RESUMO
Objective:To investigate the development and influencing factors of frailty in elderly patients on maintenance hemodialysis.Methods:A cross-sectional survey involved 146 elderly patients on maintenance hemodialysis at the blood purification department of the First Affiliated Hospital of Xi'an Jiaotong University.A self-designed demographic questionnaire was used to collect general information of patients, the Simple Physical Performance Scale(SPPB)was used to assess physical function, the 5-item SARC-F was used as a tool for rapid screening of sarcopenia, and the Hospital Anxiety and Depression Scale(HADS)was used for screening of anxiety and depression.The FRAIL scale was used for frailty assessment and participants were divided into a no frailty group, a pre-frailty group and a frailty group according to different frailty scores.Relevant influencing factors of frailty were analyzed.Results:Among 146 hemodialysis patients, 33(22.6%)were in the non-frailty group, 86(58.9%)in the pre-frailty group, and 27(18.5%)in the frailty group.Univariate analysis showed that there were statistically significant differences in sex( χ2=6.220, P=0.045), age( F=5.197, P=0.007), body type( χ2=31.927, P<0.001), SARC-F score( χ2=24.283, P<0.001)and SPPB score( χ2=26.773, P<0.001)between different groups.There were 3 patients(9.4%)at high risk for sarcopenia in the no frailty group, 13 patients(40.6%)at high risk for sarcopenia in the pre-frailty group, and 16 patients(50%)at high risk for sarcopenia in the frailty group, and differences in the occurrence of sarcopenia between the different subgroups of frailty were statistically significant( χ2=27.496, P<0.001). Multifactorial Logistic regression analysis showed that age, ( OR=1.04, 95% CI: 0.99-1.08, P=0.049), sex( OR=0.39, 95% CI: 0.17-0.87, P=0.021), body size( OR=0.07, 95% CI: 0.01-0.50, P=0.008), SARC-F( OR=0.14, 95% CI: 0.05-0.38, P<0.001)were independent influencing factors of frailty in elderly maintenance hemodialysis patients( P<0.05). Conclusions:The incidence of frailty is high in elderly patients on maintenance hemodialysis, and the development of frailty is affected by age, body mass index and sarcopenia.
RESUMO
Objective:To investigate the clinical effect on ultrasound-guided vascular access-interventional therapy of hemodialysis in day surgery mode.Methods:Hemodialysis patients with vascular access dysfunction who underwent ultrasound-guided interventional therapy in the First Affiliated Hospital of Xi'an Jiaotong University from September 1, 2018 to October 31, 2020 were retrospectively analyzed. Demographic and clinical data were collected by electronic medical record system and telephone follow-up. Kaplan-Meier method was used to analyze the patency rate of vascular access.Results:A total of 421 cases of ultrasound-guided vascular access intervention were performed in 269 patients. The technical success rates of stenosis, chronic occlusion and acute occlusion lesion were 98.8%, 90.6% and 86.4%, respectively, and 406 cases (96.4%) of 246 patients were clinically successful. The postoperative brachial artery blood flow was 821(627, 1 029) ml/min, which was significantly higher than 309(202, 453) ml/min before the operation ( Z=-13.547, P<0.001). No serious complications occurred during and after the operation. At 6, 12, 18 and 24 months after operation, the primary patency rate was 74%, 59%, 48% and 45%, respectively, the assisted primary patency rate was 94%, 91%, 88% and 82%, and the secondary patency rate was 96%, 93%, 91% and 86%. Compared with the conventional inpatient surgery mode, the total cost of the day surgery mode was significantly reduced [12 067(10 051, 13 198) yuan vs 14 986(12 411, 20 643) yuan, Z=-13.185, P<0.001], and the hospital stay was significantly shortened [5.1(3.5, 6.9) h vs 73.4(31.6, 146.6) h, Z=-13.348, P<0.001]. Conclusion:It is safe and effective to perform interventional therapy for vascular access malfunction under ultrasound in day surgery mode, which can save cost and time of hospitalization, and can be carried out in hospitals with relevant conditions.
RESUMO
Objective:To construct an integrated medical care service mode in hemodialysis and explore the application effect of the concept of integrated medical service in hemodialysis patients.Methods:In 2016,100 patients who had regular hemodialysis(lasting for more than 3 months) were selected from July to Septembe ras the control group,while another100 patients who had the regular hemo dialysis (lasting for more than 3 months) and received the concept of integrated medical care service were selected from October to December as the observation group.The treatment compliance,the incidence of hemodialysis complications,and patient satisfaction of twogroups were compared.Results:Both the treatment compliance and patient satisfaction of the participants in the observation group were significantly higher than those in the control group (P ＜ 0.05),while the incidence of hemodialysis complications in the observation group was significantly lower than that in the control group (P ＜ 0.05).Conclusion:The implementation of integrated medical careservice concept can fully deepen the service concept of people-oriented and patient-centered,carry out humanized services,improve the treatment compliance of hemodialysis patients,reduce the complications,promote the cooperation of doctors and nurses,enhance the effect of health education,and improve the patient satisfaction.