影响我国腹膜透析开展的原因分析

Factors that influence the use of peritoneal dialysis in China

目的 腹膜透析具有多种优点 ,但是在我国大部分地区 ,腹膜透析的使用率很低。因此就腹膜透析在我国的发展现状及影响腹膜透析开展的原因进行调查。方法 采用自拟的调查表 ,调查参加全国肾脏病主任学习班的 5 1名肾科主任对腹膜透析的看法及影响腹膜透析开展的因素。结果 所有参加调查的医院都开展了血液透析 ,6 8.6 %的医院开展了腹膜透析 ,5 4.9%开展肾移植治疗。 5 .9%的被调查者认为腹膜透析比血液透析优越 ,2 9.4%认为腹膜透析不如血液透析优越 ,而多数 (6 4.7%)则表示一种透析方式的优缺点需视患者而异。有 70 .6 %表示对腹膜透析有信心 ,88%调查对象都对腹膜透析表现出兴趣。90 .2 %的被调查者表示将会开展腹膜透析 (包括已开展者 )。对于腹膜透析在透析总人数中应占的百分比 ,大多数 (5 2 .9%)被调查者认为是 30 %～ 5 0 %,但事实上在多数地区 (5 8.8%)腹膜透析在透析中所占的比例小于 10 %,有 2 1.6 %的地区腹膜透析所占比例为 10 %～ 2 0 %。关于影响腹膜透析开展的原因 ,从高到低排列为 :经济因素 (5 1%) ,医患双方认识不足 (2 7.5 %) ,腹膜炎 (2 1.7%) ,腹膜透析效果不好 (15 .7%) ,患者不接受 (7.8%) ,宣教随访困难 (3.9%) ,营养不良、腹膜透析没进公费医疗。

Objective Peritoneal dialysis (PD)is an effective renal replacement therapy. However, its usage in China is rather low. The present study investigated the possible causes of the low PD penetration rate in China. Methods Fifty-one chief nephrologists from different university hospitals were asked to answer 8 questions about their attitudes towards PD and the factors that affect the use of PD in their areas. Results Hemodialysis(HD) was available in all the hospitals, while PD was available in 68.6% of the hospitals followed by renal transplantation (54.9%). 5.9% of the nephrologists believed that PD was more advantageous as compared to HD,whereas 29.4% of the nephrologists believed HD was better. However, most of the nephrologists(64.7%)thought that the advantages of each modality should be individualized and therefore the selection of the modality should be individualized accordingly. About 70.6% of the nephrologists expressed their confidence on PD and 88% were interested in PD. So 90.2% of the nephrologists said they would carry out PD later. Most (52.9%) nephrologists thought the proportion of PD in China should be 30%～50%, while the actual proportion was less than 10% in most areas (58.8%) of China. Most nephrologists indicated that the major reasons resulting in such a low usage of PD were low profit of PD treatment and insufficient patient and professional education of PD. There were a few nephrologists said that peritonitis,high dropout rate of PD and patient's preference affected also the penetration of PD. Conclusions Our findings suggest that the usage of peritoneal dialysis is rather low in China. Incentive profit system of PD treatment and insufficient education to both professionals and patients are the two main reasons that hinder the use of PD in China.