论肾脏内科住院医生与尿毒症患者关于初始透析治疗的沟通策略与艺术——一项基于文献与临床实践的教学探讨
程璐 任倩 付平

四川大学华西医院，四川成都，610041；

摘要：启动透析治疗是尿毒症患者生命中的一个重大转折点，对于患者及其家庭而言，这常被视为一个"坏消息"。肾脏内科住院医生（包括专科医师、规培及专培医生）作为与患者沟通的主力军，其沟通技巧、共情能力及信息传递方式，直接影响患者的治疗依从性、生活质量和长期预后。本文基于文献综述与临床实践经验，系统论述针对不同类型尿毒症患者（包括慢性肾脏病老病患、老年衰弱患者、年轻患者等）的个体化沟通策略，重点探讨如何运用SPIKES模型进行坏消息告知，以及通过共享决策模型实现治疗选择的最优化。文章还详细分析了透析方式选择（血液透析与腹膜透析）及血管通路建立等关键环节的沟通要点，旨在为肾脏内科住院医生提供实用性强、可操作性高的沟通指导，最终提升医疗服务质量。

关键词：医患沟通；尿毒症；透析治疗；坏消息告知；共享决策；肾脏内科

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