全程照护模式在终末期肾病腹膜透析患儿中的应用

Exploration and practice of integrated care for children undergoing peritoneal dialysis with End Stage Renal Disease

目的:评价全程照护模式在终末期肾病患儿腹膜透析中的应用效果。方法:2012年1月至2020年12月,对在复旦大学附属儿科医院就诊的0~18岁且诊断为终末期肾病行腹膜透析的380例患儿实施多学科全程照护模式,包括透析前由患儿及家庭照顾者共同参与制定腹膜透析处方,商讨最优化的治疗方式;对其家庭进行动态评估,包括经济条件及照护者的心理状况,并及时协调院内资源,帮助贫困患儿家庭申请救助基金;透析启动阶段,对患儿进行住院置管围手术期间的综合管理,对患儿或家庭照顾者进行培训和考核;出院后进行延续性护理和规律随访管理等。结果:2018年—2020年腹膜透析患儿腹膜炎的发生率为0.10~0.12次/患者年。患儿的1年成活率为97%,5年成活率为95%。结论:全程照护模式的应用最终降低了患儿腹膜透析相关并发症的发生率,优化了腹膜透析治疗的效果,从而提高了患儿的生活质量。

Objective:To evaluate the effect of integrated care model for children undergoing peritoneal dialysis with End Stage Renal Disease.Methods:A multidisciplinary,integrated care model was applied among children undergoing peritoneal dialysis aged 0 to 18 years old in Children's Hospital of Fudan University from January 2012 to December 2020.The model included prescribing treatment modalities based on an expectation of dialysis and quality of life of children and their families;optimizing the treatment based on families'preference;dynamically assessing families'financial conditions and caregivers'psychological status;coordinating the resources,and assisting in applying for fundings.During the dialysis initiation,the model included comprehensive management of children and their families during hospitalization,including symptoms management,dialysis care,training and performance assessment peritoneal dialysis,and the continuous care and routine follow-ups of families with children undergoing peritoneal dialysis after discharge.Results:From 2018 to 2020,the peritonitis rate was 0.10-0.12 per patient-year.The optimized outcomes of peritoneal dialysis were achieved through continuous quality improvement with the one-year survival rate of 97%and the 5-year survival rate of 95%.Conclusion:The implementation of the integrated care model lowered the incidence of peritoneal dialysis related complications,optimized the peritoneal dialysis treatment,and improved children's quality of life.