目的探讨如何运用腹膜透析患者分层次管理控制腹膜透析相关性腹膜炎的发生。方法运用分层分级管理方法(hierarchical management approach，HMA)，结合腹膜透析随访的工作特点及患者的家庭支持情况，在患者管理中对腹透患者进行分层及制定相应的干预措施。结果实现各层患者的有效管理，在随访患者总数迅速增长的过程中使整体随访患者的退出率下降(P =0.023),使用泊松分布分析某三级甲等医院腹膜透析中心2008～2012 年随访腹膜透析患者分层管理实施前后腹膜炎发生率(P＞0.05)，使用泼松分布分析腹膜透析相关性腹膜炎的发生率差异没有统计学意义，但有重要的临床意义。结论把HMA 应用于腹膜透析患者随访管理，提高各层次患者的自我管理能力，整体随访患者的退出率下降,有效控制腹膜透析中心腹膜炎的发生率，持续不断地提高随访质量。

Objective To explore the hierarchical management approach (HMA) using for prevention from peritonitis among out patients with periloneal dialysis． Methods According to hierarchical management criteria, the patient from different groups received different intervention respectively. The intervention was based on the primary nurse follow-up management model and the social support system of the patient. Results During 2009 to 2012, patients’number for each primary nurse increascd from 80 tO 90～110, whilet the rate of peritonitis did not increased and the rate of drop out declined in our PD center. Conclusion HMA could increase PD nurse's work efficiecy and ensure care quality at the same time．It would work as an effective method for controlling peritonitis for PD program.