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目的探讨对维持性血液透析患者持续质量改进,对预后的影响。方法质量改进小组通过各种改进措施的实施,对比观察2005年及2008年的各项化验指标及1年内的死亡率。结果 2005年维持性血液透析患者75例,平均年龄(62.43±13.16)岁,男性占61.3%,2008年患者109例,平均年龄(62.75±13.44)岁,男性占57.8%。2008年URR的平均值及达标率明显好于2005年,分别为(69.15±7.18)%和(65.23±6.46)%(P<0.001)及68.8%和53.3%(P=0.033)。2008年血红蛋白值明显高于2005年[(111.9±16.02)g/L vs.(98±17.39)g/L,P<0.001];血磷下降[(1.56±0.49)mmol/L vs.(1.77±0.61)mmol/L,P=0.033];钙磷乘积下降[(43.39±13.39)mg2/dl2vs.(52.23±19.22)mg2/dl2,P=0.001];血钙值轻度下降,但无显著性差异(2.34±0.2mmol/L vs.2.4±0.3mmol/L,P=0.081)。按照KDOQI指南2008年iPTH的达标(150～300pg/ml)率明显高于2005年(31.3%vs.22%,P=0.028),iPTH的均值有轻度下降[(393.61±443.91)pg/ml vs.(427.75±380.99)pg/ml,P=0.615]。以CRP代表炎症状态,2008年的CRP平均值低于2005年[(5.1±4.4mg/L vs.(9.6±14.7)mg/L,P=0.014]。2008年患者的血清白蛋白水平好于2005年,[(39.1±2.81)g/L vs.(37.86±4.31)g/L,P=0.034]。2008年维持性血液透析患者的透析龄为(51.19±50.22)个月,明显长于2005年患者的(32.11±32.37)个月(P=0.02)。1年时间内,2005年死亡11例,占14.7%;而2008年死亡5例,占4.6%(P=0.017),明显少于2004年。结论按照KDOQI指南,经过持续的质量改进,维持性血液透析患者的贫血、血磷代谢、继发性甲状旁腺亢进、慢性炎症及营养状况均有明显改善。患者的透析龄明显延长,死亡率下降。
Objective To investigate the effects of continuous quality improvement and prognosis on maintenance hemodialysis patients. Methods The quality improvement team implemented various improvement measures to compare various laboratory indicators in 2005 and 2008 with the one-year mortality rate. Results In 2005, there were 75 hemodialysis patients with the average age of 62.43 ± 13.16 years, 61.3% of whom were male. In 2008, 109 patients (mean age: 62.75 ± 13.44 years) and men (57.8%) were male. The average URR in 2008 and the compliance rate were significantly better than those in 2005 (69.15 ± 7.18)% and (65.23 ± 6.46)% (P <0.001) and 68.8% and 53.3% (P = 0.033), respectively. The hemoglobin value in 2008 was significantly higher than that in 2005 [(111.9 ± 16.02) g / L vs. (98 ± 17.39) g / L, P <0.001] ± 0.61) mmol / L, P = 0.033]; the product of calcium and phosphorus decreased (43.39 ± 13.39 mg2 / dl2 vs 52.23 ± 19.22 mg2 / dl2, P = 0.001] Sex differences (2.34 ± 0.2 mmol / L versus 2.4 ± 0.3 mmol / L, P = 0.081). According to the guidelines of KDOQI, the standard of iPTH (150-300pg / ml) in 2008 was significantly higher than that in 2005 (31.3% vs.22%, P = 0.028), with a slight decrease in mean iPTH [(393.61 ± 443.91) pg / ml vs. (427.75 ± 380.99) pg / ml, P = 0.615]. The mean CRP in 2008 was lower in CRP than in 2005 [(5.1 ± 4.4 mg / L vs. (9.6 ± 14.7) mg / L, P = 0.014] with CRP representing an inflammatory state. The serum albumin level in 2008 was better (39.1 ± 2.81) g / L vs. (37.86 ± 4.31) g / L, P = 0.034] in 2005. The dialysis age of maintenance hemodialysis patients in 2008 was (51.19 ± 50.22) months, which was significantly longer than that of 2005 Year (32.11 ± 32.37) months (P = 0.02) .In 1 year, 11 patients died in 2005, accounting for 14.7%; while in 2008, 5 patients died, accounting for 4.6% (P = 0.017) 2004. Conclusions According to the KDOQI guidelines, after continuous quality improvement, patients with maintenance hemodialysis have significantly improved anemia, blood phosphorus metabolism, secondary hyperparathyroidism, chronic inflammation and nutritional status.The dialysis age was significantly prolonged , The mortality rate dropped.