容量管理对持续非卧床腹膜透析患者容量负荷及心功能的影响

发布时间：2018-01-01 06:28

本文关键词：容量管理对持续非卧床腹膜透析患者容量负荷及心功能的影响　出处：《苏州大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的本研究旨在探讨容量管理对持续非卧床腹膜透析（ContinuousAmbul-atory Peritoneal Dialysis, CAPD）患者容量负荷及心功能的影响。方法筛选符合纳入标准的CAPD患者，随机分入干预组（N=34例）和对照组（N=32例）。干预组患者予以容量管理6个月，包括：（1）出院时发放与讲解《CAPD患者容量管理手册》，内容主要围绕容量管理的必要性、提高容量管理综合能力、异常容量负荷指标的监测、识别和处理等；（2）按容量管理计划给予门诊和（或）电话跟踪随访。对照组予以常规护理。比较两组患者《容量相关知识调查表》、《慢性病自我效能量表》和《CAPD患者容量管理行为量表》得分；比较两组CAPD患者整体水平（水肿、体重、出量及血压）和细胞与组织水平（ICW、ECW、TBW及ECW"h）的容量负荷、心功能（BNP水平）及6个月内因容量超负荷相关疾病的再入院次数。结果 1.6个月后，干预组患者容量管理知识、自我效能及限盐限水行为得分均显著高于对照组，比较有统计学意义（p均＜0.05）。与基线比较，，干预组容量管理知识、信念、行为得分显著高于基线时，差异有统计学意义（p均＜0.05）；而对照组的差异无统计学意义（p均＞0.05）。 2.容量负荷 2.1整体水平：6个月后，干预组水肿程度显著改善、体重显著下降、收缩压降至140.82±20.89mmHg，组间差异均有统计学意义（p均＜0.05）。与基线相比，干预组上述三项指标均显著下降，差异有统计学意义（p均＜0.05），而对照组上述指标的改变均无统计学意义。 2.2细胞与组织水平：6个月后，干预组的ICW、ECW、TBW及ECW"h低于对照组，差异有统计学意义（p均＜0.05）。与基线比较，干预组的上述指标均有下降，但无统计学意义；而对照组上述指标均呈上升趋势。 3.6个月后，干预组BNP水平较对照组有所改善，差异有统计学意义（χ2=5.945，p=0.019）。 4.因容量超负荷相关疾病的再入院次数：干预组平均住院（0.177±0.459）次，对照组（0.469±0.671）次，两组差异有统计学意义（t=2.053， p=0.045）。结论容量管理可从知-信-行方面有效提高CAPD患者的容量管理能力，从而改善容量超负荷症状及心功能水平，降低容量超负荷相关疾病导致的再入院次数，故容量管理是一种简便、经济、有效的改善CAPD患者容量超负荷及心功能不全的方法。
[Abstract]:Objective to investigate the effect of volume management on continuous ambulatory Peritoneal Dialysis in continuous ambulatory peritoneal dialysis. The effect of volume load and cardiac function in patients with CAPD. Methods 34 patients with CAPD were randomly divided into the intervention group (n = 34) and the control group (n = 32). The patients in the intervention group were given volume management for 6 months. Including 1) release and explain the Handbook of capacity Management of CAPD patients when discharged from hospital. The contents mainly focus on the necessity of capacity management, improve the comprehensive capacity management ability, and monitor the abnormal capacity load index. Identification and processing; (2) according to the capacity management plan, the outpatients and / or telephone follow-up were given. The patients in the control group were given routine nursing care. The volume related knowledge questionnaire was compared between the two groups. Scores of chronic self-efficacy scale and CAPD patient capacity management behavior scale; The volume load of CAPD patients (edema, body weight, output and blood pressure), cell and tissue levels and ECW "TBW" were compared between the two groups. Cardiac function (BNP level) and readmission times due to volume overload related diseases within 6 months. Results After 6 months, the scores of capacity management knowledge, self-efficacy and salt and water limitation behavior in the intervention group were significantly higher than those in the control group (P < 0.05). The scores of capacity management knowledge, belief and behavior in the intervention group were significantly higher than those in the baseline group (P < 0.05). There was no significant difference in the control group (P > 0.05). 2. Capacity load 2.1 overall level: after 6 months, the degree of edema and body weight in the intervention group were significantly improved, and the systolic blood pressure decreased to 140.82 卤20.89 mmHg. Compared with the baseline, the above three indexes in the intervention group were significantly decreased, and the difference was statistically significant (P < 0.05). The changes of the above indexes in the control group were not statistically significant. 2.2 Cell and tissue levels: after 6 months, the levels of ECW "TBW and ECW in the intervention group were significantly lower than those in the control group (P < 0.05). The above indexes in the intervention group were all decreased, but there was no statistical significance. In the control group, the above indexes showed an upward trend. After 6 months, the level of BNP in the intervention group was better than that in the control group, and the difference was statistically significant (蠂 ~ 2 = 5.945). 4. The number of readmissions due to volume overload related diseases: the average number of hospitalizations was 0.177 卤0.459 in the intervention group and 0.469 卤0.671 in the control group. The difference between the two groups was statistically significant. Conclusion Volume management can effectively improve the capacity management ability of patients with CAPD from the aspect of knowledge, trust and behavior, thereby improving the symptoms of volume overload and the level of cardiac function. Volume management is a simple, economical and effective method to improve volume overload and cardiac insufficiency in patients with CAPD because of reducing the number of readmission due to volume overload related diseases.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R473.5

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