• 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
    中文关键词:  慢性肾脏病  管理  临床意义
    英文关键词:
    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.