基于信息-动机-行为技巧模型的护理干预对腹膜透析患者容量负荷和透析充分性的影响

Effect of information-motivation-behavior intervention on the volume load and peritoneal adequacy of patients undergoing peritoneal dialysis

目的探讨信息-动机-行为(IMB)技巧模型对持续不卧床腹膜透析(CAPD)患者容量负荷和透析充分性的影响。方法选取2015年12月至2016年12月广西医科大学第一附属医院腹膜透析中心92例患者作为研究对象,应用随机数表法将患者随机分为干预组和对照组,每组46例,对照组患者采用常规护理干预,干预组患者接受IMB技巧模型干预,每组干预12个月。比较干预前后两组患者的肾脏病饮食依从性量表得分、水肿程度、每日饮水量、每日饮食含水量、24 h尿量和超滤量以及血尿素氮(BUN)、血肌酐(SCr)、总尿素清除指数(Kt/V)、总肌酐清除率(Ccr)和残肾肾小球滤过率(eGFR)等指标。结果 92例患者中,干预组有1例转为血液透析,对照组1例失访,最终实际纳入患者90例,干预组和对照组各45例。经过IMB技巧模型干预,干预组患者的饮食依从态度总分为(84.52±7.38)分,明显高于对照组的(80.13±7.50)分,饮食依从行为总分为(71.87±5.34)分,明显高于对照组的(68.35±5.31)分,差异均有统计学意义(P<0.05);干预组患者发生2、3度水肿例数少于对照组,差异有统计学意义(P<0.05);对照组患者每日饮水量为(630.16±354.28) m L,明显多于干预组的(472.23±348.16) mL,每日饮食含水量为(341.29±142.35) mL,明显多于干预组的(271.30±140.91) m L,差异均有统计学意义(P<0.05);对照组患者的血尿素氮为(19.16±4.73) mmol/L,明显高于干预组的(18.94±4.89) mmol/L,血肌酐值为(971.36±328.55)μmol/L,明显高于干预组的(825.57±302.99)μmol/L,差异均有统计学意义(P<0.05);24 h尿量、24 h超滤量、总尿素清除指数、总肌酐清除率、残肾肾小球滤过率干预前后干预组分别与对照组比较,差异均无统计学意义(P>0.05)。结论 IMB模型系统干预能够有效改善CAPD患者的饮食依从性,控制每日饮水量及食物摄入水量,容量负荷管理收效良好,在透析充分性中,能有效降低血尿素氮及血肌酐,对总尿素、肌酐清除率,及残余肾功能保护方面,疗效与传统方式无差异。

Objective To explore the effect of information-motivation-behavior(IMB) skills model on volume load and dialysis adequacy in patients undergoing continuous ambulatory peritoneal dialysis(CAPD). Methods Ninety-two patients in Peritoneal Dialysis Center of the First Affiliated Hospital of Guangxi Medical University from December 2015 to December 2016 were selected as the research objects. The patients were randomly divided into intervention group and control group, with 46 cases in each group. The patients in control group were given routine nursing intervention for 12 months, and the patients in intervention group received IMB skills model intervention for 6 months. The scores of dietary compliance scale, edema degree, daily drinking water, daily dietary water content, 24 h urine volume and ultrafiltration volume, blood urea nitrogen(BUN), serum creatinine(SCr), total urea clearance index(Kt/V), total creatinine clearance rate(Ccr), and residual glomerular filtration rate(eGFR) of two groups were evaluated and compared before and after intervention. Results Among 92 patients, 1 case in the intervention group was converted to hemodialysis, and 1 case in the control group was lost to follow-up. Finally, 90 patients were actually included in the intervention group and 45 patients in the control group. After the intervention of IMB skills model, total score of dietary compliance attitude was 84.52±7.38 in the intervention group, significantly higher than 80.13±7.50 in the control group(P<0.05). Total score of dietary compliance behavior was 71.87 ± 5.34 in the intervention group, significantly higher than68.35±5.31 in the control group(P<0.05). The number of patients with grade 2 and grade 3 edema in the intervention group was less than that in the control group, and the difference was statistically significant(P<0.05). The volume of daily drinking water of the control group was(630.16±354.28) mL, significantly more than(472.23±348.16) mL in the intervention group(P<0.05). Daily dietary water content of the control group was(341.29 ± 142.35) mL, significantly more than(271.30±140.91) mL in the intervention group. The daily drinking water and dietary water content of the intervention group was better controlled than that of the control group. Blood urea nitrogen of control group was(19.16 ±4.73) mmol/L, significantly higher than(18.94±4.89) mmol/L in the intervention group(P<0.05). Serum creatinine(SCr)was(971.36±328.55)μmol/L in the control group versus(825.57±302.99)μmol/L in the intervention group, and serum creatinine control was better in the intervention group(P<0.05). There was no significant difference between the two groups in urea clearance index, total creatinine clearance rate, and residual glomerular filtration rate before and after intervention(P>0.05). Conclusion The intervention of IMB skills model can effectively improve the dietary compliance of CAPD patients, control daily drinking water and daily dietary water content, and manage the volume load. It can effectively reduce blood urea nitrogen and blood creatinine, and has similar effects on the total urea, creatinine clearance rate,and residual renal function protection, as compared with routine nursing.