微信平臺隨訪對改進腎病患者自體動靜脈內瘺維護的應用探討

□ 陳琰 CHEN Yan 金領微 JIN Ling-wei 鄭育 ZHENG Yu 葉菡洋 YE Han-yang 周志宏 ZHOU Zhi-hong

Objective To investigate the effect and influence of WeChat follow-up on maintenance of autologous arteriovenous fistula (AVF) in patients with end-stage renal disease. Methods From January 2017 to August 2017, 54 patients who underwent AVF surgery in the forearm in the Department of Nephrology of our hospital were all connected with WeChat. They were randomly divided into control group (n=27) and WeChat monitoring group (n=27).The control group was given regular AVF maintenance education. The WeChat monitoring group received extra communication through WeChat compared with the control group, and was regularly monitored for patient's AVF status and other indicators. The data of the two groups were collected after 3 months and compared for treatment compliance, incidence of complications, and AVF function. Results The WeChat monitoring group yielded better compliance with medication, AVF functional exercise, self-monitoring of AVF, regular health examination and higher patient satisfaction than the control group, and the difference between the two groups were all statistically significant (p＜0.05). The incidence of complications including hyperkalemia and blood pressure control problems in the WeChat monitoring group were significantly lower than those in the control group, and the difference was statistically significant(p＜0.05). The proportion of patients with mature AVF in the WeChat monitoring group was significantly higher than that in the control group. Some patients stepped into the stage of dialysis within 3 months, and the proportion of dialysis at emergency department in the control group was higher, and the difference between the two groups was statistically significant (p＜0.05). Conclusion WeChat monitoring has a positive effect on AVF maintenance in patients with end-stage renal disease and is worthy of clinical promotion.

血液透析是終末期腎病患者進行腎臟替代治療最主要的方式之一。KDOQI指南建議自體動靜脈內瘺(arteriovenous fistula，AVF)是終末期腎病患者的血管通路首選。有文獻報道，28%～53%的AVF不能充分成熟以滿足血液透析需要[1-2]，因此為終末期腎病患者建立良好的血管通路后，如何早期干預，確保AVF的成熟并保持功能良好的工作尤為重要。本研究通過收集在我院腎內科行AVF手術后的54例終末期腎病患者，通過分組比較，探討微信平臺隨訪應用于終末期腎病患者AVF維護中的效果和價值。

資料與方法

1.一般資料。2017年1月至2017年8月在我院腎內科住院未開始透析治療的患者中，行前臂自體動靜脈內瘺(AVF)手術的患者54例，男30例，女24例，年齡37～78歲，平均年齡60.8±9.9歲，隨機分為對照組(27例)和微信監測組(27例)。

2.入選條件。(1)征得患者和家屬同意后，與入選患者(或陪護親屬)之間建立微信聯系；(2)手術前均經過病情評估及血管物理檢查，心臟超聲評估符合行前臂AVF手術要求。血管超聲評估要求符合目標靜脈束臂后內徑≥2mm，目標動脈內徑≥1.5mm。

3.實施方法。對照組給予常規的AVF保護宣教、加強AVF功能鍛煉等與AVF成熟相關的知識宣教，微信監測組在對照組宣教的基礎上與患者建立微信交流，接受有計劃的微信隨訪監測。定期獲得患者的臨床資料，血生化資料和AVF情況評估信息。

3.1 成立血管通路維護小組。由主任醫師1名、副主任醫師2名、主治醫師2名組成，小組成員均具有建立血管通路和透析的豐富經驗，負責制定微信教育計劃、內容、方法，并嚴格按計劃實施，做好各項記錄。……