目的：探索社区医生提高和防治早期CKD的效果和如何减轻疾病对健康的危害，降低医疗费用。方法：对长宁区的周家侨、华阳、新华三家社区卫生服务中心的医生随机抽取90名医生，然后到长宁区各社区进行慢性肾脏病相关知识推广和培训，1年后进行第2次问卷调查。结果：（1）推广知晓情况：推广后的平均分数（80.44±8.74）分明显高于推广前的（64.04±12.89）分，且推广后各分数段人数均明显多于推广前，差异均有统计学意义（P<0.01）。（2）对疑似肾损害患者的处置措施：推广前尿检者20名（22.22%），肾功能检查者21名（23.33%），建议专科就诊者25名（27.78%），其他24名（26.67%）。推广后尿检者45名（50.00%），肾功能检查者36名（40.00%），建议专科就诊者4名（4.44%），其他5名（5.56%），推广后社区医生给予尿检、肾功能检查、建议专科就诊、其他等处置措施的人数均明显多于推广前，差异均有统计学意义（P<0.01）。（3）评估肾功能指标的选择：推广前选择血肌酐者77名（85.56%），尿素者8名（8.89%），内生肌酐清除率者3名（3.33%），估计肾小球滤过率者2名（2.22%）。推广后选择血肌酐者60名（66.67%），尿素者1名（1.11%），内生肌酐清除率者10名（11.11%），估计肾小球滤过率者19名（21.11%），推广后社区医生选择血肌酐、尿素、内生肌酐清除情况、估计肾小球滤过问题等评估指标的人数均明显多于推广前，差异均有统计学意义（P<0.01）。结论：通过此次推广对社区医生的慢性肾脏病知识有所提高，提供了与社区医生互相交流学习的机会。%Objective:To explore the effect of preventing and controlling early of chronic kidney disease(CKD), how to decrease the harm of disease and reduce medical costs by community doctors.Method:90 doctors in Community Health Centre of Zhoujiaqiao,Huayang and Xinhua in Changning district were randomly selected.The knowledge of CKD was popularized and trained in community in changing district by them and the second questionnaire surveys were conducted after 1 year.Result:(1)Promote awareness:the average score after promotion was(80.44±8.74)score,it was significantly higher than(64.04±12.89)score before promotion,and the number of each grade score after promotion were significantly more than before promotion,the differences were statistically significant(P<0.01).(2)The disposal measures in patients with suspected renal damage:before promotion,20 patients(22.22%)with urine analysis,21 patients(23.33%)with renal function tests,25 patients(27.78%)with specialist diagnostic and 24(26.67%)other patients.After promotion,45 patients(50.00%)with urine analysis,36 patients(40.00%)with renal function tests, 4 patients(4.44%)with specialist diagnostic and 5(5.56%)other patients.After promotion,the number of patients with urine analysis,renal function tests,specialist diagnostic and other were significantly more than before promotion, the differences were statistically significant(P<0.01).(3)Estimation of renal function index:before promotion, 77 patients(85.56%)with serum creatinine,8 patients(8.89%)with urea,3 patients(3.33%)with endogenous creatinine clearance and 2 patients(2.22%)with estimation of glomerular filtration rate.After promotion,60 patients (66.67%)with serum creatinine,1 patient(1.11%)with urea,10 patients(11.11%)with endogenous creatinine clearance,19 patients(21.11%)with estimation of glomerular filtration rate.After promotion,the number of selection of serum creatinine,urea,endogenous creatinine clearance,estimation of glomerular filtration rate were significantly more than before promotion,the differences were statistically significant(P<0.01).Conclusion:The promotion can improve the knowledge of the chronic kidney disease in community doctors,provide mutual exchange of learning opportunities with community doctors.
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