持续质量改进模式在腹透患者液体平衡管理中的作用

Effect of continuous quality improvement on the management of liquid balance in patients who receiving peritoneal dialysis

目的研究持续质量改进(CQI)模式对腹膜透析(PD)患者的液体平衡的影响。方法选取2014年4—10月在本院肾内科行腹膜透析的120例患者作为研究对象,随机分为研究组和对照组各60例。研究组患者实施CQI管理模式,同时给予常规治疗和一般腹膜透析宣教,对照组患者仅给予常规治疗和一般腹膜透析宣教。6个月后对患者进行液体平衡管理的效果评价,包括血压、心率、胸片中的心胸比、血清N端前脑钠肽(NT-proBNP)水平以及外周有无浮肿等。结果干预后,接受持续质量改进组护理的研究组患者收缩压、舒张压、心率、心胸比和NT-proBNP等临床指标,均低于自身干预前及对照组患者,差异有统计学意义(P<0.01)。研究组患者6例出现浮肿症状,显著低于对照组患者15例出现浮肿症状,差异有统计学意义(χ~2=4.675,P=0.031)。结论运用持续质量改进模式能有效改善维持性腹透患者的液体平衡管理。

Objective The aim of the article is to investigate the effect of CQI management mode on fluid balance of patients who receiving peritoneal dialysis. Methods A total of 120 patients undergoing peritoneal dialysis in the Department of Nephrology of our hospital from April to October 2014 were selected az the subjects. And the patients were randomly divided into treatment group and control group, with 60 cases in each group. On the basis of routine treatment and general peritoneal dialysis education, patients in the treatment group were implemented CQI management model. And patients in the control group only received routine treatment and general peritoneal dialysis education. The effect of fluid balance management in patients was evaluated six months later, including blood pressure, heart rate, cardiothoracic ratio in chest X- ray, serum N terminal forebrain natriuretic peptide （NT-proBNP） levels, and whether there had edema outside the chest. Results After the intervention, the indexes of blood pressure, heart rate, cardiothoracie ratio and NT-proBNP of the treatment group were significantly decreased and lower than those of control group（P〈0.05）. Edema occurred in 6 patients in treatment group, while there 15 cases with edema in control group, the difference between treatment group and control group was statistically significant （ X2 = 4. 675, P = 0.031 ）. Conclusions CQI management mode can effectively improve the management of fluid balance in patients who receiving peritoneal dialysis.