中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (12): 861-864.doi: 10.3969/j.issn.1671-4091.2019.12.015

• 护理研究 • 上一篇    下一篇

医护患一体化联合“策划-实施-检查-措施”管理模式改善维持性血液透析患者低钙血症

王萌1,魏丽敏1,刘华1,蒋红利1   

  1. 1. 西安交通大学医学院第一附属医院血液净化科
  • 收稿日期:2019-07-09 修回日期:2019-09-10 出版日期:2019-12-12 发布日期:2019-12-03
  • 通讯作者: 蒋红利 j92106@sina.com E-mail:j92106@sina.com
  • 基金资助:
    国家自然科学基金青年科学基金项目(81900674)

Effects of integrated doctor-nurse-patient with PDCA management mode on hypocalcemia in maintenance hemodialysis patients#br#

  1. 1Department of Blood Purification, The First Affiliated Hospital, Xi’an Jiaotong University School of Medicine, Xi’an 710061, China
  • Received:2019-07-09 Revised:2019-09-10 Online:2019-12-12 Published:2019-12-03

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摘要： 【摘要】目的探讨医护患一体化联合“策划-实施-检查-措施(plan-do-check-act,PDCA)”管理模式改善维持性血液透析患者低钙血症的临床效果，为建立血液透析患者有效的精细化管理模式提供参考依据。方法按照纳入排除标准，纳入2017 年12 月西安交通大学医学院第一附属医院血液净化科维持性血液透析≥3 月的患者，检测基线血钙浓度、血清25 羟维生素总D3浓度及治疗依从性、满意度指标，2018 年1 月开始实施医护患一体化联合PDCA 管理模式，干预期1 年，2018 年12 月再次检测上述指标。结果研究共纳入患者320 例。干预组血钙浓度[(2.11±0.24)比(2.02±0.26)mmol/L，t=- 4.731，P＜0.001]、低钙血症发生率(45.63%比53.75%,χ2=4.187,P=0.041)、血清25 羟维生素总D3浓度[(19.22±11.59)比(15.11±11.92)ng/ml，t=4.520，P＜0.001]较对照组明显改善,差异具有统计学意义；相较于对照组，干预组疾病状态知晓率(91.25%比69.69% ,χ2=47.333,P＜0.001)、药物治疗依从性(57.81%比39.69%, χ2=21.038, P＜0.001)、正确服药依从性(47.19%比39.38%, χ2=3.978, P=0.046)及按时复诊依从性(94.69%比85.63%,χ2=14.807,P＜0.001)均明显提高，差异具有统计学意义；干预组患者满意度较对照组(94.1% 比79.7%, χ2= 32.132,P＜0.001)明显提高，差异具有统计学意义。结论医护患一体化联合PDCA管理模式有效纠正维持性血液透析患者低钙血症，改善多个血液净化质量控制指标，提高患者的治疗依从性及患者满意度，可在临床推广实施。

关键词: 医护患一体化, 血液透析, 低钙血症, 策划-实施-检查-措施

Abstract:

【Abstract】Objective To investigate the effects of integrated doctor-nurse-patient with PDCA management mode on hypocalcemia in maintenance hemodialysis (MHD) patients, in order to establish an effective and delicate management mode for MHD patients. Methods The patients treated in Dec. 2017 in our hospital and with dialysis age over three months were enrolled in this study. Their baseline serum calcium, 25-hydroxyvitamin total D3, treatment compliance, satisfaction index were recruited. The integrated doctor-nurse-patient with PDCA management mode was conducted from Jan. 2018, and lasted for one year. These parameters were evaluated again at Dec. 2018. Results A total of 320 patients were enrolled in this study. Serum calcium,
25- hydroxyvitamin total D3 and the incidence of hypocalcemia improved significantly in intervention group as compared with control group (P＜0.05). The awareness of disease state, compliance with medication treatment, compliance with correct drug intake, compliance with periodic blood tests, and satisfaction index also improved significantly in intervention group as compared with control group (P＜0.05). Conclusion The integrated doctor-nurse-patient with PDCA(plan, do, check, act) management mode can effectively improve hypocalcemia, blood purification quality control indicators, patient compliance and satisfaction index in MHD patients. This mode is clinically useful for MHD patients.

Key words: Integrated doctor-nurse-patient, Hemodialysis, Hypocalcemia, PDCA

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