目的

探讨居家管理对维持性血液透析患者综合疗效的影响。

方法

科主任、护士长、血液透析医生及责任护士通过分析151 例患者在维持性血液透析过程中存在的问题,自制患者问卷,根据问卷调查,结合患者需求,在常规血液透析护理的基础上实施了居家管理。 主要包括情志调养、饮食管理、有氧运动、用药指导、自我监测、动静脉内瘘的自我维护等方面进行干预。 比较实施前后1.5 年患者相关临床及实验室指标、健康教育依从性、并发症的发生、住院情况、护理质量等。 样本间比较采用t 检验,P ＜0.05 为差异有统计学意义。

结果

实施居家管理后较实施前患者舒张压及多项实验室指标明显改善(P ＜0.05),对治疗的依从性明显增加,自我管理疾病的能力增强(疾病知识掌握情况, χ² =18.639,P ＜0.001; 内瘘维护方法掌握情况, χ² =11.916,P=0.003),并发症发生率明显降低(P ＜0.05),151 例患者年总住院频次减少(101 次与74 次;t=11.77,P ＜0.001),兼职工作及承担家务患者数量明显增加(χ² =79.040,P ＜0.001; χ² =4.211,P=0.04),医护患关系更加融洽,护理质量也得到提高(P ＜0.05)。 差异均有统计学意义。

结论

对维持性血液透析患者实施规范化居家管理,可以提高透析质量,有效地预防和减少并发症的发生,减少住院频次,改善患者生存质量,提高护理质量。

Objective

To explore the intervention effect of the standardized home management in patients with maintenance hemodialysis.

Methods

The department director, head nurse, hemodialysis doctor, and charge nurse made questionnaire for patients through analysis of problems existing in the process of maintenance hemodialysis in 151 patients. According to the questionnaire results in combination with patients needs, the standardized management at home was carried out among 151 patients with maintenance hemodialysis on the basis of regular hemodialysis nursing, mainly including intervention in emotions care,diet management, aerobic exercise, medication guide, self-monitoring, and self-maintenance of arteriovenous fistula, etc. After 1.5 years of the home management, comparisons were made in clinical and lab examinations, as well as in education compliance, complication occurrence, hospitalization, and quality of care, and so on. For comparison between samples, t test was applied, and the difference was considered statistically significant when P value was less than 0. 05.

Results

After the implementation of home management in the patients, the diastolic blood pressure and a number of laboratory indexes were significantly improved (P ＜0.05), treatment compliance was significantly increased, self-management of disease was enhanced (disease knowledge understanding, χ² = 18. 639, P ＜ 0. 001; internal fistula maintenance, χ² = 11.916, P=0.003), incidence of complications was significantly lowered (P ＜0.05),hospitalization frequency in a year was reduced (101 vs 74; t =11.77, P ＜0.001), and the number of patients who had part-time jobs and shared housework was obviously increased (χ² =79.040, P ＜0.001;χ² = 4.211, P=0.04). The relationship between patients and medical workers was more harmonious, and the nursing quality was also improved (P ＜0.05).

Conclusions

The implementation of standardized home management in patients with maintenance hemodialysis improved the quality of dialysis, effectively prevented and reduced the occurrence of complications, reduced the frequency of hospitalization, and improved both survival quality and quality of nursing.