“新农合”政策调整前后豫北腹透患者生存质量的比较
发布时间：2018-12-07 06:47
【摘要】：背景腹膜透析是终末期肾病的主要替代治疗方法之一,随着近30年技术改进,腹膜透析技术得到大力推广和应用,但长期生存率和生活质量仍然较低,影响因素涉及多个方面。对于农村欠发达地区的患者来说,经济因素所起的作用不容忽视。2012年河南省对包括慢性肾衰竭在内的六种疾病的新农合报销比例做出重大调整,腹透病人主要经济花费的透析液报销比例由原来的40%提高至80%,从而极大地减轻了腹透病人的日常经济费用。 目的调查豫北地区(新乡、鹤壁、安阳、濮阳、焦作5个地级市及济源1个县级市)腹膜透析患者的临床化验指标,了解影响其生存率的因素,探讨新型农村合作医疗政策调整后腹透患者透析质量的影响,以期能够对患者的临床医护与综合治疗提供参考,对政府部门政策制定提供依据。 方法观察河南省新型农村合作医疗政策调整前后新乡医学院第一附属医院(调整后报销比例增加)腹膜透析患者的临床资料,2012年4月新型农村合作医疗政策调整后在我院参保农村合作医疗制度,接受持续性不卧床腹膜透析治疗3个月以上的患者为观察组,以2011年4月前相同条件的病人向前推80例病人为对照组,观察组和对照组各80例,观察终点为2012年4月1日后第80个病人向后延长1年,记录其退出原因,患者的资料及化验指标。 结果1.政策调整后的腹膜透析患者透析剂量及透析充分性提高,差异有统计学意义(P0.05)；血红蛋白、血浆白蛋白、血浆白蛋白达标率、血红蛋白达标率、高血压控制达标率升高,差异有统计学意义；心血管事件发生率降低,差异有统计学意义(P0.05);血肌酐无统计学差异(P0.05))。2.经COX比例风险回归模型分析,死亡的危险因素是老龄(HR:1.09,95%CI:1.01-1.18),糖尿病(HR:1.21,95%CI:1.09-3.78),低蛋白血症(HR:5.28,95%CI:3.56-10.01),心血管疾病(HR：5.61,95%CI2.31-13.62),较低的医疗保险支持(RR:1.10,95%CI:1.02-1.34). 结论1.“新农合”政策调整使得患者自付比例明显下降后,豫北腹透患者贫血、营养状况好转,心血管事件发生率下降,透析生存质量明显改善。 2.老龄、糖尿病、营养不良、心血管疾病、透析不充分、较低的医疗保险支持是影响腹膜透析患者预后的重要因素。
[Abstract]:Background Peritoneal dialysis (PD) is one of the main alternative therapies for end-stage nephropathy. With the improvement of peritoneal dialysis technology in recent 30 years, peritoneal dialysis technology has been popularized and applied greatly, but the long-term survival rate and quality of life are still low, and the influencing factors are related to many aspects. For patients in less developed rural areas, the role of economic factors cannot be ignored. In 2012, Henan Province made a major adjustment to the proportion of new rural cooperative reimbursement for six diseases, including chronic renal failure. The proportion of the main economic expenses of the patients increased from 40% to 80%, which greatly reduced the daily economic expenses of the patients. Objective to investigate the clinical test indexes of peritoneal dialysis patients (Xinxiang, Hebi, Anyang, Puyang, Jiaozuo five prefectural cities and one county city in Jiyuan) in north Henan, and to understand the factors affecting survival rate. To explore the effect of the new rural cooperative medical policy adjustment on dialysis quality of patients with peritoneal dialysis, in order to provide reference for clinical care and comprehensive treatment of patients, and to provide the basis for the policy formulation of government departments. Methods to observe the clinical data of peritoneal dialysis patients in the first affiliated Hospital of Xinxiang Medical College before and after the adjustment of the new rural cooperative medical policy in Henan Province. In April 2012, the new rural cooperative medical policy was adjusted in our hospital to protect the rural cooperative medical system, and patients who received continuous ambulatory peritoneal dialysis treatment for more than 3 months as the observation group. 80 patients were pushed forward by the same conditions before April 2011 as the control group, 80 patients in the observation group and 80 patients in the control group respectively. The observation end point was the 80th patient extended backwards for one year after April 1, 2012, and the reasons for withdrawal were recorded. Patient data and laboratory data. Result 1. After the policy adjustment, the dialysis dose and dialysis adequacy of peritoneal dialysis patients were increased, the difference was statistically significant (P0.05). The levels of hemoglobin, plasma albumin, hemoglobin and hypertension were increased, and the difference was statistically significant. The incidence of cardiovascular events decreased, the difference was statistically significant (P0.05), and no significant difference was found in serum creatinine (P0.05). 2. 0%). According to COX proportional risk regression model, the risk factors of death were old age (HR:1.09,95%CI:1.01-1.18), diabetes mellitus (HR:1.21,95%CI:1.09-3.78), diabetes mellitus (HR:1.21,95%CI:1.09-3.78). Hypoproteinemia (HR:5.28,95%CI:3.56-10.01), cardiovascular disease (HR:5.61,95%CI2.31-13.62), and lower medical insurance support (RR:1.10,95%CI:1.02-1.34). Conclusion 1. After the adjustment of the policy of "New Rural Cooperation", the patients with anemia, nutritional status, cardiovascular events and the quality of life of dialysis were improved obviously. 2. Aging, diabetes, malnutrition, cardiovascular disease, inadequate dialysis, and low health insurance support are important factors affecting the prognosis of peritoneal dialysis patients.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5;R197.1
[Abstract]:Background Peritoneal dialysis (PD) is one of the main alternative therapies for end-stage nephropathy. With the improvement of peritoneal dialysis technology in recent 30 years, peritoneal dialysis technology has been popularized and applied greatly, but the long-term survival rate and quality of life are still low, and the influencing factors are related to many aspects. For patients in less developed rural areas, the role of economic factors cannot be ignored. In 2012, Henan Province made a major adjustment to the proportion of new rural cooperative reimbursement for six diseases, including chronic renal failure. The proportion of the main economic expenses of the patients increased from 40% to 80%, which greatly reduced the daily economic expenses of the patients. Objective to investigate the clinical test indexes of peritoneal dialysis patients (Xinxiang, Hebi, Anyang, Puyang, Jiaozuo five prefectural cities and one county city in Jiyuan) in north Henan, and to understand the factors affecting survival rate. To explore the effect of the new rural cooperative medical policy adjustment on dialysis quality of patients with peritoneal dialysis, in order to provide reference for clinical care and comprehensive treatment of patients, and to provide the basis for the policy formulation of government departments. Methods to observe the clinical data of peritoneal dialysis patients in the first affiliated Hospital of Xinxiang Medical College before and after the adjustment of the new rural cooperative medical policy in Henan Province. In April 2012, the new rural cooperative medical policy was adjusted in our hospital to protect the rural cooperative medical system, and patients who received continuous ambulatory peritoneal dialysis treatment for more than 3 months as the observation group. 80 patients were pushed forward by the same conditions before April 2011 as the control group, 80 patients in the observation group and 80 patients in the control group respectively. The observation end point was the 80th patient extended backwards for one year after April 1, 2012, and the reasons for withdrawal were recorded. Patient data and laboratory data. Result 1. After the policy adjustment, the dialysis dose and dialysis adequacy of peritoneal dialysis patients were increased, the difference was statistically significant (P0.05). The levels of hemoglobin, plasma albumin, hemoglobin and hypertension were increased, and the difference was statistically significant. The incidence of cardiovascular events decreased, the difference was statistically significant (P0.05), and no significant difference was found in serum creatinine (P0.05). 2. 0%). According to COX proportional risk regression model, the risk factors of death were old age (HR:1.09,95%CI:1.01-1.18), diabetes mellitus (HR:1.21,95%CI:1.09-3.78), diabetes mellitus (HR:1.21,95%CI:1.09-3.78). Hypoproteinemia (HR:5.28,95%CI:3.56-10.01), cardiovascular disease (HR:5.61,95%CI2.31-13.62), and lower medical insurance support (RR:1.10,95%CI:1.02-1.34). Conclusion 1. After the adjustment of the policy of "New Rural Cooperation", the patients with anemia, nutritional status, cardiovascular events and the quality of life of dialysis were improved obviously. 2. Aging, diabetes, malnutrition, cardiovascular disease, inadequate dialysis, and low health insurance support are important factors affecting the prognosis of peritoneal dialysis patients.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5;R197.1
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