市级医院开展腹膜透析的“非医疗瓶颈因素”探讨

Discussion on Non-Medical Bottleneck Factors Affecting City Grade Hospital to Carry Out Peritoneal Dialysis

目的探讨在市级医院开展腹透的"非医疗瓶颈因素"。方法分析1996年7月-2011年12月间肾内科160例持续非卧床腹膜透析(CAPD)患者的临床资料,探讨腹透中心规模、腹透液计费方式、医患对腹透的认识等因素对开展腹透的影响;比较该科累计患者人数小于50名前及大于50名后CAPD:掉队率(DOR)、PD治疗时间(TOT)、1年技术生存率等的差异。结果考虑到"价效比"及"生活质量",分别仅45.6%与51.8%的医生推荐患者行腹透。腹透液按"药品"计费前66.8%的医生建议患者行血透,高于腹透液按"药品"计费后(43.3%),差异有统计学意义(P<0.05)。累计CAPD人数小于50名前,患者的DOR(25.2%vs 19.3%)、死亡(32.1%vs 17.7%)、漂管(5.7%vs 2.7%)、腹透漏液(3.3%vs 1.3%)、隧道感染(9.4%vs 5.4%)、腹膜炎(1∶16.3病人月vs 1∶23.9病人月)的发生率均高于累计CAPD人数大于50名后,患者的TOT[(20.4±6.3)月vs(36.3±9.6)月]、1年技术生存率(81%vs 95%)、1年导管完好率(82%vs 93%)分别低于累计CAPD患者人数大于50名后,差异有统计学意义(P<0.05)。结论医患对腹透的认识误区、腹透液计费方式、腹透中心规模的大小制约了该中心腹透的发展。

Objective To discuss the non-medical bottleneck factors that ＇affect the city grade hospitals to carry out the peri-toneal dialysis（PD）. Methods Retrospective analyze the clinical data of 160 cases of end-stage renal disease（ESRD） patients on continuous ambulatory peritoneal dialysis（CAPD） treatment from July, 1996 to December,2011 in our hospital, explore the in-fluence of peritoneal dialysis center＇ s scale size, cost of dialysate, understanding of medical personnel and ESRD patients about peritoneal dialysis on the peritoneal dialysis in our hospital. Compare the difference of the main complications of CAPD between cumulative numbers of patients less than and more than 50： drop-out rate, time on treatment（TOT）, 1 year catheter intact rate and so on. Results The, peritoneal dialysis was suggested only by 45.6% of medical personnel in terms of cost-effect ratio ,and by 51.8% in terms of quality of life. Before the dialysate is charged as a drug,66.8% of ~nal physicians suggested patients to choose hemodialysis, but it changed to 43.3 % after dialysate is charged as a supply, there is a significant difference （P 〈 0.05 ）. When the cumulative numbers of patients was less than 50, the rates of drop-out rate, death rate, vessel drifting rate, rate of dialy-sate leaks, tunnel infection rate and PD associated peritonitis were all higher, but the TOT, 1 year survival rate and 1 year vessel intact rate were lower,as compare with those when the cumulative numbers of patients was more than 50, and the difference was significance （P 〈 0.05）. Conclusion The misunderstanding of renal medicals and the ESRD patients, the way of medical pay-ment and the size of the PD center together limited the speed of the development of PD center.