Application of precision stratified management in volume load control for peritoneal dialysis patients
精准分层管理在腹膜透析患者容量负荷控制中应用

摘要

目的 探讨精准分层管理在腹膜透析（Peritoneal dialysis, PD）患者容量负荷控制中的应用效果。方法 选择湖北省十堰市某三甲医院肾病内科2025年1月~2025年6月规律随访的80例PD患者，随机分成两组。对照组（n=40）应用常规健康管理，观察组（n=40）在对照组基础上应用精准分层管理。对比两组干预前后的容量指标、水肿情况、容量相关知识水平、容量管理行为等。结果 （1）干预前，两组细胞外水（ECW）与身体总水（TBW）比值及Ｎ末端脑钠肽前体（NT-ProBNP）水平比较，差异均无统计学意义（P＞0.05）。干预6个月后，观察组ECW/TBW比值由（0.41±0.03）降至（0.37±0.02），NT-proBNP由（12856.45±352.67） pg/mL降至（8685.30±150.45） pg/mL，降幅显著大于对照组（P＜0.001）；（2）干预后，观察组中重度肢体水肿发生率为15.00%，对照组中重度肢体水肿的发生率为40.00%（P＜0.05）；（3）干预6个月后，观察组容量相关知识水平评分由（62.35±8.20）提升至（89.72±5.63），容量管理行为评分由（42.18±6.35）提升至（53.42±4.87），与对照组相比更高（P＜0.05）。结论 在PD患者容量管理中应用精准分层管理，能改善患者的容量状态，减轻肢体水肿，增强患者的自我管理能力。

Abstract

Objective To investigate the efficacy of precision stratified management in controlling volume load among peritoneal dialysis (PD) patients.
Methods Eighty PD patients undergoing regular follow-up at the Department of Nephrology, a Grade III Class A hospital in Shiyan City, Hubei Province, from January to June 2025 were randomly divided into two groups. The control group (n=40) received conventional health management, while the observation group (n=40) received precision stratified management in addition to conventional care. Comparisons were made between the two groups regarding fluid indicators, edema status, knowledge of fluid-related concepts, and fluid management behaviors before and after intervention.
Results (1) Before intervention, no statistically significant differences were observed between the two groups in extracellular water (ECW)/total body water (TBW) ratio or N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (P > 0.05). After 6 months of intervention, the ECW/TBW ratio in the observation group decreased from (0.41 ± 0.03) to (0.37 ± 0.02), while NT-proBNP decreased from (12856.45 ± 352.67) pg/mL to (8685.30 ± 150.45) pg/mL, with a significantly greater reduction than in the control group (P < 0.001). (2) After intervention, the incidence of moderate-to-severe limb edema was 15.00% in the observation group and 40.00% in the control group (P < 0.05); (3) Six months after intervention, the observation group’s fluid-related knowledge score increased from (62.35±8.20) to (89.72±5.63), and the fluid management behavior score rose from (42.18±6.35) to (53.42±4.87), both significantly higher than the control group (P<0.05).
Conclusion   Implementing precision stratified management in fluid management for PD patients improves fluid status, reduces limb edema, and enhances self-management capabilities.