with a follow-up interval> 1 month decreased from 39.34% to 17.24%（χ2=14.20， P<0.05）. Conclusion The self-management ability and dialysis quality of patients with an outpatient follow-up interval of ≤1 month are significantly higher than those of patients with an interval of >1 month. Improvement measures such as community-hospital collaborative follow-up can effectively solve the problem of long follow-up intervals for some patients.

[Key words] Peritoneal dialysis patients; Outpatient follow-up interval; Dialysis quality; PDCA

终末期肾脏病（End stage renal disease，ESRD）是由各种肾脏疾病引起的导致肾脏功能不可逆衰退的终末疾病[1]。腹膜透析是治疗终末期肾病的主要替代疗法之一[2]。腹膜透析具有保护残肾功能、安全简便、易于操作、费用较低等优点，近年来在国内外得到广泛的发展，接受腹膜透析的患者也逐年增多[3]。……