奥马哈系统个案管理对腹膜透析患者透析相关性腹膜炎的影响

摘要

目的 探讨基于奥马哈系统的个案管理模式对居家腹膜透析患者透析相关性腹膜炎的影响. 方法 采用随机数字表法选取广西医科大学第一附属医院肾内科腹膜透析中心符合纳入标准的210例居家腹膜透析患者作为研究对象,最终对照组和干预组各有103例患者完成研究,对照组患者接受常规护理,干预组患者在此基础上接受奥马哈系统个案管理干预,比较干预前及干预1年后两组患者《预防PD相关性腹膜炎质量核查表》各维度得分、透析相关性腹膜炎的发生率以及腹膜炎发生原因. 结果 干预前患者一般资料、《质量核查表》各维度得分差异无统计学意义[个人卫生(t=-0.213,P=0.832),操作环境(t=0.278,P=0.781),用品质量(t=0.543,P=0.588),操作过程(t=0.113,P=0.910),外出口和隧道情况(t=0.223,P=0.824),导管保护(t=0.155,P=0.877),操作者情况(t=0.102,P=0.919),合并感染(t=-0.213,P=0.832),营养状况(t=-0.486,P=0.627),发现问题及时性(t=0.060,P=0.952),复查频率和再培训(t=0.221,P=0.825)],干预后干预组患者腹膜炎质量核查表各维度得分增加[个人卫生(t=6.817,P＜0.001),操作环境(t=4.293,P＜0.001),用品质量(t=5.797,P＜0.001),操作过程(t=7.046,P＜0.001),外出口和隧道情况(t=4.791,P＜0.001),导管保护(t=3.566,P＜0.001),操作者情况(t=16.356,P＜0.001),合并感染(t=3.238,P=0.001),营养状况(t=6.727,P＜0.001),发现问题及时性(t=2.680,P=0.008),复查频率和再培训(t=6.628,P＜0.001)]、腹膜炎发生率降低(x2=30.171,P＜0.001),与对照组比较差异有统计学意义. 结论 基于奥马哈系统的个案管理模式能够增强腹膜透析患者无菌意识、规范换液操作流程,显著降低其透析相关性腹膜炎的发生率.%Objective To explore the effects of case management based on Omaha system model on peritoneal dialysis (PD)-related peritonitis in PD patients.Methods We used the random number table method to enrolled 210 PD patients who met the inclusion criteria and were treated in Nephrology Department of the First Affiliated Hospital,Guangxi Medical University.A total of 103 patients in intervention group and control group finally completed the study.Patients in control group received routine nursing care,and those in intervention group accepted the case management based on Omaha system in addition to routine nursing care.Their "Quality check dimension of PD-related peritonitis prevention" scores,incidence and cause of PD-related peritonitis were compared between the two groups before the intervention and after the intervention for one year.Results There was no statistical differences in baseline information and "Quality check dimension of PD-related peritonitis prevention" scores,which included personal hygiene (t=-0.213,P=0.832),operating environment (t=-0.278,P=0.781),quality of products (t=0.543,P=0.588),operation process (t=0.113,P=0.910),orifice and tunnel conditions (t=0.223,P=0.824),ductal preservation (t=0.155,P=0.877),operator condition (t=-0.102,P=0.919),concurrent infection (t=-0.213,P=0.832),nutritional status (t=-0.486,P=0.627),problemfinding promptness (t=0.060,P=0.952),and review frequency and re-training (t=0.221,P=0.825).In intervention group after the intervention for one yeaar,the "Quality check dimension of PD-related peritonitis prevention" scores increased significantly in all dimensions,including personal hygiene (t=6.817,P＜0.001),operating environment (t=4.293,P＜0.001),quality of products (t=5.797,P＜0.001),operation process (t=7.046,P＜0.001),orifice and tunnel conditions (t=4.791,P＜0.001),ductal preservation (t=3.566,P＜0.001),operator condition (t=16.356,P＜0.001),concurrent infection (t=3.238,P=0.001),nutritional status (t=6.727,P＜0.001),problem-finding promptness (t=2.680,P=0.008),review frequency and re-training (t=6.628,P＜0.001)],and decrease of PD-related peritonitis (x2=30.171,P＜0.001) as compared with those in control group.Conclusion The case management based on Omaha system model can enhance the aseptic consciousness of PD patients,standardize liquid exchange operation,and reduce the incidence of PD-related peritonitis.