基于行为转变理论的护理干预对维持性血液透析患者饮食管理依从行为及营养状况的影响

Effect of nursing intervention based on behavior change theory on compliance behavior and nutritional status of diet management in maintenance hemodialysis patients

目的探讨基于行为转变理论的护理干预在维持性血液透析(MHD)患者饮食管理中的应用效果。方法选择2017年1月—2018年12月南京医科大学附属淮安第一医院收治的MHD患者112例,根据透析时间分为实验组(2018年1—12月)、对照组(2017年1—12月),各56例。对照组给予常规饮食管理干预,实验组联合应用基于行为转变理论干预。干预6个月后,比较两组饮食管理依从行为、血清营养学指标、营养状况。结果两组患者液体限制等饮食管理依从行为评分明显高于同组干预前(P<0.05或P<0.01),实验组液体限制、摄钾管理、自我护理、面对困难评分明显高于对照组,差异有统计学意义(P<0.05或P<0.01);两组患者血清总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)营养学指标明显高于同组干预前(P<0.05或P<0.01),且实验组TP、ALB、PA水平明显高于对照组,差异有统计学意义(P<0.05);实验组营养不良发生率明显低于对照组,差异有统计学意义(P<0.05)。结论基于行为转变理论的护理干预有助于促进MHD患者饮食管理依从行为的养成,改善血清营养学指标,减少血液透析过程中营养不良发生率。

Objective To explore the effect of nursing intervention based on behavior change theory in diet management of maintenance hemodialysis patients(MHD).Methods A total of 112 patients with MHD admitted to the Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University from January 2017 to December 2018 were selected.According to the dialysis time,they were divided into treatment group(January to December 2018)and control group(January to December 2017),with 56 cases in each group.The control group was given routine diet management intervention,and the treatment group was combined with intervention based on behavior change theory.Followed up for six months,the diet management compliance behavior,serum nutrition index and nutritional status of the two groups were compared.Results The scores of dietary management compliance such as fluid restriction in the two groups were significantly higher than that before intervention in the same group(P<0.05 or P<0.01).The scores of fluid restriction,potassium uptake management,self-care and difficulties in the treatment group were significantly higher than those in the control group,with statistically significant differences(P<0.05 or P<0.01).The nutritional indexes of total protein(TP),albumin(ALB)and prealbumin(PA)in the two groups were significantly higher than those before intervention(P<0.05 or P<0.01);TP,ALB and PA levels in treatment group were significantly higher than those of the control group,and the differences were statistically significant(P<0.05);the incidence of malnutrition in the treatment group was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion The nursing intervention based on behavior change theory is helpful to promote the formation of MHD patients’diet management compliance behavior,improve serum nutrition indicators,and reduce the incidence of malnutrition during hemodialysis.