中国血液净化

中国血液净化 ›› 2024, Vol. 23 ›› Issue (10): 753-757.doi: 10.3969/j.issn.1671-4091.2024.10.005

• 临床研究 • 上一篇    下一篇

目标导向模式改善基层血液透析质量的临床研究

王  鑫    江登科    刘林昊    邓亚楠   马雪萍   王  沛   梁献慧   

  1. 450052 郑州，郑州大学第一附属医院1血液净化中心 2肾脏内科
  • 收稿日期:2024-02-08 修回日期:2024-07-21 出版日期:2024-10-12 发布日期:2024-10-12
  • 通讯作者: 梁献慧 E-mail:fccliangxh@zzu.edu.cn
  • 基金资助:
    国家自然科学基金(81873612)

A clinical study on goal-directed model for improving quality of hemodialysis at grassroots level

WANG Xin, JIANG Deng-ke, LIU Lin-hao, DENG Ya-nan, MA Xue-ping, WANG Pei, LIANG Xian-hui   

  1. Blood Purification Center and 2Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
  • Received:2024-02-08 Revised:2024-07-21 Online:2024-10-12 Published:2024-10-12
  • Contact: 450052 郑州，郑州大学第一附属医院1血液净化中心 2肾脏内科 E-mail:fccliangxh@zzu.edu.cn

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摘要： 目的 探讨目标导向模式在提升基层血液透析质量中的效果。 方法 以2021年10月—2022年3月于郑州大学第一附属医院南院区接受维持性血液透析治疗的基层患者为研究对象，观察目标导向模式管理6 m后，患者血管通路、临床指标、生活质量和卫生经济学指标等的改善情况。 结果 共纳入85例患者。与基线相比，6 m后带隧道带涤纶套导管的使用比例由42.35%降至27.06%(χ2=6.303，P=0.043)，单室尿素清除指数＜1.2的患者比例降至7.05%(χ2=21.182，P＜0.001)，透析间期体质量增加＜5%干体质量的患者比例增至70.59%(χ2=43.895，P＜0.001)，血红蛋白(χ2=15.824，P=0.001)、血钾(χ2=4.541，P=0.033)、血白蛋白(χ2=31.224，P＜0.001)、血磷(χ2=17.306，P＜0.001)及全段甲状旁腺激素(χ2=17.162，P＜0.001)达标率均提高；患者满意度由48.24%上升至100%(χ2=59.365，P＜0.001)，生活质量评分提高(t=-22.455，P＜0.001)；直接医疗总成本无明显增加(t=1.387，P=0.167)。 结论 目标导向模式有效改善了基层患者的血液透析质量，利于患者并发症控制及生活质量提高，且不额外增加医疗花费，具有较强的应用价值。

关键词: 目标导向模式, 维持性血液透析, 基层, 医疗成本

Abstract: Objective  To explore the effects of goal-directed model on improving quality of hemodialysis at grassroots level.  Methods  Patients receiving maintenance hemodialysis treatment at the Southern Branch of The First Affiliated Hospital of Zhengzhou University from October 2021 to March 2022 were enrolled in this study. After 6 months of goal-directed management, the improvement of vascular access, clinical indicators, quality of life, and health economics indicators of the patients were evaluated.  Results  A total of 85 cases were included. After 6 months of goal-directed management, proportion of the patients using tunneled-cuffed catheters decreased from 42.35% to 27.06% (χ2=6.303, P=0.043), proportion of the patients with a single-pool Kt/V ＜1.2 decreased to 7.05% (χ2=21.182, P＜0.001), and proportion of the patients with interdialytic weight gain ＜5% of dry weight increased to 70.59% (χ2=43.895, P＜0.001), as compared to the baseline data. The levels of hemoglobin (χ2=15.824, P=0.001), potassium (χ2=4.541, P=0.033), albumin (χ2=31.224, P＜0.001), phosphorus (χ2=17.306, P＜0.001) and intact parathyroid hormone (χ2=17.162, P＜0.001) improved significantly. Satisfaction of the patients increased from 48.24% to 100% (χ2=59.365, P＜0.001), and the quality of life score improved significantly (t=-22.455, P＜0.001). The total direct medical expenses did not increase significantly compared to the baseline (t=1.387, P=0.167).  Conclusion The goal-directed model effectively improves the quality of hemodialysis for grassroots patients, facilitates the management of complications and enhances the quality of life, but does not incur additional medical expenses, which demonstrate its stronger practical value.

Key words: Goal-directed model, Maintenance hemodialysis, Grassroot level, Medical cost

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