【摘要】目的探讨医护患一体化联合“策划-实施-检查-措施(plan-do-check-act,PDCA)”管理模式改善维持性血液透析患者低钙血症的临床效果，为建立血液透析患者有效的精细化管理模式提供参考依据。方法按照纳入排除标准，纳入2017 年12 月西安交通大学医学院第一附属医院血液净化科维持性血液透析≥3 月的患者，检测基线血钙浓度、血清25 羟维生素总D3浓度及治疗依从性、满意度指标，2018 年1 月开始实施医护患一体化联合PDCA 管理模式，干预期1 年，2018 年12 月再次检测上述指标。结果研究共纳入患者320 例。干预组血钙浓度[(2.11±0.24)比(2.02±0.26)mmol/L，t=- 4.731，P＜0.001]、低钙血症发生率(45.63%比53.75%,χ2=4.187,P=0.041)、血清25 羟维生素总D3浓度[(19.22±11.59)比(15.11±11.92)ng/ml，t=4.520，P＜0.001]较对照组明显改善,差异具有统计学意义；相较于对照组，干预组疾病状态知晓率(91.25%比69.69% ,χ2=47.333,P＜0.001)、药物治疗依从性(57.81%比39.69%, χ2=21.038, P＜0.001)、正确服药依从性(47.19%比39.38%, χ2=3.978, P=0.046)及按时复诊依从性(94.69%比85.63%,χ2=14.807,P＜0.001)均明显提高，差异具有统计学意义；干预组患者满意度较对照组(94.1% 比79.7%, χ2= 32.132,P＜0.001)明显提高，差异具有统计学意义。结论医护患一体化联合PDCA管理模式有效纠正维持性血液透析患者低钙血症，改善多个血液净化质量控制指标，提高患者的治疗依从性及患者满意度，可在临床推广实施。
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