基于多学科协作的精益管理对维持性血液透析患者透析质量的影响

Impacts of lean management based on multi-disciplinary collaboration on dialysis quality of maintenance hemodialysis patients

目的探讨在维持性血液透析患者治疗中辅以多学科协作精益管理模式的效果,以期能为后续临床广泛应用提供依据。方法选取厦门市海沧医院肾内科2020年8月至2021年7月收治的67例需进行维持性血液透析患者为研究对象,采用随机抽签法分为观察组(n=33)与对照组(n=34)。对照组进行常规的护理,观察组采取多学科协作精益管理模式进行护理。分析比较两组患者护理前后透析指标、透析期间体重增长控制率、透析前高血压控制率、血红蛋白、血清白蛋白以及生存质量评分。结果观察组护理后尿素下降率指标为(75.64±9.92)%、尿素清除指数为(1.48±0.12),均明显高于对照组的(68.88±7.12)%、(1.28±0.10),β2-微球蛋白指标为(40.22±2.69)mg/L,明显低于对照组的(44.75±3.73)mg/L,差异有统计学意义(P<0.05);观察组透析期间体重增长与透析前高血压控制率分别为96.97%、96.97%,显著高于对照组的61.76%、64.71%,差异有统计学意义(P<0.05);观察组血清白蛋白与血红蛋白水平均高于对照组,差异有统计学意义(P<0.05);观察组生理、心理、社会关系以及环境评分均高于对照组,差异有统计学意义(P<0.05)。结论基于多学科协作的精益管理作用于维持性血液透析患者不但可以提升透析质量,同时可以有效提升患者的生存质量,可在临床应用中推广使用。

Objective To investigate the effect of lean management mode based on multi-disciplinary collaboration in the treatment of maintenance hemodialysis patients,so as to provide the basis for the follow-up widespread clinical application.Methods A total of 67 patients who needed maintenance hemodialysis admitted to and treated in the Department of Nephrology of Xiamen Haicang Hospital from August 2020 to July 2021 were selected as the research subjects.They were divided into the observation group(n=33)and the control group(n=34)according to the random lottery method.The control group was treated with conventional nursing,while the observation group was treated with lean management mode based on multi-disciplinary collaboration.The dialysis indices,weight gain control rate during dialysis,hypertension control rate before dialysis,hemoglobin,serum albumin and quality of life score of patients in the two groups before and after the intervention were analyzed and compared.Results After nursing,the indices of urea reduction ratio and urea clearance index in the observation group were(75.64±9.92)%and(1.48±0.12)respectively,both obviously higher than(68.88±7.12)%and(1.28±0.10)in the control group,and the index ofβ2-microglobulin was(40.22±2.69)mg/L,obviously lower than(44.75±3.73)mg/L in the control group,with statistically significant differences(P<0.05).The control rates of weight gain during dialysis and hypertension before dialysis in the observation group were 96.97%and 96.97%respectively,obviously higher than 61.76%and 64.71%in the control group,with statistically significant differences(P<0.05).Serum albumin and hemoglobin levels in the observation group were both higher than those in the control group,with statistically significant differences(P<0.05).The physiological,psychological,social relations dimension and environmental score of the observation group were all higher than those of the control group,with statistically significant differences(P<0.05).Conclusion The lean management based on multi-disciplinary collaboration used in treating maintenance hemodialysis patients can not only improve the dialysis quality,but also can effectively improve the quality of life in patients,which can be promoted and utilized in clinical application.