临床护理干预对维持性血液透析患者透析充分性的影响研究

Effect of Clinical Nursing Intervention on Dialysis Adequacy of Maintenance Hemodialysis Patients

目的探析临床护理干预对维持性血液透析患者透析充分性的影响。方法方便选择该院2018年3月-2019年3月期间所接收的行维持性血液透析的100例患者,根据动静内瘘距离的不同,将其分为甲、乙两组。甲组于内瘘距离不变条件下,增加血流量,实施常规护理干预;乙组于血流量不变基础上,扩大内瘘距离到10 cm以上,于甲组护理条件下,添加全程式护理干预。比较甲组干预前后血流量与在线尿素清除率(OCM)监测值、乙组干预前后内瘘距离和OCM值及两组血液透析依从率。结果甲组血流量从(245.39±26.71)mL/min增加至(275.12±22.58)mL/min,在此条件下,OCM监测值由(1.15±0.13)升高到(1.49±0.21),干预前后差异有统计学意义(t=5.376、8.707,P=0.000、0.000<0.05);乙组干预前内瘘距离[(6.65±2.78)cm]与干预后[(10.44±2.95)cm]相比,明显扩大,干预前OCM值(1.13±0.08)与干预后(1.45±0.12)相比,有所提高,差异有统计学意义(t=5.913、14.033,P=0.000、0.000<0.05);甲组并发症总发生率为20.00%,显著高于乙组的4.00%,两组间差异有统计学意义(χ~2=6.061,P=0.014<0.05)。结论在增加血流量与扩大内瘘距离条件下,可有效提高维持性血液透析的充分性;于全程式护理干预下,可有效增加患者血液透析依从性。

Objective To analyze the effect of clinical nursing intervention on the dialysis adequacy of maintenance hemodialysis patients. Methods A total of 100 patients who underwent maintenance hemodialysis in the hospital from March 2018 to March 2019 were convenient selected and divided into two groups according to the distance between the static and dynamic fistulas. Group A increased blood flow and performed routine nursing interventions under the condition that the internal fistula distance was unchanged;Group B extended the internal fistula distance to more than 10 cm based on the constant blood flow. Under the condition of group A, added full-program nursing intervention. The blood flow and online urea clearance(OCM) monitoring values before and after intervention in Group A, the distance between internal fistula and OCM values before and after intervention in Group B, and the hemodialysis compliance rate between the two groups were compared. Results The blood flow of group A increased from(245.39±26.71) mL/min to(275.12±22.58)mL/min.Under this condition, the OCM monitoring value increased from(1.15±0.13) to(1.49±0.21). The differences were statistically significant(t=5.376,8.707,P=0.000,0.000<0.05);the distance of the internal fistula [(6.65±2.78)cm] before intervention in Group B was significantly enlarged compared with [(10.44±2.95)cm] after intervention, the OCM value before intervention(1.13±0.08) was improved compared with that after intervention(1.45±0.12), and the difference was statistically significant(t=5.913,14.033,P=0.000,0.000 <0.05);the total complications incidence rate of group A was 20.00%, which was significantly higher than 4.00% in group B. The difference between the two groups was statistically significant(χ~2=6.061, P=0.014 <0.05).Conclusion Under the conditions of increasing blood flow and increasing the distance of internal fistula, the adequacy of maintenance hemodialysis can be effectively improved;with the intervention of full-program nursing, it can effectively increase the patient’s hemodialysis compliance.