持续质量改进对腹膜透析病人高血压的作用

Effect of continuous quality improvement (CQI) on hypertension management in continuous ambulatory peritoneal dialysis(CAPD) patients

目的 :通过持续质量改进措施 ,纠正腹膜透析病人的高血压。方法 :运用PDCA四步法 ,即设计 (plan) -实施 (do) -检验 (check) -应用 (act) ,设计并实施纠正高血压的治疗流程。结果 :1 4 5例透析时间 3个月及以上的病人参与此次研究。 4 9例长期腹膜透析病人中 ,血压未达控制目标的病人由 4 9%降至 1 6 .3% ,人均降压药用量、超滤量和尿量的总排出量没有显著变化。 96例新增病人中 ,未达到血压控制目标的病人由透析前的 6 1 .3%降至2 8%。病人身高标化的细胞外液 (nECW )明显降低 [男 ,(1 0 .8± 1 .4 )kg/m降至 (1 0 .3± 1 .7)kg/m ;女 ,(9.6±1 .2 )kg/m降至 (8.6± 1 .2 )kg/m]。结论

Objective:To improve hypertension management in peritoneal dialysis patients through CQI process. Methods: Using the 4 step problem solving framework called the PDCA cycle-plan, do, check and act, we conducted a CQI program. Results: One hundred and forty five peritoneal dialysis patients dialyzed for more than 3 months participated in the study. In 49 prevalent patients, the incidence of uncontrolled hypertension (BP≥140/90 mm Hg, 1 mm Hg=0.133 kPa) decreased from 49% to 16.3% although there were no significant changes in antihypertensive medication and total fluid removal. The incidence of uncontrolled hypertension in incident patients decreased from 61.3% to 28%. Height normalized extracellular water decreased significantly. In males it was from (10.8±1.4) kg/m to (10.3± 1.7) kg/m and in females (9.6±1.2) kg/m to (8.6±1.2) kg/m. Conclusion:CQI is a useful method in the management of hypertension in peritoneal dialysis patients.