品管圈在改善腹膜透析患者矿物质和骨代谢异常中的应用研究

Application of Quality Control Circle in Improving Mineral and Bone Disorder in Peritoneal Dialysis Patients

摘要: 目的：探讨品管圈(Quality Control Circle, QCC)在改善腹膜透析患者矿物质和骨代谢紊乱(mineral and bone disorder, MBD)中的作用。方法：将89例出院后需要进行腹膜透析的患者按随机抽样法分为QCC组(45例)和对照组(44例)。两组均实施常规的随访管理，QCC组在此基础上按照制定的QCC活动流程实施QCC活动，两组干预时间均为1年。比较两组血磷、血钙、全段甲状旁腺素(iPTH)、维生素D、碱性磷酸酶等指标。结果：QCC组与对照组相比，血磷[(1.64 ± 0.26) mmol/L比(1.83 ± 0.27) mmol/L, t = 3.549, P = 0.001]、iPTH [(289.55 ± 180.55) pg/ml比(416.51 ± 285.80) pg/ml, t = 2.499, P = 0.015]、ALP [(87.26 ± 59.79) U/L比(107.96 ± 72.26) U/L, t = 2.156, P = 0.031]较低，有统计学意义；QCC组与对照组相比，矫正后血钙[(2.30 ± 0.24)比(2.18 ± 0.30), t = 2.123, P = 0.036]、维生素D [(12.78 ± 5.16) IU比(9.74 ± 4.23) IU, t = 3.036, P = 0.003]较高；QCC组与对照组相比血清白蛋白、前白蛋白、MQSGA无统计学意义。Spearman相关性分析结果显示，血磷水平与受教育程度呈负相关(r = −0.29, P < 0.05)，血清白蛋白水平与受教育程度呈正相关(r = 0.20, P < 0.05)。结论：QCC管理模式能改善腹膜透析患者的矿物质和骨代谢异常。

Abstract: Objective: To explore the effect of Quality Control Circle (QCC) in improving mineral and bone dis-order (MBD) in patients with peritoneal dialysis. Methods: 89 patients who required peritoneal di-alysis after discharge were randomly divided into QCC group (45 cases) and control group (44 cases). The two groups underwent routine follow-up management. On the basis of this, the QCC group im-plemented QCC activities according to the established QCC activity process. The intervention time was 1 year. Serum phosphorus, Serum calcium, iPTH, vitamin D and other indicators were com-pared between the two groups. Results: Compared with the control group, the serum phosphorus of QCC group (1.64 ± 0.26 mmol/L vs (1.83 ± 0.27) mmol/L, t = 3.549, P = 0.001), iPTH [(289.55 ± 180.55) pg/ml vs (416.51 ± 285.80) pg/ml, t = 2.499, P = 0.015], ALP [(87.26 ± 59.79) U/L vs (107.96 ± 72.26) U/L, t = 2.156, P = 0.031] is low, which has statistical significance; Corrected serum calcium [(2.30 ± 0.24) vs. (2.18 ± 0.30), t = 2.123, P = 0.036], vitamin D [(12.78 ± 5.16) IU vs. (9.74) ± 4.23] IU, t = 3.036, P = 0.003] were higher in QCC group than in control group; serum albumin, prealbumin, and MQSGA had no statistical differences between the two groups. Spearman correla-tion analysis showed that serum phosphorus levels were negatively correlated with education (r = −0.29, P < 0.05), and serum albumin levels were positively correlated with education (r = 0.20, P < 0.05). Conclusion: The QCC management model can improve mineral and bone disorder in perito-neal dialysis patients.