4R理论视觉下基层医院腹膜透析患者腹膜炎管理模式的建立

The establishment of peritonitis management system for patients with peritoneal dialysis in primary hospitals of 4R theory

目的探讨4R危机理论在构建基层医院腹膜透析患者腹膜炎管理模式的作用。方法选取2018年1月至2019年1月长期随访的186例腹膜透析患者,采取方便抽样的方法将患者分为对照组87例和干预组99例。干预组成立危急管理小组,运用4R危机理论进行管理,分为缩减力、预备力、反应力、恢复力4个阶段,评价实施后2组患者腹膜炎发生率和操作考核合格率。结果对照组发生腹膜炎23例,发生率为0.26次/患者年;干预组发生腹膜炎12例,发生率为0.12次/患者年。干预组腹膜炎发生率低于对照组,差异有统计学意义(χ^2=6.212,P=0.013);对照组操作合格60例(68.97%),干预组合格85例(85.86%),干预组操作合格率高于对照组,差异有统计学意义(χ^2=7.69,P=0.008)。结论在4R理论视觉下构建基层医院腹膜透析患者腹膜炎管理模式,符合医疗发展的需求,也能有效降低腹膜透析相关性腹膜炎的发生。

Objective To explore the role of 4R crisis theory in the establishment of peritonitis management system for patients with peritoneal dialysis in primary hospitals.Methods A total of 186 cases of peritoneal dialysis patients who were followed up in our hospital from January 2018 to January 2019 were selected as study objects.The patients were divided into control group(87 cases)and intervention group(99 cases)by convenience sampling.The control group received the routine management method,and the intervention group received the 4R crisis theory for management on the basis of the routine management.The incidence of peritonitis and the operation assessment qualified rate were compared between the two groups.Results The incidence of peritonitis was 26.44%in the control group,and the incidence of peritonitis was 12.12%in the intervention group,the incidence of peritonitis in the intervention group was lower than that in the control group,with statistically significant difference(χ^2=6.212,P=0.013).60 patients in the control group qualified for operation,with a qualified rate of 68.97%;85 patients in the intervention group qualified for operation,with a qualified rate of 85.86%;the qualified rate of the intervention group was higher than that of the control group,with statistically significant difference(χ^2=7.69,P=0.008).Conclusion 4R crisis theory can effectively reduce the incidence of peritonitis in patients with peritoneal dialysis,and gradually form the management system for peritonitis in patients with peritoneal dialysis in primary hospitals.