基于网络的自我管理模式预防肾病综合征患者肾静脉血栓发生的效果研究

Effects of web-based self-management model on preventing renal vein thrombosis in patients with nephrotic syndrome

目的探讨基于网络的自我管理模式在预防肾病综合征(NS)患者发生肾静脉血栓(RVT)中的应用效果。方法采用便利抽样法,选择2017年6月—2018年6月于郑州大学第一附属医院收治的NS患者126例为研究对象,采用抓阄法随机分为常规管理组64例和网络自我管理组62例。常规管理组给予常规的出院指导,网络自我管理组在常规干预的基础上,实施全方位的基于网络的自我管理模式,包括开设宣教网页、建立微信群及基于电信网络进行短信和电话提醒等。出院6个月后门诊收集两组患者RVT发生情况,出院当天和出院6个月后采用自我效能测量表和健康促进生活方式量表(HPLP-II)评价两组患者的自我管理效能水平和健康行为状况。结果网络自我管理组(1例失访)发生RVT患者1例,常规管理组(4例失访)发生RVT患者8例,网络自我管理组RVT发生率1.64%,低于常规管理组的发生率13.33%,差异有统计学意义(χ^2=6.008,P=0.014);出院6个月后,常规管理组和网络自我管理组患者自我效能测量表2个维度评分和总分均升高,且网络自我管理组均高于常规管理组,差异有统计学意义(P<0.01);与出院当天相比,出院6个月后两组患者HPLP-II量表各维度评分均升高,差异有统计学意义(P<0.01),且网络自我管理组评分较常规管理组高,差异有统计学意义(P<0.01)。结论基于网络的自我管理模式可以降低NS患者RVT的发生率,并提高患者的自我管理效能,改善健康行为状况,提高患者院外自我管理水平。

Objective To explore the effects of web-based self-management model on preventing renal vein thrombosis(RVT)in patients with nephrotic syndrome(NS).Methods Totally 126 NS patients hospitalized in the First Affiliated Hospital of Zhengzhou University from June 2017 to June 2018 were selected by convenient sampling and divided into conventional management group(n=64)and web-based self-management group(n=62)by random draw.Patients in the conventional management group received routine discharge guidance,while patients in the web-based self-management group received comprehensive web-based self-management based on routine nursing,including education webpage,WeChat group,and SMS and phone alerts based on the telecommunications network.The incidence of RVT in the two groups was collected in the outpatient clinic 6 months after discharge.The Self-Efficacy Scale and Health Promoting Lifestyle Profile(HPLP-II)were used to evaluate the self-management efficacy and health behavior of the two groups on the day of discharge and 6 months after discharge.Results One cases of RVT occurred in the web-based self-management group(1 case was lost to follow-up),and 8 cases of RVT occurred in the conventional management group(4 cases were lost to follow-up).The incidence of RVT in the web-based self-management group was 1.64%,lower than 13.33%in the conventional management group,and the differences were statistically significant(χ^2=6.008;P=0.014).The scores of two dimensions as well as the total self-efficacy scores increased in both groups 6 months after discharge,and those of the web-based self-management group were higher than those of the conventional management group,and the differences were statistically significant(P<0.01).Compared with the day of discharge,the scores in different HPLP-II dimensions increased in both groups 6 months post discharge,and the differences were statistically significant(P<0.01).The scores of the web-based self-management group were higher than those of the conventional management group,and the differences were statistically significant(P<0.01).Conclusions The web-based self-management model can reduce the incidence of RVT in NS patients,and improve their self-efficacy,health behavior and self-management out of hospital.