基层医院对肾移植术后患者管理的现状调查及意义

The management situation analysis of renal-post-transplant patients in primary hospital

目的探讨基层医院对辖区内肾移植术后患者管理的现状、管理对策及意义。方法以攀枝花市肾移植术后患者79例作为研究对象。采用横断面问卷调查,调查项目包括基本信息、肾移植前透析情况、肾移植及配型情况、抗排斥治疗、血药浓度监测及其他等5个维度,56个条目。结果 78例患者的问卷调查有效,有效率98.7%,男43例,女35例,平均年龄（47.4±6.4）岁。94.9%的患者在省级以上的医院行肾移植手术,其中在四川大学华西医院手术者占70.5%。受调查者对配型情况知晓率为100%。肾移植抗排斥治疗2个月内,100%的患者选择肾移植医院治疗;移植术后3～5个月和6～24个月,分别有84.6%的患者和45.4%的患者选择肾移植医院进行随访;而肾移植术后25～59个月,仅17.4%的患者选择肾移植医院随访,82.6%的患者选择在其所在地地市级或其他医院随访。肾移植术后25～59个月和≥60个月分别有29.0%和21.6%的患者不监测血药浓度。再次住院的主要原因是感染和急性排斥反应。结论地市级基层医院应该至少培养一名有肾移植管理经验的专科医生,与区域内上级医院合作。实行医疗保险定点建档、一体化管理体制对肾移植术后患者的管理具有重要的现实意义。

Objective To investigate the management situation of patient after renal transplantation in primary hospital. Methods Seventy-nine patients after renal transplantation in Panzhihua were included for the study. The questionnaires of total 56 items included kidney dialysis before transplantation, renal matching, treatment after transplantation, monitoring of blood drug concentration and so on.The questionnaires were recorded by doctors and patients face to face. Results Seventy-eight questionaires（98.7%） from 35 male and 43 female patients were effective. The kidney transplantations were carried out in provincial tertiary hospital in Chengdu accounted for 94.9%, 70.5% in West-China Hospital of Sichuan university. All the patients were awareness of the kindy matching. All patients were follow-up in the original operation hospital in 2 months after transplantation, the proportion decreased to 84.6% during 3-5 months,and 45.4% during 6-24 months.However,only 17.4% of all the patients were follow-up in the original operation hospital during 25-59 months after transplantation. The proportion of non-monitor of plasma drug concentration during 25-59 month,≥60month after transplantation was 29.0%, 21.6%. Acute infections and rejection were the main reasons of rehospitalization. Conclusion It is necessary that at least one doctor who is specialized in kidney transplant management should be cultivated in the local municipal hospital. It is necessary to cooperate with regional superior hospital. The integrative system of the medical management is very important to the renal-post-transplant patients.