摘要
目的:探讨应用持续质量改进(CQI)的方法纠正老年腹膜透析患者钙磷代谢紊乱的效果。方法:运用PDCA四步法,即设计、实施、检验和应用,设计并实施改善老年腹膜透析患者钙磷代谢紊乱的治疗措施。结果:45例腹膜透析时间>3个月的老年患者参与了此项研究。经9个月CQI,各种钙磷代谢紊乱总发生率由82.22%降至42.22%(P<0.05)。其中高钙血症组血钙由(2.71±0.25)mmol/L降至(2.52±0.31)mmol/L(P<0.05),低钙血症组血钙由(1.78±0.42)mmol/L升至(2.11±0.24)mmol/L(P<0.05),血磷水平由(2.13±0.62)mmol/L降至(1.67±0.53)mmol/L(P<0.05),钙磷乘积由(80.22±16.61)mg2/dl2降至(54.58±15.93)mg2/dl2(P<0.05),继发性甲状旁腺功能亢进患者的血清全段甲状旁腺素(iPTH)由(488.12±227.31)pg/ml降至(290.3±171.15)pg/ml(P<0.01),血清碱性磷酸酶水平由(108.75±35.31)U/L降至(88.75±38.14)U/L(P<0.05)。有残肾功能较无残肾功能组,虽KT/V差异不大,在CQI后纠正高磷血症、高钙血症、甲状旁腺功能亢进上差异均有统计学意义(P<0.05)。结论:持续质量改进措施显著改善了老年腹膜透析患者的钙磷代谢紊乱。
Objective：To evaluate the effect of continuous quality improvement （CQI） on management of calcium and phos- phorus metabolism disorders in elderly patients undergoing peritoneal dialysis. Methods： With the use of PDCA four - step （ plan, do, check and act） ,we designed and carried out treatments to improve calcium and phosphorus metabolism in ederly patients undergoing peritoneal dialysis. Results ：45 elderly patients dialyzed for more than 3 months participated in the study. The overall incidence of cal- cium and phosphorus metabolism disorders got down from 82.22% to 42.22% after CQI. In details, the level of serum calcium re- duced from （2.71 ± 0.25 ）mmol/L to （ 2.52 ± 0.31 ）mmol/L in hypercalcemia group （P 〈 0.05 ）. The level of serum calcium increased from （ 1.78± 0.42） mmol/L to （2.11 ± 0.24） mmol/L in hypocalcemia group （P 〈 0.05 ） . The level of serum phosphorus reduced from（2.13 20.62） mmol/L to（ 1.67± 0.53 ） mmol/L（ P 〈 0.05 ）. The level of calcium - phosphorus product reduced from （80.22 ±16.61 ） mg2/dl2 to （54.58± 15.93 ） mg2/dl2 （ P 〈 0.05 ）. The level of serum intact parathyroid hormone （ iPTH ） reduced from（488.12 ±227.31 ）pg/ml to （290. 30 ± 171. 15 ）pg/ml in SPTH group （P 〈 0. 05 ）. The level of serum alkaline phosphatase （ALP） reduced from to （ 108.75 ±35.31 ） U/L to （ 87.75 ± 38.14） U/L （ P 〈 0.05 ）. Although the difference of KT/V was insignificant, hyperphosphatemia, hypercalcemia, hyperparathyroidism were significantly different after CQI between groups with and without residual renal function （ P 〈 0.05 ）. Conclusion： CQI is a useful method on the management of disorders of calcium and phosphorus in elderly patients undergoing peritoneal dialysis.
出处
《中国中西医结合肾病杂志》
2012年第8期694-697,共4页
Chinese Journal of Integrated Traditional and Western Nephrology
基金
瑞安市科技计划资助项目(No.201002078)
关键词
腹膜透析
持续质量改进
钙磷代谢紊乱
Peritoneal dialysis Continuous quality improvement Disorders of calcium and phosphorus
