【摘要】目的探讨持续质量改进模式在维持性血液透析(maintenance hemodialysis，MHD)患者透析中低血压(intra dialytic-hypotension,IDH)管理的应用效果。方法选择2018 年3～6 月发生反复低血压患者22 例，自身前后对照，基于持续质量改进模式进行3 个月护理干预。统计基线和3 个月的低血压总发生率及不同时段发生率、提前30min 下机发生率、血红蛋白(hemoglobin，Hb)、血清白蛋白(albumin，Alb)、尿素清除指数(Kt/V)，采用Zung 氏焦虑自评量表(self-rating anxiety scale,SAS)评估干预前后的焦虑水平。结果IDH 主要原因为脱水量/干体质量＞5%、透析前服用降压药、透析中进餐、糖尿病等，IDH 出现在透析中各时段，尤3h 时段最为显著。22 例患者干预前后IDH 发生率分别为15.73%(45/286)和6.14%(18/293)，差异有统计学意义(χ²=38.662,P =0.005),提前30min 下机发生率下降(χ²=10.741,P =0.027)，Alb 和Kt/V 均上升(t 值分别为-2.134、-2.092，P 值分别为0.038、0.041)，SAS评分下降(t =4.473,P =0.008)。结论IDH 防治流程降低了IDH 的发生率，改善患者的心理和生理状态。
【Abstract】Objective To evaluate the effect of FOCUS-PDCA model in the management of intradialytic hypotension (IDH) in maintenance hemodialysis (MHD) patients. Methods Twenty-two patients with recurrent hypotension during hemodialysis from March to June in 2018 were selected. They were compared themselves before and after the intervention of FOCUS-PDCA for 3 months. The incidences of IDH and dropping out of the hemodialysis session 30 minutes earlier, laboratory indicators and self- rating anxiety scale (SAS) score at baseline and after the intervention of FOCUS-PDCA for 3 months were counted. Results The
major causes of IDH were dehydration volume/dry weight＞5%, anti-hypertensive drugs before hemodialysis, meals during hemodialysis and diabetes mellitus. IDH occurred in every period especially after three hours during hemodialysis. The incidences of IDH in 22 patients before and after the intervention of FOCUS-PDCA were 15.73% (45/286) and 6.14% (18/293) respectively (χ2=38.662, P=0.005). After the intervention, the incidence of dropping out of the hemodialysis session 30 minutes earlier decreased (χ2=10.741, P=0.027), Alb and kt/V increased (t=-2.134, P=0.038, t=-2.092, P=0.041), and SAS score decreased (t=4.473, P=0.008). Conclusion The procedures of IDH prevention and control reduced the incidence of IDH and improved the psychological and physiological status in MHD patients.
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