摘要
目的观察中国慢性肾脏病高钾血症风险评估工具在维持性血液透析(maintenance hemodialysis,MHD)患者中的应用效果。方法纳入苏州高新区人民医院、南京医科大学附属苏州医院、上海交通大学医学院附属苏州九龙医院的MHD患者280例,对照组(n=142)予常规的高钾血症防治方法,试验组(n=138)基于高钾血症风险等级,采用查找、组织、澄清、了解、选择(find organize clarify understand select,FOCUS)-计划、执行、检查、操作(plan do check act,PDCA)的持续质量改进模式进行分级干预,比较干预前后高钾血症相关指标。结果干预24周后,试验组的高钾血症患病比例(χ^(2)=4.722,P=0.030)、血钾水平(t=2.850,P=0.005)低于对照组,透析充分性(Z=-5.360,P<0.001)及生活质量(t=-4.004,P<0.001)高于对照组。干预12周、18周、24周后,试验组的高钾血症患病比例(χ^(2)=19.37,P<0.001)、血钾水平(F=51.52,P<0.001)低于干预前。干预24周后,31例(22.4%)极高危和高危患者转为中危级(Z=16.326,P=0.001)。结论基于高钾血症风险评估工具,采用FOCUS-PDCA模式对MHD患者进行分级管理,可降低血钾水平和高钾血症发生风险,提高透析充分性及生活质量,值得在临床中运用并进行推广。
Objective The aim of this study was to observe the effect of the Chinese hyperkalemia risk assessment tool in maintenance hemodialysis(MHD)patients.Methods A total of 280 MHD patients from the three hospitals in the Suzhou New District were enrolled in this study.The control group(n=142)was given routine prevention and treatment methods for hyperkalemia.The experimental group(n=138)used Find,Organize,Clarify,Understand,Select,–Plan,Do,Check,Act(FOCUS-PDCA)model for graded intervention based on the risk level of hyperkalemia.The hyperkalemia related indexes were compared before and after the intervention.Results After 24 weeks of intervention,the prevalence of hyperkalemia(13.8%vs.23.9%,χ^(2)=4.722,P=0.030)and blood potassium level(4.44±0.35 vs.4.58±0.47mmol/l,t=2.850,P=0.005)were significantly lower in the experimental group than in the control group;the dialysis adequacy[1.32(1.22~1.54)vs.1.24(1.20~1.30),Z=-5.360,P<0.001]and quality of life(63.79±14.59 vs.56.30±16.29,t=-4.004,P<0.001)were significantly higher in the experimental group than in the control group.After 12,18 and 24 weeks of intervention,the prevalence of hyperkalemia(36.2%vs.31.2%vs.27.5%vs.13.8%,χ^(2)=19.37,P<0.001)and blood potassium level(5.02±0.43 vs.4.81±0.42 vs.4.68±0.39 vs.4.44±0.35 mmol/L,F=51.52,P<0.001)in the experimental group decreased gradually along with the intervention duration.After 24 weeks of intervention,31 extreme-risk or high-risk patients(22.4%)turned to moderate-risk level(Z=16.326,P=0.001).Conclusion Based on the hyperkalemia risk assessment tool,the hierarchical management of MHD patients through FOCUS-PDCA model can significantly reduce potassium level and risk of hyperkalemia,and improve dialysis adequacy and quality of life.This method is worthy of promotion for clinical application.
作者
高玉梅
吴桃峰
林丽华
蔡惠兰
邱宏
金东华
GAO Yu-mei;WU Tao-feng;LIN Li-hua;CAI Hui-lan;QIU Hong;JIN Dong-hua(Department of Nephrology,The People’s Hospital of Suzhou New District,Suzhou 215129,China;Department of Nephrology,Suzhou Municipal Hospital,Suzhou 215002,China;Department of Nephrology,Suzhou Kowloon Hospital,Shanghai Jiao Tong University School of Medicine,Suzhou 215101,China)
出处
《中国血液净化》
CSCD
2022年第9期692-696,共5页
Chinese Journal of Blood Purification
基金
上海交通大学医学院附属第九人民医院护理联盟创新项目(JYHLLM010)
南京医科大学附属苏州医院护理科研项目(Slyyhl202002)
苏州市医学重点扶持学科建设项目(SZFCXK202110)。
关键词
高钾血症风险评估工具
血液透析
分级管理
持续质量改进
Hyperkalemia risk assessment tool
Maintenance hemodialysis
Grading management
Continuous quality improvement
