执业护士改善慢性肾病护理质量：一项随机研究的两年结果
Nurse practitioners improve quality of care in chronic kidney disease: two-year results of a randomised study.
作者信息
van Zuilen A D, Blankestijn P J, van Buren M, ten Dam M A G J, Kaasjager K A H, Ligtenberg G, Sijpkens Y W J, Sluiter H E, van de Ven P J G, Vervoort G, Vleming L, Bots M L, Wetzels J F M
机构信息
Department of Nephrology, University Medical Center Utrecht, Utrecht, the Netherlands.
出版信息
Neth J Med. 2011 Nov-Dec;69(11):517-26.
BACKGROUND
Chronic kidney disease (CKD) is associated with increased cardiovascular risk. Here we evaluate whether strict implementation of guidelines aimed at multiple targets with the aid of nurse practitioners (NP) improves management in patients with CKD.
METHODS
MASTER PLAN is a randomised controlled clinical trial, performed in nine Dutch hospitals. Patients with CKD (estimated glomerular filtration rate (eGFR) 20-70 ml÷min) were randomised to receive NP support (intervention group (IG)) or physician care (control group (CG)). Patients were followed for a median of five years. Presented data are an interim analysis on risk factor control at two-year follow-up.
RESULTS
We included 788 patients (532 M, 256 F), (393 CG, 395 IG), mean (±SD ) age 59 (±13) years, eGFR 38 (±15) ml÷min÷1.73m(2), blood pressure (BP) 138 (±21)÷80 (±11) mmHg. At two years 698 patients (352 IG, 346 CG) could be analysed. IG as compared with CG had lower systolic (133 vs 135 mmHg; p= 0.04) and diastolic BP (77 vs 80 mmHg; p=0.007), LDL cholesterol (2.30 vs 2.45 mmol(-l); p= 0.03), and increased use of ACE inhibitors, statins, aspirin and vitamin D. The intervention had no effect on smoking cessation, body weight, physical activity or sodium excretion.
CONCLUSION
In both groups, risk factor management improved. However, changes in BP control, lipid management and medication use were more pronounced in IG than in CG. Lifestyle interventions were not effective. Coaching by NPs thus benefits everyday care of CKD patients. Whether these changes translate into improvement in clinical endpoints remains to be established.
背景
慢性肾脏病（CKD）与心血管风险增加相关。在此，我们评估在执业护士（NP）协助下严格实施针对多个目标的指南是否能改善CKD患者的管理。
方法
“总体规划”（MASTER PLAN）是一项在九家荷兰医院开展的随机对照临床试验。CKD患者（估计肾小球滤过率（eGFR）为20 - 70 ml÷min）被随机分配接受NP支持（干预组（IG））或医生护理（对照组（CG））。对患者进行了为期五年的中位随访。呈现的数据是两年随访时危险因素控制情况的中期分析。
结果
我们纳入了788例患者（男性532例，女性256例），（393例CG，395例IG），平均（±标准差）年龄59（±13）岁，eGFR为38（±15）ml÷min÷1.73m²，血压（BP）为138（±21）÷80（±11）mmHg。两年时，698例患者（352例IG，346例CG）可进行分析。与CG相比，IG的收缩压（133 vs 135 mmHg；p = 0.04）和舒张压（77 vs 80 mmHg；p = 0.007）更低，低密度脂蛋白胆固醇（2.30 vs 2.45 mmol⁻¹；p = 0.03），且ACE抑制剂、他汀类药物、阿司匹林和维生素D的使用增加。该干预对戒烟、体重、身体活动或钠排泄无影响。
结论
两组的危险因素管理均有改善。然而，IG在血压控制、血脂管理和药物使用方面的变化比CG更显著。生活方式干预无效。因此，NP指导有益于CKD患者的日常护理。这些变化是否能转化为临床终点的改善仍有待确定。
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