一站式全病程管理有利于慢性肾脏病的救治
One-stop full-course management is beneficial to the treatment of chronic kidney disease

位红兰.一站式全病程管理有利于慢性肾脏病的救治[J].内科急危重症杂志,2021,27(4):

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DOI：10.11768/nkjwzzzz20210416

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基金项目:武汉市卫生计生委项目（No：WG15A02；WX18Q31）

作者	单位	E-mail
位红兰	武汉市第四医院	Dongjunwu@126.com

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中文摘要:

目的：探索慢性肾脏病（CKD）缺乏早期预警、复诊率低、危重并发症救治成功率低的解决办法。方法:2012年1月1日-2013年12月31日为传统CKD管理期（简称A阶段）：武汉市第四医院肾内科CKD患者采取Excel表系统管理；2014年1月1日-2019年7月15日为一站式全病程CKD管理期（简称B阶段）：武汉市第四医院组建CKD管理团队并同质化培训、对危重的慢性肾衰竭（CRF）患者实行一站式多学科团队协作（MDT）管理。比较A阶段与B阶段患者复诊率、每千人年死亡率、危重患者成功救治率。结果：A阶段纳入CKD管理1669例，规律复诊937例（56.14%），失访577例（34.57%），肾脏替代治疗122例（7.31%），死亡33例\[17.61/(千人•年)\]；B阶段纳入CKD管理4027例，规律复诊2742例（68.09%),明显高于A阶段（ P<0.05），失访837例（20.78%），肾脏替代治疗230例（5.71%），死亡218例\[14.68/(千人•年)\]，明显低于A阶段（P<0.05）。A阶段与B阶段CRF合并消化道出血成功救治率分别为67.31%和82.35%（χ2=3.909，P=0.048）；合并急性冠脉综合征成功救治率分别为68.97%和87.29%（χ2=4.458，P=0.034）；合并脑卒中成功救治率分别为87.50%和97.35%（χ2=4.710，P=0.030）。结论：一站式全病程CKD管理是一种有效且值得推广的CKD管理模式。

英文摘要:

Objective: To explore the solution to the lack of early warning of chronic kidney disease (CKD), low rate of follow-up, and low success rate of critical complications. Methods: The CKD early warning system was established from January 1, 2012. During 2012. 1. 1 to 2013. 12. 31 (traditional CKD management period, referred to as stage A): The kidney physician used the Excel table or the first generation simple CKD management system to management. During 2014. 1.1 to 2019. 7. 15 (one-stop full-course CKD management period, referred to as stage B): On-line one-stop full-course CKD management system; formation of CKD management team and homogenization training; implementation of a one-stop Multi Disciplinary Team (MDT) management for critical chronic renal failure (CRF) patients. The follow-up rate of patients in stage A and stage B, the number of deaths per thousand people per year, and the successful treatment rate of critically ill patients were compared. Results: In stage A, 1669 people were enrolled in CKD management, containing 815 males (48.83%) and 854 females (51.17%). The average age was 62.4±16.9 years old. A total of 937 people (56.14%) were routinely reviewed, and 577 people (34.57%) were lost to follow-up. A total of 122 patients (7.31%) were treated with replacement therapy, and 33 patients died (17.61/1000 persons/year). A total of 4027 patients with CKD were included in stage B, containing 2535 (62.95%) males and 1492 (37.05%) females. The average age was 64.7±13.2 years old. A total of 2742 patients (68.09%, P<0.05) were regularly reviewed and 837 (20.78%) were lost to follow-up. A total of 230 (5.71%) were treated with renal replacement, and 218 (14.68/1000 persons/year, P<0.05) died. The successful treatment rate of stage A and stage B CRF patients with gastrointestinal hemorrhage was 67.31% and 82.35% respectively(χ2=3.909, P=0.048). The successful treatment rate of acute coronary syndrome was 68.97% and 87.29% respectively (χ2=4.458, P=0.034). The successful treatment rate for combined stroke was 87.50% and 97.35% respectively (χ2=4.710, P=0.030). Conclusion: One-stop full-course CKD management is an effective and worthwhile CKD management model.