ObjectiveTo investigate whether continuous quality improvement (CQI) measures can reduce the episodes of peritonitis. MethodsWe analyzed the data of 114 cases of peritoneal dialysis related peritonitis from January to December 2011 before applying CQI measures and 72 cases from January and December 2012 after applying CQI measures in West China Hospital. Then we studied the episodes, cause and pathogenic bacteria species of peritonitis in peritoneal dialysis patients. We implemented the process of reducing the episodes of peritonitis by applying PDCA four-step design: plan-do-check-act. ResultsThe episodes of peritonitis were reduced from per 60.8 patient-months (0.197/patient-years) to per 66.6 patient-months (0.180/patient-years) after applying CQI measures. The positive rate of pathogenic bacteria culture was both 50.0% before and after applying CQI measures, in which 66.7% were gram-positive cocci. The curing rate of peritonitis was increased from 57 case/times (76.3%) to 87 case/times (79.2%). Switching to hemodialysis rate was reduced from 17 cases/times (14.9%) to 10 cases/times (13.9%). Death cases was reduced from 9 cases/times (7.9%) to 5 cases/times (6.9%). ConclusionThese results show that the incidence of peritoneal dialysis related peritonitis decreases and the curing rate increases through CQI measures.
【摘要】 目的 探讨生理钙透析液对持续性不卧床腹膜透析（CAPD）患者钙磷代谢的影响。 方法 回顾性分析2008年1月-2009年12月腹膜透析患者的钙磷指标，资料齐全的患者中使用钙浓度为1.25 mmol/L的腹膜透析液（生理钙组）的患者有30例，使用钙浓度为1.75 mmol/L的透析液（标准钙组）患者30例。对两组患者钙磷代谢指标进行比较。 结果 治疗前后两组的血磷、钙磷乘积和全段甲状旁腺素差异均无统计学意义（Pgt;0.05）；治疗后标准钙组血钙较前升高，差异有统计学意义（Plt;0.05），而生理钙组治疗前后血钙差异无统计学意义（Pgt;0.05）。 结论 不同含钙浓度腹膜透析液对机体钙磷代谢的影响是不同的，在高钙、高磷、低转运骨病的腹膜透析患者中使用钙浓度为1.25 mmol/L的生理钙透析液减轻了钙负荷，为临床医生使用含钙磷结合剂提供了治疗空间。【Abstract】 Objective To investigate the effects of physiological calcium dialysate on the calcium and phosphorus metabolism in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods We retrospectively analyzed the clinical data of 60 patients having undergone CAPD in West China Hospital of Sichuan University between January 2008 and December 2009. The patients were divided into two groups with 30 in each by calcium concentration of the dialysate: the physiological calcium dialysate group (1.25 mmol/L) and the standard calcium dialysate group (1.75 mmol/L). The metabolism indexes of calcium and phosphorus for the two group of patients were compared. Results Levels of Serum phosphate, calcium-phosphate product and immoreactive parathyroid hormone (iPTH) of all the patients in both groups before and after treatment showed no significant differences (Pgt;0.05). Serum calcium increased significantly in patients treated with standard calcium dialysate (Plt;0.05), while it did not change significantly in patients treated with physiological calcium dialysate (Pgt;0.05). Conclusions Dialysate with different concentrations of calcium provides different influence on the metabolism of calcium and phosphorus. Changing calcium concentration to 1.25 mmol/L in the dialysate can lower the calcium load for patients with hypercalcium and/or hyperphosphate with low bone turnover, providing treatment space for clinical doctors to use binders containing both calcium and phosphorus.
During the medical rescue after Wenchuan earthquake, based on the design and implementation of the management process of blood purification equipment, we gave the top priority to those patients with post-disaster crush syndrome to ensure their hemodialytic treatment. Through strict management of blood purification technology, the outcomes of these patients have been fundamentally improved and the incidence of complications was substantially reduced. Safe and effective hemodialytic treatment have been administered to 77 patients with crush syndrome (813 case-times).
ObjectivesTo explore the association between initial peritoneal transport characteristics and patient survival, and to evaluate the risk factors for mortality of continuous ambulatory peritoneal dialysis (CAPD) patients.MethodsBetween January 2011 and December 2016, the patients diagnosed with end stage renal disease commencing CAPD in West China Hospital were enrolled. According to the value of dialysate to plasma ratio for creatinine at 4 hour [D/P Cr (4 h)], CAPD patients were divided into two groups: the lower transport group [D/P Cr (4 h)<0.65] and the higher transport group [D/P Cr (4 h)≥0.65]. The survival of these two groups of peritoneal dialysis patients were plotted using survival analysis. CAPD patient outcomes were analyzed using multivariable Cox proportional hazards regression models.ResultsCompared with the lower transporter (n=246), higher transporter (n=345) were older, and with more peritoneal protein loss, lower level of serum albumin, lower level of hemoglobin, and less ultrafiltration (P<0.001). Higher transport group had lower survival rate compared to those in the lower transport group (P=0.001). The 1-, 3- and 5-year patient survival rates were 97.0%, 83.2%, and 71.7% in the higher transport group, and 98.7%, 93.9%, and 86.1% in the lower transport group, respectively. There was a positive relationship between D/P Cr (4 h) and serum peritoneal protein loss (P<0.001). D/P Cr (4 h) was inversely related to serum albumin (P<0.001). Cox regression analysis demonstrated that lower albumin [hazard ratio (HR)=0.921, 95% CI (0.885, 0.958), P<0.001], presence of cardiovascular disease [HR=1.996, 95% CI (1.256, 3.173), P=0.003], elder age [HR=1.049, 95% CI (1.033, 1.065), P<0.001], lower hemoglobin [HR=0.988, 95% CI (0.976, 1.000), P=0.044] and lower urea clearance index (KT/V)[HR=0.680, 95%CI (0.465, 0.994), P=0.046] could independently predicted mortality with significance in CAPD patients. But higher peritoneal transport was not a risk factor for mortality [HR=1.388, 95%CI (0.829, 2.322), P=0.212] in either model including serum albumin.ConclusionsFor CAPD patients, initial higher transporter had a higher mortality than lower transporter. However, initial higher peritoneal transport was not a risk factor for mortality independent of serum albumin in CAPD patients. Relationship between D/P Cr (4 h) and serum peritoneal protein loss and serum albumin suggests that higher peritoneal transport characteristics might worsen prognosis by lowering serum albumin level at initiation of peritoneal dialysis.
ObjectiveTo reduce the incidence of peritoneal dialysis (PD) catheter complications through a continuous quality improvement (CQI) process. MethodsTwenty-nine patients with catheters inserted (from January 2011 to March 2011) before CQI, and another 41 patients with catheters inserted (between April 2011 and January 2012) after CQI were observed and analyzed. The possible causes of complications of catheter were summarized, and then on the basis of that, a PDCA four-step (plan-do-check-act) method was designed with a view to reducing the incidence of postoperative complications. ResultsPD catheter dysfunction decreased from 6.90% to 2.44%. The incidence of leakage decreased from 44.83% to 9.76%. ConclusionCQI is a useful method to reduce the incidence of postoperative complications of PD catheter in peritoneal dialysis.
ObjectiveTo systematically review the efficacy and safety of different non-peros (NPO) times [( trial group: preoperative solid fast, 6 hours; fluid fast 2–3 hours) vs. (control group: preoperative solid fast, 12 hours; fluid fast 4–6 hours)] in elective general anesthesia patients in China.MethodsRandomized controlled trials (RCTs) and quasi-RCT of NPO time in elective general anesthesia patients were searched and retrieved through online databases (PubMed, Cumulative Index to Nursing and Allied Health, Embase, Cochrane Library, China Biology Medicine database, China National Knowledge Internet, VIP, WanFang, SUMsearch, and Google search engine) and related literatures were reviewed up to April 25th, 2018. Two investigators independently screened literatures, extracted data, and evaluated the risk of bias assessment tools for RCT using the Version 5.1.0 of Cochrane Handbook for Systematic Reviews of Interventions. Then, Meta-analysis was performed using RevMan 5.3 software.ResultsA total of 16 RCTs involving 2 722 elective general anesthesia patients (1 372 in the trial group and 1 350 in the control group) were included. The Meta-analysis showed that: the preoperative residual gastric volume [mean difference (MD)=–1.45 mL, 95% confidence interval (CI) (–2.88, –0.01) mL, P=0.05], the incidence of preoperative hypoglycemia [odds ratio (OR)=0.12, 95%CI (0.05, 0.28), P<0.000 01, the incidence of preoperative thirst [OR=0.15, 95%CI (0.11, 0.21), P<0.000 01], the incidence of preoperative hunger [OR=0.13, 95%CI (0.10, 0.18), P<0.000 01], the incidence of preoperative flustered tiredness [OR=0.11, 95%CI (0.07, 0.17), P<0.000 01], and the incidence of preoperative anxiety [OR=0.21, 95%CI (0.12, 0.37), P<0.000 1] in the trial group were significantly lower than those in the control group. There was no statistically significant difference in the intra-operative residual gastric volume between the two groups (P>0.05), and no intra-operative vomiting or aspiration took place in either group. The recovery time of exhaust and defecate of anus [MD=–8.71 hours, 95%CI (–11.43, –6.00) hours, P<0.000 01] in the trial group was significantly shorter than control group, and there was no statistically significant differences in the incidence of postoperative pneumonia, postoperative nausea, postoperative vomiting, or the postoperative thirsty and hungry between the two groups (P>0.05).ConclusionsCurrent evidence shows that, compared with the control group, the trial group could decrease the incidences of preoperative hypoglycemia, thirst, hunger, flustered tiredness and anxiety, and shorten the recovery time of exhaust and defecate of anus for postoperative patients, without increasing incidences of intraoperative or postoperative adverse reactions. Due to the limited quantity and quality of the included studies, the above conclusions still need to be verified by carrying out more large-scale samples and high-quality RCTs studies.
目的 比较两种不同方法护理腹膜透析患者导管出口处的效果。 方法 选取2008年7月－2009年12月51例患者作为试验组，直接采用聚维酮碘溶液擦洗导管出口处，2007年1月－2008年7月45例患者作为对照组，先用生理盐水清洗遂道口，再用聚维酮碘溶液擦洗导管出口处。比较两组导管出口处感染的情况及操作所需时间。 结果 试验组出口评分系统（ESS）＜2分15例，2～3分34例，≥4分7例；对照组＜2分10例，2～3分24例，≥4分16例；两组差异有统计学意义（P＜0.05）。试验组护士操作时间为（3.0 ± 1.0）min，患者操作时间为（5.0 ± 1.5）min；对照组护士操作时间为（8.0 ± 2.0）min，患者操作时间为（10.0 ± 2.0）min；两组差异有统计学意义（P＜0.05）。 结论 聚维酮碘溶液直接清洗、消毒导管出口处降低了感染的发生率，减少了操作环节和所需物品，缩短了操作时间。