持续质量改进用于糖尿病肾病患者血液透析中低血糖管理

Continuous quality improvement for hypoglycemia management in hemodialysis of patients with diabetic nephropathy

目的:探究持续质量改进在糖尿病肾病患者血液透析中低血糖管理中的价值。方法:将2015年8月-2016年1月在我院进行血液透析的80名糖尿病肾病(DN)患者纳入观察组,2015年2月-2015年7月在我院进行血液透析的80名DN患者纳入对照组。比较2组患者基本资料、不同时段发生低血糖次数、血糖变化方面的差异,分析持续质量改进的临床价值。结果:透析开始时2组患者血糖无明显差异(P>0.05),透析2 h后,2组患者血糖均出现不同程度的下降,但仍无明显差异(P>0.05)。透析结束时,观察组血糖为(6.94±3.02)mmol/L,对照组血糖为(4.96±2.13)mmol/L。观察组明显高于对照组(P<0.05),差异有统计学意义;观察组患者共发生低血糖120次,对照组共发生低血糖364次。观察组少于对照组(P<0.05),差异有统计学意义。2组患者均随透析时长增长血糖不断下降,在透析2~3 h时透析低血糖次数最多,观察组70次,对照组206次,随后低血糖次数下降,观察组19次,对照组50次。在各透析时段,观察组低血糖次数均少于对照组(P<0.05),差异有统计学意义。结论:持续质量改进用于糖尿病肾病患者血液透析中低血糖的管理能有效降低低血糖的发生率,应大力推广。

Objective： To explore the continuous quality improvement value for hypoglycemia management in the hemodialysis of patients with diabetic nephropathy （DN）. Methods：80 DN patients undergoing hemodialysis were included in a study group, and another 80 DN patients were enrolled in a control group. Differences between the two groups were compared in terms of the basic information, the number of hypoglycemia occurrence in different periods, blood glucose changes, and the clinical value of continuous quality improvement was analyzed. Results： Blood glucose showed no difference between the two groups at the beginning of dialysis （ P 〉 0.05 ）. 2h af- ter dialysis, blood glucose of the two groups decreased variously, but was still not significantly different （ P 〉 0.05 ）. By the end of dialysis, blood glucose of the study group was （6.94 ± 3.02） mmol / L, higher than the control groupg （4.96 ± 2.13） mmol / L. The difference was statistically significant （P 〈 0.05 ）. The occurrence of hypoglycemia in the study group was 120 times, in contrast with the control groupg 364 times. The difference was of statistical value （ P 〈 0.05 ）. Blood glucose of the two groups decreased as dialysis went on, and the number of hypoglycemia occurrence reached the highest when dialysis continued 2 -3h, with 70 times in the study group and 206 times in the control group. Then a decline followed with 19 times in the study group and 50 times in the control group. In each dialysis session, the study group showed less number of hypoglycemia than the control group. The difference was statis- tically significant （ P 〈 0.05 ）. Conclusion： Continuous quality improvement for hypoglyeaemia management in hemodialysis of patients with DN can effectively reduce the incidence of hypoglycemia and should be vigorously promoted.