杭州市腹膜透析和血液透析治疗费用与疗效的比较研究

为比较腹膜透析和血液透析的费用和效果,对浙江大学附属第一医院和杭州市中医院的腹膜透析和血液透析者进行问卷调查。结果显示：（1）腹透者花费的年透析费用和因透析发生的年总医疗费用低于血透者;（2）腹透者可以间隔较长的时间到医院就诊,对于患者的治疗比较方便;（3）腹膜透析对生命质量的改善优于或至少不低于血液透析;（4）腹透并发症住院率高于血透。故建议积极推广腹膜透析,同时提高腹膜透析服务质量,降低其并发症发生率。     

血液透析与腹膜透析的效果、费用及其补偿机制的回顾性分析

终末期肾病透析治疗方式包括血液透析(简称血透)和腹膜透析(简称腹透)两类,但血透技术在终末期肾病患者中的应用远高于腹透。本研究通过对国内外两种透析效果、费用及补偿机制进行回顾性分析,探讨其卫生经济学的深层次原因。     

透析的疾病经济负担研究

目的：测定我国血液透析和腹膜透析的疾病经济负担，为建立合理的透析治疗费用支付范围和标准提供决策依据。方法：根据血透和腹透患者的年直接医疗费用、直接非医疗费用和间接费用计算经济负担。结果：血透和腹透患者的年总费用分别是98204元和84141元，其中直接医疗费用分别是80988元和76205元，直接非医疗费用分别是6014元和3522元，间接费用分别是11132元和4414元；医保部分每年为每位血透患者和腹透患者分别负担总费用的65．8％和72．0％。血透患者和腹透患者的负债率分别是8．2％和3．6％。结论：透析对患者和医保部门来说经济负担都是沉重的，需要多方面积极采取措施，控制费用，提高疗效。     

重症肾衰急诊血液透析与腹膜透析的疗效观察

目的:通过观察分析重症肾衰患者在初次透析时,选择血透、腹透的疗效、利弊,为更好地选择透析方案提供指导。方法:对从1998年至2001年我科收住的25例重症肾衰患者急诊透析疗效,按年龄、疾病分层分析。结果:血透与腹透疗效相似。但血透心血管并发症明显高于腹透,腹透并发高血糖及营养不良高于血透组。结论:对有高血压III级、冠心病、房颤、室早者易早期进行腹膜透析;对有营养不良、高血糖未控制的患者易早进行血液透析。     

血液透析与腹膜透析的效果及其费用补偿模式分析

国外多数研究表明,腹膜透析(简称腹透)与血液透析(简称血透)人群在费用消耗、死亡风险等客观指标方面并无显著差异。同样,在均衡各类影响因素后,两者的主观评价指标(即生命质量)差异也不显著。但由于透析费用补偿模式的差异,造成了对服务提供方的利益驱动,并影响了透析技术的合理应用。本研究进一步比较两种透析方式的效果,剖析现行透析相关政策的影响,并以此为据,探讨透析费用补偿模式等相关政策的调整和完善。     

腹膜透析和血液透析技术利用公平性研究

目的:从技术的提供和使用两方面分析腹膜透析(腹透)和血液透析(血透)两种常见终末期肾病治疗技术在我国应用的公平性并探讨相关影响因素.方法:通过结合问卷调查和访谈等定性研究方法和数据收集整理等定量研究方法开展回顾性队列研究.结果:腹透和血透患者生存质量近似,但腹透患者治疗不充分现象较血透普遍,64.9％因经济原因减少治疗次数或透析量,同时腹透患者疾病经济负担较重,灾难性支出发生率为74.1％,大于血透患者(60.1％).结论:认知、资源、经济、管理和政策五方面因素严重影响腹透技术利用的公平性.     

新型农村合作医疗对透析服务管理现状研究

各地新农合筹资能力不同,支付水平和保障力度不同,造成参合透析患者灾难性支出发生比例较高,普遍存在新农合患者透析开展较晚、透析不充分和负债透析现象。出于支付能力和交通便利的考虑,新农合患者大多选择腹透,而生存质量调查显示,腹透患者生活质量优于血透患者。建议提高新农合透析患者保障水平,出台政策鼓励腹透的推广应用,使更多农村患者能够获得透析服务。     

尿毒症患者平均红细胞血红蛋白与铁含量的关系

目的探讨尿毒症患者平均红细胞血红蛋白与铁含量的关系。方法89例尿毒症患者按治疗方法分为三组(未透析组、腹透组及血透组),分别测定血红蛋白(Hb)、红细胞压积(Hct)、平均红细胞血红蛋白(MCH)、血清铁、总铁结合力、血清铁蛋白等,并计算转铁蛋白饱和度。结果血透组MCH较未透析组和腹透组均明显降低(P均<0.05);未透析组和腹透组间差异无统计学意义(P>0.05)。血透组血清铁及转铁蛋白饱和度较腹透组均明显降低(P<0.005或<0.05)。MCH<30pg的患者转铁蛋白饱和度较MCH≥30pg的患者明显减低(P<0.05);两者血清铁及铁蛋白水平差异均无统计学意义(P均>0.05)。尿毒症患者MCH与转铁蛋白饱和度呈正相关,r=0.559,P<0.001。结论尿毒症患者透析与否普遍存在贫血,腹透患者缺铁的程度较轻。MCH可替代转铁蛋白饱和度作为尿毒症患者铁状态的参考指标,血常规检查可以既简便又快速地初步了解尿毒症患者的铁状态。     

160例次老年慢性肾功能不全患者感染的临床特征及相关因素分析

目的探讨老年慢性肾功能不全患者感染的临床特征及相关因素。方法回顾63例老年慢性肾功能不全患者共160例次住院资料,分析其感染部位、营养状况等。结果非透析患者感染率低于透析患者(P<0.05);革兰阴性菌感染最常见;感染组营养指标低于非感染组(P<0.05);血透和腹透患者总体感染率无差异(P>0.05);血透患者肝炎病毒感染率高于腹透患者(P<0.05);腹透患者腹腔真菌感染率高于血透患者(P<0.05)。结论老年慢性肾功能不全患者感染率较高,营养不良、自费等均增加感染机会。     

慢性肾衰患者血浆LPO的观察

本文用改良硫代巴比妥酸—荧光微量法测定了58例慢性肾衰(CRF)患者和15例健康成人的血浆脂质过氧化物(LPO),和部分透析病人的血透进出液和腹透进出液LPO浓度。发现CRF患者血浆LPO浓度显著增高,血透和腹透后显著降低,血透和腹透出液的LPO浓度分别较血透和腹透进液显著增高,说明血浆LPO是一种可透性尿毒物质。肾移植术后第15天血浆LPO浓度无显著降低。     

The past and present of peritoneal dialysis

The author reviews briefly the history of peritoneal dialysis, and highlights the significance of the work of two Hungarian nephrologists, Stephen I. Vas and István Taraba . By now, peritoneal dialysis has been considered as equal renal replacement modality compared to haemodialysis. It is even more advantageous in the protection of the patients' residual renal function, morbidity-mortality indices, and quality of life peritoneal dialysis in the first two years. From economical point of view peritoneal dialysis is less expensive than hemodialysis, therefore in the future its greater role can be expected in the treatment of more and more renal patients. The recently achieved technical development, and also the more widespread use of the automated peritoneal dialysis machines contribute to quality improvement. The peritoneal dialysis therapy, by the patients' self-treatment, establishes a new kind of relationship between the patients and the medical personnel; there is a growing requirement for patient education, the patients' self-esteem and cooperation increase, which altogether provides better results in rehabilitation and higher quality of life. Our national peritoneal dialysis utilization falls behind the European achievements, but has been growing dynamically, and we can expect an increase of the number of renal patients on peritoneal dialysis.     

血液透析和腹膜透析患者生活质量调查

目的：了解血液透析和腹膜透析病人的生活质量及与生活质量有关的因素。方法：采用健康生活量表36项（SF-36）问卷调查31例腹膜透析病人和46例血液透析病人。结果：两组病人的一般资料和生活质量无显著差异。多元逐步回归分析发现,教育程度和治疗依从程度进入回归模型。结论：血液和腹膜透析这两种方式在体力、精神方面均无显著差异,受教育程度高和治疗依从性好可显著提高患者生活质量。     

Quality of life of patients in renal replacement therapy in Brazil: comparison of treatment modalities

Purpose

This study aimed to analyze and compare the quality of life of renal replacement therapy patients undergoing hemodialysis, peritoneal dialysis and those with renal transplantation in Brazil. In addition, we aimed to verify factors associated with patients?? quality of life and the relationship between quality of life and treatment modality, socioeconomic and demographic conditions as well as aspects related to the disease and health services.

Methods

A representative sample of the dialysis units and transplant centers was obtained. Structured questionnaires were used to interview 3,036 patients in one of three treatment modalities: hemodialysis, peritoneal dialysis and renal transplant. Information was collected about socioeconomic and demographic characteristics and quality of life measures.

Results

There were significant differences between renal transplants and both forms of dialysis for all dimensions of the SF-36. Hemodialysis patients showed better results in the dimensions of functional capacity, physical aspects and social aspects, compared to peritoneal dialysis patients. Renal transplant patients had the best mean score in the physical component of quality of life. There were no significant differences among treatment groups regarding the mental component of quality of life. The physical and mental components were associated with comorbidities and age; however, older patients had better mental quality of life but worse physical quality of life. Patients in a higher socioeconomic class and patients that were not hospitalized also reported better quality of life. Unmarried and male patients presented better physical quality of life. The dialysis units and transplant centers influenced the patients?? quality of life.

Conclusions

Renal transplant patients have the best quality of life of the three treatment modalities. It is necessary to increase access to renal transplants.     

血液透析与腹膜透析的卫生经济学研究概述

目的 比较血液透析与腹膜透析人群的费用、效果及其影响因素，分析其疾病经济负担，剖析现行医疗保险补偿模式对透析技术的影响，进而为临床合理应用透析技术及透析相关政策的调整和完善提供参考依据。方法 采用回顾性调查方法，对首次透析时间在1995-1998年间的上海市6所医院155例血液透析患者和223例腹膜透析患者的费用和效果进行比较。用多元回归法分析费用的影响因素，用COX回归方法分析死亡风险的影响因素，用Logistic回归法分析生命质量的影响因素。回顾性调查210例存活者的疾病负担。运用政策分析法分析补偿模式对透析技术应用的影响。结果 血液透析与腹膜透析人群的死亡风险、生命质量以及医疗费用并无显著差异，而统计描述差异是由于两类人群透析初始的健康状况不均衡造成的。透析人群疾病伤残程度很高，疾病经济负担沉重，负债透析的现象普遍。结论 医疗保险对腹膜透析与血液透析的费用补偿方式差异，造成血液透析技术的过度利用，进一步加重了各方费用的负担。因此，有必要从筹资、补偿模式、供方医疗行为规范等方面调整和完善透析相关政策。     

Systematic review of the effectiveness of home versus hospital or satellite unit hemodialysis for people with end-stage renal failure

BACKGROUND: Home hemodialysis offers potential advantages over hospital hemodialysis, including the opportunity for more frequent and/or longer dialysis sessions. Expanding home hemodialysis services may help cope with the increasing numbers of people requiring hemodialysis. METHODS: We sought comparative studies or systematic reviews of home versus hospital/satellite unit hemodialysis for people with end-stage renal failure (ESRF). Outcomes included quality of life and survival. We searched MEDLINE, EMBASE, HealthSTAR, CINAHL, PREMEDLINE, and BIOSIS. Two reviewers independently extracted data and assessed the quality of the studies included. RESULTS: Twenty-seven studies of variable quality were included. People on home hemodialysis generally experienced a better quality of life and lived longer than those on hospital hemodialysis. Their partners, however, found home hemodialysis more stressful. Four studies using a Cox proportional hazards model to compare home with hospital hemodialysis reported a lower mortality risk for home hemodialysis. Of two studies using a Cox model to compare home with satellite unit hemodialysis, one reported a similar mortality risk, whereas the other reported a lower mortality risk for home hemodialysis. CONCLUSIONS: Home hemodialysis was generally associated with better outcomes than hospital hemodialysis and (more modestly so) satellite unit hemodialysis, in terms of quality of life, survival, and other measures of effectiveness. People on home hemodialysis, however, are a highly selected group. Home hemodialysis also provides the opportunity for more frequent and/or longer dialysis sessions than would otherwise be possible. It is difficult to disentangle the true effects of home hemodialysis from such influencing factors.     

以家庭医生为核心的社区腹膜透析管理模式效果分析

目的探索社区腹膜透析管理模式,提高管理效率,提升治疗效果。方法选取嘉定区安亭社区的52例腹膜透析患者作为干预组,其余社区的74例患者作为对照组,对照组患者采用常规随访,干预组在常规随访的基础上实施以家庭医生为核心的社区腹膜透析管理模式,包括操作指导、健康教育等,干预2年后对管理后的效果进行评估。结果干预组患者自我管理行为、生活质量和血生化指标均比干预前明显改善(P0.01),且干预组患者在干预后各项指标较对照组有明显改善(P0.01);干预组患者腹膜炎、隧道口感染和导管移位的发生率较对照组明显减少(P0.01);干预组患者的透析充分率明显高于对照组,而死亡率和进入血液透析率明显低于对照组(P0.01)。结论开展以家庭医生为核心的社区腹膜透析管理,能够减缓疾病的发展,改善患者的预后,且患者的生存质量能够得到有效提高,具有推广价值。     

血液透析联合腹膜透析对尿毒症患者心功能及营养状态的影响

目的 探讨血液透析联合腹膜透析对尿毒症患者心功能及营养状态的影响.方法 98例尿毒症患者随机分为两组各49例,对照组采用腹膜透析治疗,观察组采用血液透析联合腹膜透析治疗,比较两组治疗前后的心功能、营养状态以及并发症.结果 治疗后,两组的LVEF、Hb含量、A1b含量均较治疗前显著升高,且观察组的各项指标均显著高于对照组...     

Quality of Life Assessed with the Medical Outcomes Study Short Form 36-Item Health Survey of Patients on Renal Replacement Therapy: A Systematic Review and Meta-Analysis

OBJECTIVES: The Medical Outcomes Study Short Form 36-Item Health Survey (SF-36) is the most widely used generic instrument to estimate quality of life of patients on renal replacement therapy. Purpose of this study was to summarize and compare the published literature on quality of life of hemodialysis (HD), peritoneal dialysis (PD), and renal transplant (RTx) patients. METHODS: We used random-effects regression analyses to compare the SF-36 scores across treatment groups and adjusted this comparison for age and prevalence of diabetes using random-effects meta-regression analyses. RESULTS: We found 52 articles that met the inclusion criteria, reporting quality of life of 36,582 patients. The unadjusted scores of all SF-36 health dimensions were not significantly different between HD and PD patients, but the scores of RTx patients were higher than those of dialysis patients, except for the dimensions Mental Health and Bodily Pain. Point differences between dialysis and RTx patients varied from 2 to 32. With adjustment for age and diabetes, the differences became smaller (point difference 2-22). The significance of the differences of both dialysis groups compared with RTx recipients disappeared for the dimensions Vitality and Social Functioning. The significance of the differences between HD and RTx patients disappeared on the dimensions Physical Functioning, Role Physical, and Bodily Pain. CONCLUSION: We conclude that dialysis patients have a lower quality of life than RTx patients, but this difference can partly be explained by differences in age and prevalence of diabetes.     

The work results in a recently created pediatric dialysis unit

Results of the first period of two working years in a dialysis unit, at a provincial pediatric hospital, are exposed. A total of 26 patients, 20 children and 6 adults, was submitted to hemodialysis and peritoneal dialysis. Within the first, male sex prevailed and age groups more often submitted to dialysis were those under one year old and school children aged 5-14 years. A total of 370 peritoneal dialysis and 264 hemodialysis was performed to children. In the case of peritoneal dialysis, 11.1% was performed by puncture catheter, for acute patients, and the remainder 88.9% by fixed Tenckhoff's catheter, for patients with chronic renal insufficiency. Diseases that more often require the use of dialytic methods were, in first place, acute renal insufficiency, followed by chronic renal insufficiency and, in second place, obstructive uropathies. At the end of the research, 56.0% of the patients assisted in the dialysis unit was cured, with renal transplantations presenting a good evolution or under periodical dialysis waiting for transplantation. Emphasis is made on the most frequent complications occurred during the performance of the fore-mentioned procedures.