家属参与式个案管理对血液净化病人疾病管理能力及钙磷代谢紊乱的影响

Effect of family-involved case management on disease management ability and calcium and phosphorus metabolism disorder in patients with blood purification

[目的]探讨家属参与式个案管理对血液净化治疗维持血液透析病人疾病管理能力及钙磷代谢紊乱的影响。[方法]选取2015年6月—2017年6月本院血液净化中心收治的经血液净化治疗的维持血液透析终末期肾病病人90例,根据随机数字表法将病人分为对照组及观察组各45例,对照组实施血液内科常规性护理干预,观察组在对照组基础上实施家属参与式个案管理,记录两组病人干预后血磷达标率、血钙达标率、钙磷乘积达标率及高磷血症发生率情况,比较两组病人干预前后疾病管理能力及生活质量改善情况。[结果]观察组干预后血磷、血钙、钙磷乘积达标率高于对照组(P<0.05),而高磷血症发生率低于对照组(P<0.05)。观察组干预后疾病管理评分及自我效能评分均高于对照组(P<0.05)。观察组干预后肾病影响、肾病负担、工作状况、认知功能、社交质量、医护鼓励及总体生活质量评分均高于对照组(P<0.05)。[结论]家属参与式个案管理能有效提高血液净化病人疾病管理能力及自我效能,改善钙磷代谢紊乱,预防高磷血症发生,提高病人生活质量。

Objective:To explore the impact of family involved case management on disease management ability,calcium,and phosphorus metabolism disorder,and the quality of life(QOL)in patients with blood purification treatment to maintain the hemodialysis.Methods:A total of 90 patients with the end stage renal disease who underwent blood purification treatment to maintain the hemodialysis admitted to our hospital from June 2015 to June 2017 were divided into the control group(n=45)and the observation group(n=45)according to the random number table method.The control group received routine nursing intervention and the observation group received family involved case management based on the routine nursing.The compliance rate of blood phosphorus,blood calcium,calcium phosphorus product,and the incidence of hyperphosphatemia was recorded after the intervention.The disease management ability and QOL improvement of the two groups before and after the intervention were compared.Results:The obeyed rate of blood phosphorus,calcium,calcium,and phosphorus of the observation group was higher than those in the control group(P<0.05),while the incidence of hyperphosphatemia was lower than that of the control group(P<0.05).The scores of disease management and self efficacy of the observation group were higher than those in the control group after the intervention(P<0.05).The levels of kidney disease,kidney burden,work status,cognitive function,social quality,medical care encouragement,and overall QOL of the observation group were higher than those of the control group(P<0.05).Conclusions:Family involved case management could effectively improve the ability of disease management and self effectiveness in patients with blood purification,improve the calcium and phosphorus metabolism disorder,prevent the occurrence of hyperphosphatemia,and improve the QOL of patients.