基于互联网的管理系统对有透析中低血压和肌肉痉挛风险的血液透析患者的益处：一项前后对照研究。

Benefit of an Internet-Based Management System among Hemodialysis Patients at the Risk of Intradialytic Hypotension and Muscle Cramps: A Controlled before and after Study.

作者信息

Xu Jinsheng, Jin Jingjing, Cheng Meijuan, Zhou Wei, Zhang Shenglei, Bai Yaling

机构信息

Department of Nephrology, Hebei Key Laboratory of Vascular Calcification in Kidney Disease, Hebei Clinical Research Center for Chronic Kidney Disease, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China.

出版信息

Blood Purif. 2022;51(5):464-471. doi: 10.1159/000518695. Epub 2021 Sep 15.

DOI:10.1159/000518695

PMID:34535587

Abstract

BACKGROUND

The purpose of this study was to observe the impact of an internet-based management system on the incidence of intradialytic hypotension (IDH) and muscle cramps in hemodialysis patients.

METHODS

The patients, who underwent maintenance hemodialysis in the center from January 2018 to June 2020, were recruited and divided into the pre-intervention group (before operation of the internet-based hemodialysis management system, from January 2018 to December 2018) and intervention group (after operation of the system, from June 2019 to June 2020). The clinical outcomes were compared between groups.

RESULTS

The compound endpoint of >1 IDH or muscle cramps happened in 182 patients (61.7%) in the pre-intervention group and 99 participants (30.8%) in the intervention group (relative risk [RR] = 0.50 [95% confidence interval [CI], 0.42; 0.60]). IDH occurred in 122 patients (1-5 episodes in 47 patients, 6-10 episodes in 25 patients, and >10 episodes in 50 patients) and 33 patients (30 patients had 1-5 episodes and 3 patients had 6-10 episodes) before and after execution of the internet-based management system, respectively (RR = 0.25 [95% CI, 0.18; 0.35]). The incidence of muscle cramps was significantly decreased (RR = 0.57 [95% CI, 0.45; 0.73]) after the implementation of the system, and the number of patients with 6-10 episodes dropped from 10 to 1. Multivariate analyses also showed significantly lower RRs in the intervention group: 0.29 ([95% CI, 0.20; 0.41]) for IDH and 0.58 ([95% CI, 0.45; 0.74]) for muscle cramps. Compared with the pre-intervention, participants in the intervention group had a large improvement in self-management (p < 0.001) and self-efficacy (p < 0.001).

CONCLUSION

The study found that the internet-based hemodialysis management system was effective in reducing the IDH and muscle cramp events and improving self-management. It provided a significant implication for the development and application of internet-based programs in hemodialysis management.

摘要

背景

本研究旨在观察基于互联网的管理系统对血液透析患者透析中低血压（IDH）和肌肉痉挛发生率的影响。

方法

选取2018年1月至2020年6月在该中心接受维持性血液透析的患者，分为干预前组（2018年1月至2018年12月，基于互联网的血液透析管理系统运行前）和干预组（2019年6月至2020年6月，系统运行后）。比较两组的临床结局。

结果

干预前组182例患者（61.7%）出现1次以上IDH或肌肉痉挛这一复合终点事件，干预组99例参与者（30.8%）出现该复合终点事件（相对风险[RR]=0.50[95%置信区间[CI]，0.42；0.60]）。基于互联网的管理系统实施前后，分别有122例患者（47例发生1 - 5次、25例发生6 - 10次、50例发生10次以上）和33例患者（30例发生1 - 5次、3例发生6 - 10次）发生IDH（RR = 0.25[95%CI，0.18；0.35]）。系统实施后，肌肉痉挛发生率显著降低（RR = 0.57[95%CI，0.45；0.73]），发生6 - 10次肌肉痉挛的患者人数从10例降至1例。多因素分析还显示，干预组的RR显著更低：IDH为0.29（[95%CI，0.20；0.41]），肌肉痉挛为0.58（[95%CI，0.45；0.74]）。与干预前相比，干预组参与者在自我管理（p < 0.001）和自我效能（p < 0.001）方面有很大改善。