目的 探索慢性肾脏病维持性血液透析患者的有效管理模式.方法 采取自身前后对照研究,筛选血磷≥1.78 mmol/L的规律透析患者入组,组建医护患质量改善团队,采取责任护士分组管理,运用五"E"模式通过鼓励、教育、运动、工作、评价5项措施干预18个月,并评价患者自我管理能力和血磷水平改善情况.结果 五"E"模式干预18个月后,患者自我管理各维度及总分较干预前明显提高,血磷平均值由(2.15±0.32)mmol/L下降至(1.78±0.42)mmol/L(t=6.249,P<0.01),血磷<1.78 mmol/L的比例提升60.32％;NT-proBNP平均值下降幅度43.24％.结论 运用五"E"模式对透析患者进行全程管理,形成以护士为主导的医护患多团队协作一体化闭环管理架构,可以提高患者自我管理能力,有利于患者的预后及提高生活质量.

目的 探索适合血液透析患者的系统饮食教育,改善透析患者的钙磷水平,提高患者的营养状况.方法 组建健康饮食教育团队,筛选40例高磷血症维持性血液透析患者,采取责任护士分组管理,通过集体教育、个体化教育的系统饮食教育,干预3个月后,采取自身前后对照研究的方法评估患者营养状况及钙磷代谢变化.结果 3个月后,患者血磷由(2.12±0.31) mmol/L下降到(1.68 ±0.49) mmol/L(P＜0.01),全段甲状旁腺激素由(824.52±588.07) ng/ml下降到(567.61±526.59) ng/ml(P＜0.05).结论 通过集体教育、个体化教育的系统饮食教育,可以提高患者健康饮食知识水平和依从性,改善饮食习惯,减少磷的摄入,血磷水平下降,改善患者的钙磷代谢.

Objective To investigate the effect of shortening the hemodialysis patients′waiting time for treatment on improving the medical condition. Methods A total of 294 hemodialysis patients in our dialysis center were randomly enrolled in the study from January to June, 2013. The patients, enrolled from January to March, received traditional method ( n=150 ) , and the patients, enrolled from April to June received quality control circle method (n=144), using of the method of slip the peak waiting time for treatment. The application of quality control circle was applied in patients′ waiting, pre-diagnosis, on-line and other medical aspect of continuous quality. The time and satisfaction were compared. Results Three months after the intervention, the waiting time of patients shortened 11 minutes compared with before. The satisfaction of patients improved from 80. 00% to 94. 40% in the pre-diagnosis in order, and the difference was statistically significant (χ2 =13. 792, P<0. 05). Conclusions The implementation of slip the peak waiting time for treatment shortened patients′waiting time and make the pre-diagnosis in order. It can not only reduces the incidence of cross infection, but enhance the concept of nursing care-fair and reasonable. Patients satisfaction on nursing work is also significantly improved, so it effectively avoid the accidental events.