【摘要】目的总结对口援建西藏自治区拉萨市人民医院血液透析室的经验，分析尿毒症患者的透析质量控制情况。方法选派北京医学专家对口支援，培养当地医学专业人才，建设血液透析室。参照血液净化标准化操作规程及相关指南，指定患者医疗质量控制的监测指标，对患者实施治疗及健康宣教。定期评估考核援建成效。建立患者临床资料数据库并进行统计分析。结果4年时间建成血液透析室，培养当地医学人才11人，可独立开展血液透析治疗。规律血液透析患者70人，医疗质量控制良好。3个月规律治疗后，患者营养良好的达标率由17.1%上升至31.4%(χ2=6.149, P=0.046)；血液透析组患者透析前血钙由1.78mmol/L 升至2.20mmol/L(t=- 6.004,P＜0.001)，血磷由2.76mmol/L 降至2.18mmol/L(t=6.149, P＜0.001)，PTH 由681.93pg/ml 降至461.85pg/ml(t=7.136, P＜0.001)，差异具有统计学意义。6 个月规律治疗后，血红蛋白(100～130g/L)达标率由21.7%提高到78.3%(χ2=37.254，P＜0.001)。结论对口援建方式对高原地区血液透析室建设、运行及医疗质量控制起到重要推动作用，效果显著，值得推广。
【Abstract】Objective To summarize the experience of hemodialysis unit construction in Lhasa People's Hospital of Tibet Autonomous Region supported by the medical experts from corresponding cities, and to analyze the quality control of hemodialysis for uremic patients. Methods Several medical experts from hospitals in Beijing were assigned to work in Tibet for professional assistance, medical staff training, and hemodialysis unit construction. They undertook the use of standardized operating procedures (SOP) and related guidelines for blood purification, the establishment of indices for medical service quality surveillance, treatment and health education for the patients, and the setup of patients’databases for statistical analysis of the clinical data. Their working efficacies were assessed regularly. Results In a period of four years, a hemodialysis unit was established and 11 medical professionals in Lhasa were retrained to enable them to perform hemodialysis independently.Atotal of 70 uremic patients were treated with regular hemodialysis under strict control of hemodialysis quality. After the hemodialysis for 3 months, the compliance rate of nutritional status increased from 17.1% to 31.4% (χ2=6.149, P=0.046), serum calcium increased from 1.78 mmol/L to 2.20mmol/L(t=-6.004, P＜0.001), serum phosphate decreased form 2.76mmol/L to 2.18mmol/L (t=6.149, P＜0.001), and PTH decreased from 681.93pg/mL to 461.85pg/mL (t=7.136, P＜0.001). After the hemodialysis for 6 months, the compliance rate of hemoglobin increased from 21.7% to 78.3% (χ2=37.254, P<0.001). Conclusion The assistance scheme from corresponding cities exerted considerable influences on the construction, operation and quality control of hemodialysis units in plateau areas, and is worthwhile to be promoted further.
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