【摘要】目的分析老年血液透析患者的医疗质量控制指标的控制情况，并对患者的预后进行判断。方法纳入航天中心医院2019 年60 岁以上老年维持性血液透析患者共64 例，分析总结1 年内4 个季度的医疗质量控制指标控制情况，并随访1 年，利用COX 比例风险模型判断死亡风险。结果2019 全年4 个季度均达标的MHD 患者情况为血红蛋白16 例(25.0% )、血清白蛋白30 例(46.9% )、血钙45 例(70.3%)、血磷20 例(31.3%)、甲状旁腺激素29 例(45.3%)、Kt/V 26 例(40.6%)。血红蛋白和甲状旁腺激素达标次数的增加可以降低死亡发生的风险，相对危险度分别为0.05(95%CI：0.00～0.74，P=0.029)和0.03(95%CI：0.00～0.69，P=0.028)，具有统计学差异。结论老年血液透析患者的达标率低，血红蛋白等质量控制指标达标次数较高的患者1 年内死亡发生的风险也相对较低。加强老年血液透析患者医疗质量的管理，关注其医疗质量控制指标的达标情况具有重要临床意义。
【Abstract】Objective To analyze the control status of medical quality indexes in elderly maintenance hemodialysis (MHD) patients and its effect on prognosis of the patients. Methods A total of 64 MHD patients over 60 years old treated in our hospital in 2019 were enrolled in this study. Medical quality indexes evaluated every 3 months in 2019 were analyzed. They were followed up for one year. Cox proportional hazard model was used to assess the risk of death. Results In the 64 MHD patients, the medical quality indexes that met the control standards in the 4 evaluations in 2019 were hemoglobin (16 cases, 25.0%), serum albumin (30 cases,
46.9%), serum calcium (45 cases, 70.3%), serum phosphorus (20 cases, 31.3%), parathyroid hormone (29 cases, 45.3%) and Kt/V (26 cases, 40.6%). The increase of control rates of hemoglobin and parathyroid hormone could reduce the risk of death with the risk ratio of 0.05 (95% CI 0.00～0.74, P=0.029) and 0.03 (95% CI 0.00～0.69, P=0.029), respectively. Conclusion The control rates of medical quality indexes were low in elderly MHD patients. Patients with a higher control rates of hemoglobin and other medical quality indexes had a relatively lower risk of death in one year. Strict control of medical quality indexes has a great clinical
significance in elderly MHD patients.
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