一体化综合管理模式在维持性血液透析患者动静脉内瘘管理中的应用效果

Effects of integrated comprehensive management model in the management of arteriovenous fistula in maintenance hemodialysis patients

目的探讨一体化综合管理模式在维持性血液透析(MHD)患者动静脉内瘘管理中的应用效果。方法采用便利抽样法,选取2020年1—12月于郑州大学第一附属医院血液净化中心行MHD治疗的174例患者为研究对象,根据随机数字表法将患者分为一体化管理组和常规管理组,各87例。常规管理组患者入院后接受常规的血管通路护理,一体化管理组在常规血管通路管理的基础上,引入多学科血管通路管理团队应用于MHD患者通路管理中,将血管通路管理分为术前评估、建立通路、通路使用、通路监测及通路维护5个关键环节,并制订每个环节的具体措施和内容施行一体化综合管理模式。干预3个月后,比较两组患者一次穿刺成功率、首次透析内瘘使用率、相关并发症发生率及透析耐受度。结果一体化管理组一次性穿刺成功率和首次透析内瘘使用率均高于常规管理组,差异有统计学意义(P<0.05)。一体化管理组总体并发症发生率为6.90%(6/87),低于常规管理组的31.03%(27/87),差异有统计学意义(χ^(2)=16.491,P<0.01)。一体化管理组患者透析耐受性评估2个部分的得分及总分均高于常规管理组,差异有统计学意义(P<0.05)。结论一体化综合管理模式在MHD患者血管通路管理中应用可以提高动静脉内瘘一次性穿刺成功率和首次透析内瘘使用率,降低相关并发症发生率,改善患者耐受度。

Objective To explore the effect of integrated comprehensive management model in the management of arteriovenous fistula in maintenance hemodialysis(MHD)patients.Methods From January to December 2020,174 patients undergoing MHD in the Blood Purification Center of the First Affiliated Hospital of Zhengzhou University were selected as the research object by convenience sampling.According to the random number table method,the patients were divided into the integrated management group and the routine management group,with 87 cases in each group.Patients in the routine management group received routine vascular access nursing after admission.On the basis of routine vascular access nursing,the integrated management group introduced a multidisciplinary vascular access management team to apply it to the access management of MHD patients,and divided the vascular access management into five key links of preoperative assessment,access establishment,access use,access monitoring and access maintenance,and formulated specific measures and content for each link to implemented an integrated comprehensive management model.After three months of intervention,the successful rate of one-time puncture,the use rate of the first dialysis internal fistula,the incidence of associated complications and dialysis tolerance were compared between the two groups.Results The one-time puncture success rate and the first dialysis internal fistula usage rate in the integrated management group were higher than those in the routine management group,and the differences were statistically significant(P<0.05).The overall complication rate in the integrated management group was 6.90%(6/87),which was lower than 31.03%(27/87)in the routine management group,and the difference was statistically significant(χ^(2)=16.491,P<0.01).The scores of the two parts and total scores of the dialysis tolerance in the integrated management group were higher than those in the routine management group,and the difference was statistically significant(P<0.05).Conclusions The integrated comprehensive management model applied in the management of vascular access in MHD patients can increase the one-time puncture success rate of arteriovenous fistula and the use rate of the first dialysis fistula,reduce the incidence of associated complications,and improve patient tolerance.