三元联动管理模式对居家腹膜透析患者容量状态和容量管理行为的影响 [中文引用][英文引用]

目的  探讨三元联动管理模式（tripartite collaborative management model，TCMM）在居家腹膜透析（peritonealdialysis，PD）患者容量管理中的应用效果。方法  选择 2021 年 7 月— 2024 年 7 月在本院 PD 中心随访管理的 120 例居家 PD患者作为研究对象，将 2021 年 7 月— 2022 年 12 月入组的 60 例居家 PD 患者作为对照组，将 2023 年 1 月— 2024 年 7 月入组的 60 例居家 PD 患者作为研究组。对照组患者实施常规出院宣教和随访管理，研究组患者实施三元联动管理模式，包括医院技术输出与专业支持、社区常态随访与落地执行和家庭日常监督与行为落实。干预时间 12 个月。比较两组患者容量状态、容量管理行为、心功能分级、感染情况、心血管事件与再住院情况。结果  两组各 60 例患者均完成研究。重复测量方差分析显示，两组居家 PD 患者体质量、收缩压、舒张压、24 h 超滤量、容量管理行为评分的时间主效应、组间主效应、交互效应有统计学意义（均 P<0.05），其中干预后 6 个月、12 个月研究组体质量、收缩压、舒张压小于对照组，研究组 24 h 超滤量、容量管理行为评分高于对照组，差异具有统计学意义（均 P<0.05），干预后 6 个月、12 个月研究组患者心功能分级优于对照组（均 P<0.05）。干预后研究组的腹膜透析相关性腹膜炎发生率、导管出口处感染发生率、心血管事件总发生率、再住院率低于对照组，差异具有统计学意义（均 P<0.05）。结论  居家 PD 患者应用 TCMM 可改善患者容量状态、心功能分级、容量管理行为，进而减少感染、心血管事件与再住院事件，值得推广应用。

Objective To observe the application effect of the tripartite collaborative management model（TCMM）in volume management of the patients undergoing home-based peritoneal dialysis（PD）. Methods A total of 120 patients who had homebased peritoneal dialysis（PD）were selected in a follow-up and managed by the PD centre of our hospital from July 2021 to July 2024. The patients were grouped according to the time of enrolment. The 60 home-based PD patients enrolled from July 2021 to December 2022 were assigned to the control group（implemented with routine discharge education and follow-up management），and the 60 homebased PD patients enrolled from January 2023 to July 2024 were assigned to the study group（implemented with TCMM）including hospital technology output and professional support, regular follow-up and implementation in the community, as well as daily supervision and behavioral implementation at home. The intervention period is 12 months. The volume status，volume management behaviour， cardiac function，infection，cardiovascular events and rehospitalisation were compared between the groups. Results Sixty patients in the control group and the study group completed the study. Results of repeated measures ANOVA showed that there were statistically significant differences（all P<0.05）between the two groups in the main effect，group main effect，and interaction effect of body weight， systolic and diastolic blood pressures，24h ultrafiltration volume and scores of volume management behaviour of home-based PD patients. Among them，the body weight，systolic and diastolic blood pressures of the study group were lower than those of the control group at 6 and 12 months after the intervention，while the 24h ultrafiltration volume and scores of volume management behaviour of the study group were higher than those of the control group（all P<0.05）. The grade of cardiac function of the study group was better than that of the control group at 6 months and 12 months after the intervention（all P<0.05）. After the intervention，the incidence of peritoneal dialysis-associated peritonitis（PDAP），the incidence of catheter outlet infection，the total incidence of cardiovascular events，and the rehospitalisation rate in the study group were all lower than those in the control group，and the differences were statistically significant（all P<0.05）. Conclusion Application of TCMM in volume management for home-based PD patients has achieved improvement in volume status，cardiac function and volume management behaviours，and reductions in infections，cardiovascular events，and rehospitalisation.