基层医院慢性肾脏病钙磷代谢及骨病的诊疗情况调查

目的 通过调查德州市基层医院慢性肾脏病患者钙磷代谢、甲状旁腺功能亢进、肾性骨病诊疗的达标情况,观察肾内科医师掌握《临床诊疗指南肾脏病分册》的情况,为提高基层医院的诊疗水平提供理论依据.方法 观察50例首次住院的3～5期CKD患者的血钙、血磷、iPTH、腹部平片的检查率,观察120人次维持性血液透析患者的血钙、磷、钙磷乘积、CO2-CP的治疗达标率、钙磷摄入情况,采用自行设计的调查表,对30名肾内科医师进行问卷调查,观察肾内科医师对《临床诊疗指南肾脏病分册》矿物质和骨代谢异常及相关知识的掌握程度.结果 50例首次入院的3～5期CKD患者iPTH检查率8％,治疗率8％,远远低于国内外综合医院100％的检查率.120例维持性血液透析患者血钙的达标率44.2％,和国内外报道无明显差异,血磷的达标率为32.5％,钙磷乘积的达标率47.5％,明显低于国内外的相关报道,CO2-CP的达标率19.2％,患者钙磷摄入的知晓率、达标率非常低,肾内科医师掌握钙、磷、甲状旁腺功能亢进、肾性骨病知识平均分较低.结论 要提高基层医院该领域的诊疗水平需要加强肾内及透析科的专科队伍建设,提高专科医师的整体诊疗水平是关键;制定个体化治疗方案对提高整体水平是非常必要的;引进相关辅助检查设备是重要保障;建立持续性改进的质量控制管理体系是必由之路.

Status survey of abnormal metabolism and osteopathy in patients with chronic renal failure in primary hospital

Objective By observing the situation of calcium phosphorus metabolism,hyperparathy- roidism,renal bone disease of patients with chronic kidney disease（CKD） and the renal physicians＇ mastering degree of the clinical guidelines kidney volume, we provide theoretical basis of primary hospital in this field. Methods We observed the inspect rate of blood calcium, phos- phorus, iPTH, abdominal plain film of 50 CKD patients for the first time in the hospital. Mean-while we observed the blood calcium, phosphorus and the calcium-phosphorus product, CO2-CP and calcium and phosphorus＇ intake of 120 maintenance hemodialysis patients. 30 cases of renal physicians were questioned by the self-designed questionnaire to observe the mastering degree of related knowledge of the clinical guidelines for kidney disease mineral and bone metabolism. Re- suits The iPTH inspection and therapy rate of 50 cases（CKD 3 to 5） was far lower than that of the superior hospitals. The success rate of blood phosphorus and calcium-phosphorus product of 120 patients maintenancing hemodialysis was lower than those of the domestic and foreign related reports. Conclusion Improving the diagnosis and treatment level of specialists is the key. Intro- ducing related auxiliary examination equipment is the important guarantee. Individualized treatment and the quality control of continuous improvement management system are necessary.