目的 分析2018—2023年广西壮族自治区南宁市血液透析质量，探讨市、县区域发展不均衡的现状及改进方向，以期提高全市血液透析整体质量。 方法 收集2018—2023年南宁市属各透析单位基础数据与质控数据，质控指标包括血压、血红蛋白(hemoglobin, Hb)、甲状旁腺激素(intact parathyroid hormone,iPTH)、血钙(blood calcium，Ca)、血磷(blood phosphorus，P)、白蛋白(albumin,Alb)、血管通路类型及常见并发症等，达标率按《血液净化标准操作规程2021版》标准进行评估，对比市、县区域血液透析发展的现状及差异。 结果 ①2018—2023年南宁市属透析单位由19家增至35家，透析机由358台增至1015台，资质医师由65人增至146人，资质护士由155人增至464人，资质技师由19人增至39人，维持性血液透析患者由2231人增至5148人，治疗量由200 801例次增至569 935例次；②2019年起，县区组透析机数量、患者人数、治疗量均超过市区组，在反映血透资源配置与工作负荷方面的比值[如患者/医师比(Z=-6.570，P＜0.001)、患者/护士比(Z=-2.286，P=0.022)、治疗例次/医师比(Z=-6.270，P＜0.001)、治疗例次/护士比(Z=-3.084，P=0.002)等]比较，县区组均更高；③质控指标管理方面，2组在监测率：血压(t=-0.339，P=0.704)、Hb(t=-1.662，P=0.158)、Alb(t=-0.975，P=0.373)、血Ca(t=0.750， P=0.485)、血P(t=-0.440，P=0.676)；达标率：血压(t=-1.221，P=0.227)、Hb(t=-0.406，P=0.699)、Alb(t=1.017，P=0.356)方面比较，差异无统计学意义；在iPTH监测率(t=3.384，P=0.019)，iPTH达标率(t=3.547，P=0.016)、血Ca达标率(t=3.048，P=0.029)、血P达标率(t=3.836，P=0.012)方面比较，市区组均更高；县区组自体动静脉内瘘使用率更高(t=-5.077，P=0.004)。 结论 2018—2023年南宁市血液透析质量得到显著提高，县区发展速度更快，但医护人员工作压力更大，应增加县区血液透析医护人员配置，优先提升慢性肾脏病-矿物质骨异常并发症的管理能力。
Abstract
Objective To analyze the quality of hemodialysis services in 2018 to 2023 in Nanning city, Guangxi Zhuang Autonomous Region. The hemodialysis units were classified into urban group and county group based on their geographical location. Comparisons of hemodialysis service quality between the two groups demonstrate the current status of developmental differences across urban and county regions, from which strategies targeting the differences can then be organized to enhance the overall hemodialysis quality throughout the city. Methods Baseline data, quality control indicators including blood pressure, hemoglobin (Hb), intact parathyroid hormone (iPTH), blood calcium (Ca), blood phosphorus (P), albumin (Alb), vascular access type and common complications, and compliance rates assessed according to the "Standard Operating Procedures for Blood Purification, 2021 Edition" during 2018-2023 were recruited from the hemodialysis units in Nanning city. The differences in hemodialysis service quality were compared between the hemodialysis units in urban and county regions. Results ①From 2018 to 2023, the number of hemodialysis units in Nanning city increased from 19 to 35, dialysis machines from 358 to 1,015, qualified physicians from 65 to 146, qualified nurses from 155 to 464, and qualified technicians from 19 to 39. The number of maintenance hemodialysis patients rose from 2,231 to 5,148, and treatment sessions increased from 200,801 to 569,935. ②Since 2019, the number of dialysis machines, patient number and treatment sessions were higher in the county group than those in the urban group. For resource allocation and workload, the ratios of patients per physician (Z=-6.570, P<0.001), patients per nurse (Z=-2.286, P=0.022), treatment sessions per physician (Z= -6.270, P<0.001) and treatment sessions per nurse (Z=-3.084, P=0.002) were higher in the county group than those in the urban group. ③For management of quality control indicators, the monitoring rates of blood pressure (t=-0.339, P=0.704), Hb (t=-1.662, P=0.158), Alb (t=-0.975, P=0.373), blood Ca (t=0.750, P=0.485 ) and blood P (t=-0.440, P=0.676), and the compliance rates of blood pressure (t=-1.221, P=0.227), Hb (t=-0.406, P=0.699) and Alb (t=1.017, P=0.356) had no differences between urban group and county group; but the monitoring rate of iPTH (t=3.384, P=0.019) and the compliance rates of iPTH (t=3.547, P=0.016), blood Ca (t=3.048, P=0.029) and blood P (t=3.836, P=0.012) were higher in urban group than those in county group; the use rate of autogenous arteriovenous fistula (t=-5.077, P=0.004) was higher in county group than that in urban group. Conclusion During 2018 to 2023, hemodialysis quality increased significantly in Nanning city, in which hemodialysis quality developed faster in the county regions than urban regions, but the medical staff working in county regions bore more working burdens. Therefore, the number of medical staff should be increased and the management of chronic kidney disease-mineral and bone disorder should be improved in county regions.
关键词
血液透析 /
质控指标 /
达标率 /
血管通路
Key words
Hemodialysis /
Quality control indicator /
Compliance rate /
Vascular access
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