新型コロナウイルス肺炎流行時の腹膜透析患者のフォローアップ管理戦略

Follow-up management strategy for patients undergoing peritoneal dialysis during novel coronavirus pneumonia epidemic.

抄録

目的:

本研究の目的は、新型コロナウイルス肺炎（NCP）流行時に腹膜透析（PD）を受けている患者に対する最善の追跡管理戦略を探ることである。

OBJECTIVE: The study aimed to explore the best follow-up management strategy for patients undergoing peritoneal dialysis (PD) during the novel coronavirus pneumonia (NCP) epidemic.

患者と方法:

当院でNCP流行時にフォローアップを受けた腹膜透析患者を本研究に登録した。流行抑制の必要性から、流行期間中はWeChat、QQ、電話を主な連絡手段としたフォローアップシステムを構築した。透析の安全性と流行の予防と制御を確実にするために、外来および緊急フォローアップが実施された。フォローアップ戦略には、流行状況に関連した対応策、PDに関連した腹膜炎の予防、水分・塩分管理、運動指導、精神的ケアなどが含まれた。患者の状態に応じて予約制を導入し、1人の患者に対して1つの診察室と1つのプロセスを設けた。緊急患者は流行状況に応じて隔離した。

PATIENTS AND METHODS: Patients undergoing PD who were followed up during the NCP epidemic by our hospital were enrolled in this study. Because of the need to control the epidemic, a follow-up system was established during the epidemic period, with WeChat, QQ, and the telephone as the main methods of communication. Outpatient and emergency follow-ups were carried out to ensure the safety of dialysis and the prevention and control of the epidemic. The follow-up strategy included response measures related to the epidemic situation, prevention of peritonitis related to PD, water and salt control, exercise guidance, and psychological care. According to the patient's condition, the appointment system was implemented, with one consulting room and one process for each patient. The emergency patients were isolated in accordance with the epidemic situation.

結果:

2020年1月以降、当科で経過観察を行ったPD患者580名とその家族において、NCP感染者はいなかった。流行期間中、標準ヘモグロビン値および入院率は低下した。腹膜炎、容積負荷による心血管系合併症、肺感染症などのPDに関連する合併症は有意に増加せず、離脱率、死亡率は前年同期と比較して減少した。

RESULTS: Since January 2020, among the 580 patients undergoing PD who were followed up in our department and their families, none had NCP infection. During the epidemic period, the standard hemoglobin level and the inpatient rate decreased. Complications related to PD, such as peritonitis, cardiovascular complications caused by volume overload, and pulmonary infection, did not significantly increase, and the withdrawal rate and mortality rate decreased compared with those in the same period last year.

結論:

流行期の患者フォローアップ戦略は、流行の予防と制御に大きなプラスの効果をもたらした。さらに、流行期間中、患者や介護者に家庭での保護に注意を払い、外出を避け、自己管理を強化することなどを奨励したことは、腎臓病自体のコントロールに有益であり、推進する価値がある。流行期における医師と患者の緊密な関係は、PDを受ける患者に関連する合併症の発生に好影響を及ぼした。

CONCLUSIONS: The patient follow-up strategy during the epidemic period had a significant positive effect on preventing and controlling the epidemic. Furthermore, during the epidemic period, encouraging patients and caregivers to pay attention to protection at home, avoid going out, strengthen self-management, and other measures were beneficial to the control of kidney disease itself, which is worth promoting. The close relationship between doctors and patients during the epidemic had a positive effect on the occurrence of complications related to patients undergoing PD.