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目的探讨基层医院对辖区内肾移植术后患者管理的现状、管理对策及意义。方法以攀枝花市肾移植术后患者79例作为研究对象。采用横断面问卷调查,调查项目包括基本信息、肾移植前透析情况、肾移植及配型情况、抗排斥治疗、血药浓度监测及其他等5个维度,56个条目。结果 78例患者的问卷调查有效,有效率98.7%,男43例,女35例,平均年龄(47.4±6.4)岁。94.9%的患者在省级以上的医院行肾移植手术,其中在四川大学华西医院手术者占70.5%。受调查者对配型情况知晓率为100%。肾移植抗排斥治疗2个月内,100%的患者选择肾移植医院治疗;移植术后3~5个月和6~24个月,分别有84.6%的患者和45.4%的患者选择肾移植医院进行随访;而肾移植术后25~59个月,仅17.4%的患者选择肾移植医院随访,82.6%的患者选择在其所在地地市级或其他医院随访。肾移植术后25~59个月和≥60个月分别有29.0%和21.6%的患者不监测血药浓度。再次住院的主要原因是感染和急性排斥反应。结论地市级基层医院应该至少培养一名有肾移植管理经验的专科医生,与区域内上级医院合作。实行医疗保险定点建档、一体化管理体制对肾移植术后患者的管理具有重要的现实意义。
Objective To explore the status quo, management strategies and significance of primary hospital management of patients after renal transplantation in the area. Methods 79 cases of renal transplantation patients in Panzhihua City as the research object. The cross-sectional questionnaire survey included 56 items in 5 dimensions including basic information, pre-renal dialysis, renal transplantation and matching, anti-rejection therapy, plasma concentration monitoring and others. Results The questionnaire survey of 78 patients was effective. The effective rate was 98.7%. There were 43 males and 35 females with an average age of 47.4 ± 6.4 years. 94.9% of the patients underwent renal transplantation in hospitals above the provincial level, among which 70.5% were surgery at West China Hospital of Sichuan University. The respondents know the matching situation is 100%. Renal transplant rejection within 2 months, 100% of patients selected renal transplantation hospital; 3 to 5 months after transplantation and 6 to 24 months, respectively, 84.6% of patients and 45.4% of patients selected renal transplant hospital At follow-up from 25 to 59 months after renal transplantation, only 17.4% of the patients underwent renal transplantation. 82.6% of the patients were followed up at their local hospitals or other hospitals. Blood levels were not monitored in 29.0% and 21.6% of patients 25 and 59 months after renal transplantation and ≥60 months respectively. The main reason for hospitalization again is infection and acute rejection. Conclusions The municipal-level primary-level hospitals should at least train a specialist who has experience in kidney transplantation and cooperate with the higher-level hospitals in the region. Implementation of medical insurance sentinel documentation, integrated management system for the management of patients after kidney transplantation has important practical significance.