腹膜透析病人实施一体化管理模式的临床效果

Effect of the integrated nursing management model in peritoneal dialysis patients

目的:探讨专业医护人员组成专职团队对腹膜透析(PD)病人实施一体化管理的效果。方法:选择2009年6月至2012年5月于血液净化中心接受维持性PD治疗的226例病人实施一体化管理模式,观察病人的实验室指标、护理指标达标率、心脏影像学在实施1年内的变化情况,并统计腹膜炎发生情况。结果:与出院当天相比,病人在PD治疗3、6、12个月时血清白蛋白(Alb)、总蛋白(TP)、血红蛋白(Hb)、肌酐(Cr)水平上升,血磷水平降低(P<0.05~P<0.01);与治疗3个月比较,在PD治疗12个月时Alb水平明显上升(P<0.01)。腹膜炎发生情况显示,2010-2012年的发生率分别为1次/37.7病人月、1次/56.5病人月、1次/75.3病人月,发生率整体呈下降趋势。与出院当天相比,病人在PD治疗1年期间左心房内径无明显变化(P>0.05),治疗3、6、12个月心胸比、右心室内径、室间隔厚度均增加(P<0.05~P<0.01);与治疗3个月比较,治疗6、12个月心胸比,治疗12个月的右心室内径均增加(P<0.01)。病人在PD治疗1年期间自护技能、自护责任感、自我概念、健康知识、总分均逐渐上升(P<0.01),治疗3、6、12个月均高于出院当天,治疗6、12个月均高于治疗3个月,治疗12个月高于治疗6个月(P<0.01)。结论:将一体化管理模式应用于PD病人的护理中,能有效改善PD病人的生理健康状况,提高病人的自我效能,具有重要的临床应用价值。

Objective:To explore the application value of the integrated nursing management model in peritoneal dialysis(PD)patients.Methods:From June 2009 to May 2012,226 chronic renal failure patients treated with PD were nursed using the integrated nursing model.The changes of laboratory indicactors,care indicator compliance rate and cardiac imaging were observed within 1 year,and the incidence rate of peritonitis was analyzed.Results:Compared to the day of discharge,the serum levels of Alb,TP,Hb and Cr increased,and the level of serum phosphorus decreased in PD patients at 3,6 and 12 months of treatment(P<0.05 to P<0.01).Compared with at 3 months of treatment,the serum level of Alb in PD patients significantly increased at 12 months of treatment(P<0.01).The incidence rate of peritonitis from 2010 to 2012 were 1/37.7,1/56.5 and 1/75.3 times a month in patients,respectively,and the incidence rate of which showed downward trend.Compared to the day of discharge,the change of left atrial diameter in PD patients was not obvious with in 1 year of treatment(P>0.05).The cardiothoracic ratio,right ventricular diameter,and interventricular septal thickness increased at 3,6,and 12 months of treatment(P<0.05 to P<0.01).Compared with 3 months of treatment,the cardiothoracic ratio at 6 and 12 months of treatment increased,and the right ventricular diameter increased 12 months of treatment(P<0.01).The self-care skills,self-care responsibility,self-concept,health knowledge and total score of the patients gradually increased during the 1 year of treatment,and the differences among different time points were statistically significant(P<0.01),those at 3,6 and 12 months of treatment were higher than that on the day of discharge,and those in 6 months and 12 months of treatment were higher than that at 3 months of treatment(P<0.01).Conclusions:The integrated nursing management model in the application of PD patients has important clinical significance,which can effectively improve the quality of life and self-efficacy of patients.