腹膜透析患者门诊随访依从性及其对腹膜透析质量的影响

摘要

[目的]探讨腹膜透析患者门诊随访依从性状况和相关因素以及门诊随诊依从性对患者预后的影响。[方法]回顾性分析本院162例规律腹膜透析患者的门诊随访依从性，根据随访率将患者分为随访情况较好组和随访差组，分析随访差的原因，同时比较两组患者的一般情况及预后。[结果]162例患者中位随访率是84％，其中随访好组98例（60．49％），随访差组64例（39．51％）。随访差的原因主要包括家到医院距离远（占35．94％），经济条件不允许（占17．19％），还有部分患者嫌麻烦（占26．56％）和认为没有必要（18．75％），另外有18．75％的外地患者受到医保政策的限制，在当地进行随访。两组患者在年龄、合并糖尿病以及腹膜透析操作方式中并无统计学差异，但随访好组男性及仍从事工作患者的比例要高于随访差组，本地患者的比例也明显高于随访差组（ P ＝0．002）。随访差组患者的住院率要明显高于随访好组（ P ＜0．001），而退出率，无论是死亡还是转血液透析者也明显高于随访好组。两组腹膜炎发生率及退出患者腹膜透析时间相比较差异无显著性（ P ＞0．05）。[结论]腹膜透析部分患者，尤其是外地患者会因各种原因导致门诊随访依从性差，且与患者不良预后相关，应针对性采取有效干预措施提高门诊依从性，进而改善患者预后。%[Objective]To explore the follow-up compliance status ,the related factor and the influence on the prognosis of peritoneal dialysis(PD) outpatients .[Methods]The follow-up compliance in 162 regular PD outpatients in out hospital was analyzed retrospectively .According to the follow-up rate ,all patients were di-vided into good follow-up group and poor follow-up group .The reasons for poor follow-up were analyzed . Meanwhile ,general condition and prognosis of patients were compared between two groups .[Results]The median follow-up rate of 162 patients was 84% .The good follow-up group had 98 patients(60 .94% ) and the poor follow-up group had 64 patients(39 .51% ) .The main reasons for poor follow-up included long distance from home to hospital(35 .94% ) ,bad economic condition(17 .19% ) and some subjective factors such as fol-low-up trouble (26 .56% ) or unimportance(18 .75% ) .In addition ,18 .75% of ecdemic patients were followed up in local hospital due to the limitation of medical insurance policy .There was no significant difference in age , incidence of diabetes mellitus and the operation mode of PD between two groups .However ,the proportion of male and patients still with the work in good follow-up group was higher than in poor follow-up group ,and the proportion of local patients in good follow-up group was obviously higher than that in poor follow-up group( P=0 .002) .The hospitalization rate in poor follow-up group was obviously higher than that in good follow-up group( P<0 .001) ,and dropout rate of dead cases and hemodialysis patients in good follow-up group were al-so obviously higher than that in poor follow-up group .There was no significant difference in the incidence of peritonitis and PD time of dropout patients between two groups ( P >0 .05) .[Conclusion]Some PD patients , especially ecdemic patients ,have poor follow-up compliance due to various reasons .Poor compliance is associ-ated with poor prognosis .Effective measures should be taken to improve follow-up compliance in outpatients and further improve outcomes of PD patients .