持续质量改进对老年腹膜透析患者钙磷代谢紊乱的作用

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。

The Effect of Continuous Quality Improvement(CQI) on Disorders of Calcium and Phosphorus Metabolism Management in Continuous Ambulatory Peritoneal Dialysis(CAPD) Patients

Objective:To evaluate the effect of continuous quality improvement(CQI) on management of calcium and phosphorus 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 calcium and phosphorus metabolism disorders got down from 82.22% to 42.22% after CQI.In details,the level of serum calcium reduced 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±0.62)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.