【摘要】：背景腹膜透析是終末期腎病的主要替代治療方法之一,隨著近30年技術(shù)改進(jìn),腹膜透析技術(shù)得到大力推廣和應(yīng)用,但長期生存率和生活質(zhì)量仍然較低,影響因素涉及多個(gè)方面。對于農(nóng)村欠發(fā)達(dá)地區(qū)的患者來說,經(jīng)濟(jì)因素所起的作用不容忽視。2012年河南省對包括慢性腎衰竭在內(nèi)的六種疾病的新農(nóng)合報(bào)銷比例做出重大調(diào)整,腹透病人主要經(jīng)濟(jì)花費(fèi)的透析液報(bào)銷比例由原來的40%提高至80%,從而極大地減輕了腹透病人的日常經(jīng)濟(jì)費(fèi)用。 目的調(diào)查豫北地區(qū)(新鄉(xiāng)、鶴壁、安陽、濮陽、焦作5個(gè)地級市及濟(jì)源1個(gè)縣級市)腹膜透析患者的臨床化驗(yàn)指標(biāo),了解影響其生存率的因素,探討新型農(nóng)村合作醫(yī)療政策調(diào)整后腹透患者透析質(zhì)量的影響,以期能夠?qū)颊叩呐R床醫(yī)護(hù)與綜合治療提供參考,對政府部門政策制定提供依據(jù)。 方法觀察河南省新型農(nóng)村合作醫(yī)療政策調(diào)整前后新鄉(xiāng)醫(yī)學(xué)院第一附屬醫(yī)院(調(diào)整后報(bào)銷比例增加)腹膜透析患者的臨床資料,2012年4月新型農(nóng)村合作醫(yī)療政策調(diào)整后在我院參保農(nóng)村合作醫(yī)療制度,接受持續(xù)性不臥床腹膜透析治療3個(gè)月以上的患者為觀察組,以2011年4月前相同條件的病人向前推80例病人為對照組,觀察組和對照組各80例,觀察終點(diǎn)為2012年4月1日后第80個(gè)病人向后延長1年,記錄其退出原因,患者的資料及化驗(yàn)指標(biāo)。 結(jié)果1.政策調(diào)整后的腹膜透析患者透析劑量及透析充分性提高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)；血紅蛋白、血漿白蛋白、血漿白蛋白達(dá)標(biāo)率、血紅蛋白達(dá)標(biāo)率、高血壓控制達(dá)標(biāo)率升高,差異有統(tǒng)計(jì)學(xué)意義；心血管事件發(fā)生率降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05);血肌酐無統(tǒng)計(jì)學(xué)差異(P0.05))。2.經(jīng)COX比例風(fēng)險(xiǎn)回歸模型分析,死亡的危險(xiǎn)因素是老齡(HR:1.09,95%CI:1.01-1.18),糖尿病(HR:1.21,95%CI:1.09-3.78),低蛋白血癥(HR:5.28,95%CI:3.56-10.01),心血管疾病(HR：5.61,95%CI2.31-13.62),較低的醫(yī)療保險(xiǎn)支持(RR:1.10,95%CI:1.02-1.34). 結(jié)論1.“新農(nóng)合”政策調(diào)整使得患者自付比例明顯下降后,豫北腹透患者貧血、營養(yǎng)狀況好轉(zhuǎn),心血管事件發(fā)生率下降,透析生存質(zhì)量明顯改善。 2.老齡、糖尿病、營養(yǎng)不良、心血管疾病、透析不充分、較低的醫(yī)療保險(xiǎn)支持是影響腹膜透析患者預(yù)后的重要因素。
[Abstract]:Background Peritoneal dialysis (PD) is one of the main alternative therapies for end-stage nephropathy. With the improvement of peritoneal dialysis technology in recent 30 years, peritoneal dialysis technology has been popularized and applied greatly, but the long-term survival rate and quality of life are still low, and the influencing factors are related to many aspects. For patients in less developed rural areas, the role of economic factors cannot be ignored. In 2012, Henan Province made a major adjustment to the proportion of new rural cooperative reimbursement for six diseases, including chronic renal failure. The proportion of the main economic expenses of the patients increased from 40% to 80%, which greatly reduced the daily economic expenses of the patients. Objective to investigate the clinical test indexes of peritoneal dialysis patients (Xinxiang, Hebi, Anyang, Puyang, Jiaozuo five prefectural cities and one county city in Jiyuan) in north Henan, and to understand the factors affecting survival rate. To explore the effect of the new rural cooperative medical policy adjustment on dialysis quality of patients with peritoneal dialysis, in order to provide reference for clinical care and comprehensive treatment of patients, and to provide the basis for the policy formulation of government departments. Methods to observe the clinical data of peritoneal dialysis patients in the first affiliated Hospital of Xinxiang Medical College before and after the adjustment of the new rural cooperative medical policy in Henan Province. In April 2012, the new rural cooperative medical policy was adjusted in our hospital to protect the rural cooperative medical system, and patients who received continuous ambulatory peritoneal dialysis treatment for more than 3 months as the observation group. 80 patients were pushed forward by the same conditions before April 2011 as the control group, 80 patients in the observation group and 80 patients in the control group respectively. The observation end point was the 80th patient extended backwards for one year after April 1, 2012, and the reasons for withdrawal were recorded. Patient data and laboratory data. Result 1. After the policy adjustment, the dialysis dose and dialysis adequacy of peritoneal dialysis patients were increased, the difference was statistically significant (P0.05). The levels of hemoglobin, plasma albumin, hemoglobin and hypertension were increased, and the difference was statistically significant. The incidence of cardiovascular events decreased, the difference was statistically significant (P0.05), and no significant difference was found in serum creatinine (P0.05). 2. 0%). According to COX proportional risk regression model, the risk factors of death were old age (HR:1.09,95%CI:1.01-1.18), diabetes mellitus (HR:1.21,95%CI:1.09-3.78), diabetes mellitus (HR:1.21,95%CI:1.09-3.78). Hypoproteinemia (HR:5.28,95%CI:3.56-10.01), cardiovascular disease (HR:5.61,95%CI2.31-13.62), and lower medical insurance support (RR:1.10,95%CI:1.02-1.34). Conclusion 1. After the adjustment of the policy of "New Rural Cooperation", the patients with anemia, nutritional status, cardiovascular events and the quality of life of dialysis were improved obviously. 2. Aging, diabetes, malnutrition, cardiovascular disease, inadequate dialysis, and low health insurance support are important factors affecting the prognosis of peritoneal dialysis patients.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692.5;R197.1

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 汪濤,葉任高;腹膜透析應(yīng)作為腎臟病替代治療的首選方法[J];中國中西醫(yī)結(jié)合腎病雜志;2002年03期

2 王蘭,駱?biāo)仄?全蕾,魯新紅,汪濤;協(xié)議護(hù)理對腹膜透析病人容量負(fù)荷的影響[J];護(hù)理研究(上旬版);2005年13期

3 俞雨生,韓國鋒,沈克勤,樊榮,胡偉新,姚小丹,唐政,黎磊石;殘余腎功能對腹膜透析的影響[J];腎臟病與透析腎移植雜志;1996年04期

4 王學(xué)梅;唐雯;方積乾;汪濤;;新管理模式下腹膜透析病人的隨訪和生存情況分析[J];中國醫(yī)院管理;2008年11期

5 高秀林;腹膜透析患者的管理[J];中國血液凈化;2004年12期

6 張偉明;錢家麒;;上海市透析登記及其結(jié)果分析[J];中國血液凈化;2012年05期

7 汪濤,田信奎;腹膜透析患者的康復(fù)治療[J];中國康復(fù)醫(yī)學(xué)雜志;2003年08期

8 俞雨生,沈克勤,樊榮,胡偉新,姚小丹,唐政,季大璽,黎磊石;持續(xù)性非臥床腹膜透析患者如何合理選擇透析劑量[J];中華內(nèi)科雜志;1998年03期

9 吳s，

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