跨理论模型在腹膜透析患者水盐摄入护理及容量平衡中的应用

发布时间：2018-03-04 20:48

本文选题：腹膜透析　切入点：跨理论模型　出处：《锦州医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的探讨跨理论模型在腹膜透析患者维持容量平衡、提高自身容量管理能力等方面中的应用效果,降低心力衰竭的发生,为长期居家的腹膜透析患者形成良好的健康教育模式,以提高患者居家生活的自我管理能力,为护理人员制定针对腹膜透析患者的健康教育策略提供参考依据。方法选择沈阳军区总医院肾内科腹膜透析中心持续非卧床腹膜透析患者70例作为研究对象,将研究对象分为干预组和对照组每组各35例。对照组患者给以常规健康教育;干预组患者在常规健康教育的基础上给予跨理论模型为依据的水盐摄入综合干预,观察时间3个月,比较患者在基线、1个月、3个月的容量管理行为能力及容量状态指标。容量管理能力评估运用容量管理行为量表,容量状态指标包括体重、收缩压、舒张压、24小时尿量、24小时超滤量、水肿程度。结果1、干预前后患者的行为阶段比较:干预3个月干预组患者较干预前行为阶段发生正向递进,多半患者处于行动及维持阶段,较干预前患者各行为阶段的人数有显著性差异(P0.05)。2、两组患者干预前后相关指标的比较:两组患者在基线水平时,差异无统计学意义(P0.05);干预1个月及3个月,两组患者的收缩压差异有统计学意义(P0.05)。3、两组患者干预前后相关指标的交互作用:经重复测量方差分析,对两组患者容量指标进行组间效应、时间效应、时间与分组交互作用进行分析。结果显示,两组患者容量指标在时间和组间效应中存在交互作用(P0.05),时间作用随着干预因素的改变而改变,两组间的差异随着观察时间的延长而愈加明显,即两组患者容量控制趋势不同,干预组容量控制状况优于对照组,组间效应差异有统计学意义(F值为5.321;P0.05)。4、两组患者基线与干预3个月水肿程度比较:干预前两组患者的水肿程度差异无统计学意义(P0.05);干预组患者经过3个月的综合干预,水肿程度较对照组明显降低,差异具有统计学意义(P0.05)。5、两组患者干预前后于容量管理行为评分量表进行比较:干预前两组患者容量管理行为评分比较,差异无统计学意义(P0.05);干预3个月后干预组患者容量管理行为评分均高于基线水平,两组患者比较差异有统计学意义(P0.05)。结论通过应用跨理论模型为框架的水盐摄入护理干预,可以促进患者行为阶段的正向递进,提高患者的容量管理能力。进而预防或纠正腹膜透析患者容量相关性疾病的发生,减少心衰的发生,提高患者生存质量。制定既遵循治疗原则又利于患者接受的干预策略,为居家腹膜透析患者制定良好的健康教育方案,完善在临床中优质可行的延续护理模式。
[Abstract]:Objective to investigate the transtheoretical model to maintain the balance of capacity in peritoneal dialysis patients, improve their application ability and other aspects of capacity management, reduce the occurrence of heart failure, the formation of good health education mode for peritoneal dialysis patients with long-term home, Ju Jiasheng live to improve patient self management ability, to provide reference for health education strategies in peritoneal dialysis patients the nursing staff development. Methods the General Hospital of Shenyang Military Department of Nephrology peritoneal dialysis center of continuous ambulatory peritoneal dialysis in 70 patients as the research object, the research object will be divided into intervention group and control group, 35 cases in each group. The control group were given conventional health education; patients in the intervention group were given on the basis of routine health education the transtheoretical model for water and salt intake on the basis of comprehensive intervention, the observation time of 3 months, compared with patients at baseline, 1 months, 3 months of capacity management Capacity and capacity of state capacity management ability evaluation index. The use of capacity management behavior scale, capacity status indicators including body weight, systolic blood pressure, diastolic blood pressure, urine volume in 24 hours, 24 hours, ultrafiltration volume, edema. Results 1 patients before and after the intervention phase comparison behavior: intervention 3 months intervention group compared with the intervention the behavior of positive progressive stage, most patients in the operation and maintenance phase, there is significant difference compared with the number of patients before the intervention phase (P0.05).2, compared two groups of patients before and after intervention related indicators: two groups of patients in the baseline level, the difference was not statistically significant (P0.05); intervention for 1 months and 3 months, the two groups of patients with systolic blood pressure difference was statistically significant (P0.05.3), the interaction of the two groups before and after intervention related indicators: the repeated measures analysis of variance between groups of patients in the two group effect, time effect when the capacity index. With the group interaction were analyzed. The results showed that two groups of patients with capacity index there is interaction between time and group effects (P0.05), time changes with the intervention factors change, the difference between the two groups with prolonged observation time became more and more obvious that the two groups of patients with different volume control trend, intervention capacity control status is better than the control group, the difference was statistically significant between group effect (F-measure 5.321;.4, P0.05) were compared between the two groups at baseline and 3 months of intervention: edema degree of statistical significance between the two groups of patients with edema before intervention (P0.05); patients in the intervention group after intervention for 3 months the degree of edema was significantly lower than the control group, the difference was statistically significant (P0.05.5), two groups of patients before and after intervention in capacity management behavior scale comparison: two groups before intervention capacity management behavior scores were compared, no difference Statistical significance (P0.05); 3 months after the intervention, patients in the intervention group were higher than that of the capacity management behavior at baseline, the two groups were statistically significant difference (P0.05). Conclusion through the application of the trans theoretical model for water and salt intake framework of nursing intervention can promote patients to stage positive progression, improve the patient's capacity management ability. Then preventive or corrective related diseases in patients with peritoneal dialysis capacity, reduce the occurrence of heart failure, improve the quality of life of patients. Both follow the principle of treatment and to formulate intervention strategies for patients, making health education a good solution for home peritoneal dialysis patients, improve the quality of continued nursing mode in the clinical work.

【学位授予单位】：锦州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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