群组管理模式在腹膜透析患者容量管理中的应用

Application of group visits on fluid status in peritoneal dialysis patients

目的评价群组管理模式在腹膜透析患者容量管理的应用效果。方法选取宁夏医科大学总医院腹膜透析中心2014年1月~2015年1月进行腹膜透析治疗的120例患者作为研究对象。干预组接受群组管理模式及常规护理,而对照组只接受常规护理,比较干预前及干预3个月后,两组患者容量状况及实验室指标的差异。结果本研究共纳入进行腹膜透析治疗的120例患者,其中男53例,女67例,平均年龄(56.05±10.33)岁,对照组及干预组各60例。干预前两组患者容量状况及实验室指标及双下肢水肿程度比较,差异无统计学意义;干预后,干预组患者收缩压及液体摄入量低于对照组,差异有统计学意义(t=2.650,P=0.011;Z=-2.140,P=0.032);且干预后,干预组患者双下肢水肿例数低于对照组,差异有统计学意义(χ~2=10.985,P=0.012)。结论群组管理模式有助于改善腹膜透析患者的容量状况,加强患者之间的沟通交流;有助于提高患者水盐摄入的依从性,是值得推广的慢性病疾病管理模式。

Objective To evaluate the effectiveness of group visits on fluid status in peritoneal dialysis （PD） patients. Methods One hundred and twenty PD patients were randomly and equally assigned into two groups. Patients in experimental group received group visits and routine health care, while those in control group only received routine health care. Their fluid status was compared before intervention and after interven- tion for 3 months. Results Before intervention, there were no significant differences in blood pressure, dialy- sis dose, urine volume, ultrafiltration volume, glucose concentration in dialysate, body weight, fluid intake, se- rum creatinine, serum protein and edema in lower extremities between the two groups. After intervention, pa- tients in the experimental group had lower systolic blood pressure （t=-2.650, P=-0.01）, less fluid intake （Z=-2.140, P=0.032） and fewer extremity edema （X^2=10.985, P=0.012） as compared with the control group. Con- elusion The group visits program is an effective model to improve volume status, to promote communication with medical staffs, and to increase the compliance with water and salt management in PD patients. It is a valuable management model for chronic diseases to be used in clinical practice.