维持性血液透析患者控液手册的设计与应用研究

发布时间：2019-04-28 07:39

【摘要】：研究目的设计一种临床实用性较强的应用手册,为维持性血液透析患者提供一种更加直观,更加便于操作,具有科学性的、人性化的合理控制液体入量的工具。进而减少患者的液体摄入,减少透析间期的体重增长,减少并发症,改善维持性血液透析患者的生存质量。研究对象与方法本研究为类实验性研究设计。设计控液手册,在征询专家意见后临床应用。本研究随机选择在山东省某三甲医院进行维持性血液透析的患者共60名,按照患者入院时间的前后排序,分别划分为观察组和对照组,两个组别各包括30名。对照组懫取目前工作中使用的尿毒症病人护理常规健康指导内容,在限定摄取过多水分方面进行健康指导。在常规限制液体摄入健康教育内容的基础上,对观察组维持性血液透析患者指导和辅助使用本研究设计的控液手册。衡量MHD患者体重增重数值,分别评估观察组和对照组体重增重数值。透析间期体重增长值应该在干体重的3%～5%的范围内[1]。患者透析间期体重增加值/干体重在3%～5%范围内提示患者的液体摄取依从性好,超出此范围提示患者未按要求摄取液体。观察设计手册是否可以更有效的限制MHD患者的体重增加。收集到的数据通过spss17.0软件分析。统计方法包括描述性统计分析、t检验、卡方检验等。统计分析,符合正常分布的测量数据结果均表示为均值+标准差,P0.05为差异有统计学意义。研究结果本研究共选取60例,因患者病情加重出现严重并发症后转至重症监护室等原因而改变原有血液透析模式共失访3例,共完成57例,观察组29例,对照组28例,样本流失率为5.0%。1.两组干预前IDWG比较:结果显示差异没有统计学意义(P=0.2310.05)2.干预前后IDWG对比:观察组优于对照组,差异存在统计学意义(P=0.0240.05)。干预前,观察组IDWG平均值(2.47±0.92)kg,干预后其平均值为(2.00±0.75)kg,降低了0.47kg;观察组患者IDWG/干体重的平均值由5.23%降至4.17%,差异有统计学意义(P0.05)。3.通过干预分别比较两组限制液体摄取情况:经过12周的干预研究后,观察组优于对照组,差异有统计学意义(P0.05)。研究结论应用控液手册可以更好的减少摄取液体,控制间期增重,减少并发症的发生,体现人性化护理理念。
[Abstract]:Objective to design a practical clinical application manual for maintenance hemodialysis patients to provide a more intuitive, easier to operate, scientific, humanized and reasonable control of liquid intake tool. To reduce the intake of liquid, reduce the weight gain between dialysis, reduce complications, improve the quality of life of patients with maintenance hemodialysis. Research objects and methods this study was designed as a quasi-experimental study. Design manual for fluid control and clinical application after consultation with experts. In this study, 60 patients with maintenance hemodialysis were randomly selected from a third class A hospital in Shandong Province. According to the order of admission time, they were divided into two groups: observation group and control group, 30 patients in two groups were divided into two groups: observation group and control group, 30 patients in each group were divided into observation group and control group. The control group took the routine health guidance contents of uremia patients which were used in the current work, and carried out the health instruction in limiting the intake of too much water. On the basis of the content of health education to limit liquid intake, the manual of fluid control designed in this study was used to guide and assist the patients with maintenance hemodialysis in the observation group. The weight gain of MHD patients was measured, and the weight gain of observation group and control group were evaluated. Interdialysis body weight gain should be within 3% to 5% of dry weight [1]. Interdialysis body weight gain / dry weight within the range of 3% to 5% indicated that patients had good compliance with liquid uptake, and beyond this range suggested that the patient did not consume the liquid as required. Observe whether the design manual can more effectively limit weight gain in patients with MHD. The collected data were analyzed by spss17.0 software. Statistical methods include descriptive statistical analysis, t-test, chi-square test and so on. Statistical analysis, the results of normal distribution of the measured data are expressed as mean standard deviation, P0.05 is statistically significant. Results A total of 60 cases were selected in this study. Because of the serious complications, the original hemodialysis mode was changed to intensive care unit in 3 cases, 57 cases completed, 29 cases in the observation group and 28 cases in the control group. The sample wastage rate is 5.0%. Pre-intervention IDWG comparison between the two groups: the results showed no significant difference (P < 0. 2310.05) 2. Comparison of IDWG before and after intervention: the observation group was better than the control group, the difference was statistically significant (P < 0.0240.05). Before intervention, the mean value of IDWG in the observation group was (2.47 卤0.92) kg, and its average value was (2.00 卤0.75) kg, decreased by 0.47 kg after intervention. The average dry weight of IDWG/ in observation group decreased from 5.23% to 4.17%, the difference was statistically significant (P0.05). After 12 weeks of intervention, the observation group was better than the control group, the difference was statistically significant (P0.05). Conclusion the manual of liquid control can reduce liquid intake, control interphase weight gain, reduce complications, and reflect the concept of humanized nursing.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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