CAJ | 학술논문

目的探讨应用持续质量改进(continous quality improvement,CQI)方法对老年腹膜透析患者营养、炎症、透析充分性和心血管事件的改善作用. 方法本研究为前瞻自身前后对照研究,选择我院病情稳定的老年维持性腹膜透析患者32例,运用设计、实施、检验和应用(PDCA)四步法,针对腹膜透析各项指标和工作环节进行改进,分析比较CQI前后透析充分性、营养、炎症和心血管事件等各项指标的变化. 结果 CQI前后比较,每周总尿素清除指数(Kt/V)达标率增加(71.8％比93.8％,P＜0.05),Kt/V水平升高(1.97±0.36比2.08±0.33,P＜0.05)；血清学指标白蛋白(ALB)、前白蛋白(PAB)、血清二氧化碳结合力浓度明显升高(P＜0.05)；白蛋白达标率增加(9.4％比31.3％,P＜0.05)；营养评估直接体测量指标(上臂围、肱三头肌皮褶厚度、上臂肌围),以及瘦体质量、瘦体质量百分比、标准化的总氮出现率相当蛋白、左右手握力明显改善(P＜0.05)；微炎症指标超敏-C反应蛋白(hs-CRP)下降,分别为(8.65±6.22) mg/L比(5.37±4.33) mg/L(P＜0.01)；超敏C反应蛋白阳性率减低(53.1％比25.0％,P＜0.05)；腹膜炎发生率降低(1次/25.4患者月比1次/78.1患者月,P＜0.05)；因心血管事件住院率下降(25.0％比3.1％,P＜0.05). 结论 CQI措施能够改善老年腹膜透析患者的营养、炎症和透析充分性,从而降低心血管事件住院率.
목적 탐토응용지속질량개진(continous quality improvement,CQI)방법대노년복막투석환자영양、염증、투석충분성화심혈관사건적개선작용. 방법 본연구위전첨자신전후대조연구,선택아원병정은정적노년유지성복막투석환자32례,운용설계、실시、검험화응용(PDCA)사보법,침대복막투석각항지표화공작배절진행개진,분석비교CQI전후투석충분성、영양、염증화심혈관사건등각항지표적변화. 결과 CQI전후비교,매주총뇨소청제지수(Kt/V)체표솔증가(71.8％비93.8％,P＜0.05),Kt/V수평승고(1.97±0.36비2.08±0.33,P＜0.05)；혈청학지표백단백(ALB)、전백단백(PAB)、혈청이양화탄결합력농도명현승고(P＜0.05)；백단백체표솔증가(9.4％비31.3％,P＜0.05)；영양평고직접체측량지표(상비위、굉삼두기피습후도、상비기위),이급수체질량、수체질량백분비、표준화적총담출현솔상당단백、좌우수악력명현개선(P＜0.05)；미염증지표초민-C반응단백(hs-CRP)하강,분별위(8.65±6.22) mg/L비(5.37±4.33) mg/L(P＜0.01)；초민C반응단백양성솔감저(53.1％비25.0％,P＜0.05)；복막염발생솔강저(1차/25.4환자월비1차/78.1환자월,P＜0.05)；인심혈관사건주원솔하강(25.0％비3.1％,P＜0.05). 결론 CQI조시능구개선노년복막투석환자적영양、염증화투석충분성,종이강저심혈관사건주원솔.
Objective To investigate the preventive effect of continuous quality improvement(CQI) on malnutrition,inflammation,peritoneal dialysis adequacy and cardiovascular events in elderly patients undergoing peritoneal dialysis.Methods A single-center prospective self-controlled study was performed.32 stable elderly patients to undergo continuous ambulatory peritoneal dialysis (CAPD) were included.The continuous quality improvement program was conducted by using the 4-step problem-solving framework called the PDCA cycle (plan,do,check and act).The dialysis adequacy,nutritional status,inflammation and cardiovascular events were analyzed before and after PDCA.Results Compared with before PDCA,the proportion of patients with Kt/V≥1.7 and urea kinetics (Kt/V) level were increased after PDCA [71.8％ vs.93.75％,(1.97±0.36) vs.(2.08±0.33),both P＜ 0.05].Serum levels of albumin (ALB),prealbumin (PAB) and serum carbon dioxide combining power (CO2 CP) were increased after PDCA (all P＜0.05).The proportion of patients with ALB≥40 g/L was increased after PDCA as compared with before PDCA (9.4％ vs.31.3％,P＜0.05).The nutritional variables including mid-arm circumference (MAC),triceps skinfold thickness (TSF),mid arm muscle circumference (MAMC),and lean body mass (LBM),lean body mass percentage (LBM％),normalized protein equivalent of total nitrogen appearance (nPNA),handgrip strength were improved after PDCA (P＜ 0.05).High sensitivity C-reactive protein (hs-CRP) level and the proportion of patients with hs-CRP＞3 mg/L were decreased after PDCA as compared with before PDCA [(8.65±6.22) mg/L vs.(5.37±4.33) mg/L,53.1％ vs.25％,both P＜0.05].The incidence of peritoneal dialysis related peritonitis was reduced obviously from 1 case every 25.4 months to 1 case every 78.1 months after PDCA (P ＜ 0.05).The hospitalization rate due to cardiovascular events was decreased after PDCA as compared with before PDCA (25％ vs.3.13％,P＜0.05).Conclusions CQI may significantly improve the malnutrition,inflammation and dialysis adequacy,and reduce the hospitalization rate due to cardiovascular events in elderly patients undergoing peritoneal dialysis.