【摘要】目的构建基于远程监控系统的自动化腹膜透析(automated peritoneal dialysis，APD)患者联合照护模式，分析其应用效果。方法采用前瞻性队列研究，选择2018 年6 月1 日到2019 年1 月31日在陆军军医大学第二附属医院肾内科腹膜透析中心置管的终末期肾病(end stage renel disease, ESRD)患者为研究对象，将持续非卧床腹膜透析(continuous ambulatoty peritoneal dialysis, CAPD)患者作为对照组，实施常规随访模式，将APD 患者作为观察组，实施基于远程监控系统的联合照护模式。比较2 组患者并发症、Kt/V 达标情况并运用自制一般问卷和睡眠量表(medical outcomes study sleepscale, MOS-SS)比较2 组患者社会回归和睡眠质量。结果随访至2020 年2 月，APD 组在社会回归方面全职率明显高于CAPD 组(χ2=71.180，P＜0.001)；APD 组和CAPD 组在腹膜炎、外出口感染、机械性并发症、退出、急诊入院次数、Kt/V 达标方面无差异(χ2值分别为0.162，0.154，0.643，0.167，0.548，0.651；P 值分
别为0.687, 0.215, 0.423, 0.683, 0.459, 0.420)；APD 组和CAPD 组在自我报告的总体睡眠质量(包括睡眠干扰、睡眠充足度、日间精神状态、打鼾、醒后气促、睡眠量,总体睡眠质量评分)方面均无差异 (χ2值分别为0.042, 2.311, 0.752, 0.429, 0.548, 0.173, 1.086；P 值分别为0.839, 0.131, 0.388, 0.513, 0.460, 0.678, 0.269)。结论基于远程监控系统的联合照护模式可以促进APD 患者社会回归、改善睡眠质量，达到与CAPD相当的并发症结局和透析效果，值得临床推广。
【Abstract】Objective To establish a joint care mode for automated peritoneal dialysis (APD) patients based on a remote monitoring system and to analyze its application effects. Methods This was a prospective cohort study which recruits the end stage renal disease (ESRD) patients treated in the Peritoneal Dialysis Center of the Department of Nephrology, the Second Affiliated Hospital of PLA Military Medical University from June 1, 2018 to January 31, 2019. The patients with continuous ambulatory peritoneal dialysis (CAPD) and treated with routine follow-up mode were used as the control group; the APD patients with the joint care mode based on a remote monitoring system were used as the observation group. Complications and compliance of Kt/V were compared between the two groups. Social re-participation and sleep quality were compared between the two groups using the self-made general questionnaire and the sleep quality scale, medical outcomes study sleep scale (MOS-SS). Results In the follow-up period until February 2020, the rate of fulltime social re-participation was 74.58% in the APD group, higher than 5.13% in the CAPD group (χ2=71.180, P=0.000). However, there were no statistical significances in peritonitis, exit infection, mechanical complications, withdrawal from the treatment, emergent hospitalization and compliance of Kt/V between the two groups (χ2= 0.162, 0.154, 0.643, 0.167, 0.548 and 0.651 respectively; P=0.687, 0.215, 0.423, 0.683, 0.459 and 0.983 respectively), neither in self-reported overall sleep quality including sleep disturbance, sleep adequacy, daytime mental state, snoring, breath shortness after wakening, sleep volume and overall sleep score (χ2=0.042, 2.311, 0.752, 0.429, 0.548, 0.173 and 1.086 respectively; P= 0.839, 0.131, 0.388, 0.513, 0.460, 0.678 and 0.269 respectively). Conclusion The joint care mode for APD patients based on the remote monitoring system can improve their social re-participation and sleep quality, achieve the complication occurrence and dialysis effect similar to those in CAPD patients, and is worthy of promotion in clinical practice.
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