CAJ | 학술논문

目的：探讨基层医院对辖区内肾移植术后患者管理的现状、管理对策及意义。方法以攀枝花市肾移植术后患者79例作为研究对象。采用横断面问卷调查，调查项目包括基本信息、肾移植前透析情况、肾移植及配型情况、抗排斥治疗、血药浓度监测及其他等5个维度，56个条目。结果78例患者的问卷调查有效，有效率98.7%，男43例，女35例，平均年龄（47.4±6.4）岁。94.9％的患者在省级以上的医院行肾移植手术，其中在四川大学华西医院手术者占70.5％。受调查者对配型情况知晓率为100%。肾移植抗排斥治疗2个月内，100%的患者选择肾移植医院治疗；移植术后3~5个月和6~24个月，分别有84.6％的患者和45.4％的患者选择肾移植医院进行随访；而肾移植术后25~59个月，仅17.4％的患者选择肾移植医院随访，82.6％的患者选择在其所在地地市级或其他医院随访。肾移植术后25~59个月和≥60个月分别有29.0%和21.6%的患者不监测血药浓度。再次住院的主要原因是感染和急性排斥反应。结论地市级基层医院应该至少培养一名有肾移植管理经验的专科医生，与区域内上级医院合作。实行医疗保险定点建档、一体化管理体制对肾移植术后患者的管理具有重要的现实意义。
목적：탐토기층의원대할구내신이식술후환자관리적현상、관리대책급의의。방법이반지화시신이식술후환자79례작위연구대상。채용횡단면문권조사，조사항목포괄기본신식、신이식전투석정황、신이식급배형정황、항배척치료、혈약농도감측급기타등5개유도，56개조목。결과78례환자적문권조사유효，유효솔98.7%，남43례，녀35례，평균년령（47.4±6.4）세。94.9％적환자재성급이상적의원행신이식수술，기중재사천대학화서의원수술자점70.5％。수조사자대배형정황지효솔위100%。신이식항배척치료2개월내，100%적환자선택신이식의원치료；이식술후3~5개월화6~24개월，분별유84.6％적환자화45.4％적환자선택신이식의원진행수방；이신이식술후25~59개월，부17.4％적환자선택신이식의원수방，82.6％적환자선택재기소재지지시급혹기타의원수방。신이식술후25~59개월화≥60개월분별유29.0%화21.6%적환자불감측혈약농도。재차주원적주요원인시감염화급성배척반응。결론지시급기층의원응해지소배양일명유신이식관리경험적전과의생，여구역내상급의원합작。실행의료보험정점건당、일체화관리체제대신이식술후환자적관리구유중요적현실의의。
Objective To investigate the management situation of patient after renal transplantation in primary hos-pital. Methods Seventy-nine patients after renal transplantation in Panzhihua were included for the study. The question-naires of total 56 items included kidney dialysis before transplantation, renal matching, treatment after transplanta-tion, monitoring of blood drug concentration and so on .The questionnaires were recorded by doctors and patients face to face. Results Seventy-eight questionaires (98.7%) from 35 male and 43 female patients were effective. The kidney trans-plantations were carried out in provincial tertiary hospital in Chengdu accounted for 94.9%, 70.5%in West-China Hospital of Sichuan university. All the patients were awareness of the kindy matching. All patients were follow-up in the original operation hospital in 2 months after transplantation, the proportion decreased to 84.6%during 3-5 months ,and 45.4%dur-ing 6-24 months.However,only 17.4% of all the patients were follow-up in the original operation hospital dur-ing 25-59 months after transplantation. The proportion of non-monitor of plasma drug concentration during 25-59 month,≥60month after transplantation was 29.0%, 21.6%. Acute infections and rejection were the main reasons of rehospitaliza-tion. Conclusion It is necessary that at least one doctor who is specialized in kidney transplant management should be cultivated in the local municipal hospital. It is necessary to cooperate with regional superior hospital. The integrative system of the medical management is very important to the renal-post-transplant patients .