基于Donabedian质量理论的护理干预在行血管通路术的血液净化患者中的应用效果分析

Effects of nursing intervention based on Donabedian quality theory in blood purification patients undergoing vascular access

目的:分析基于Donabedian质量理论的护理干预对行血管通路术血液净化患者的干预效果。方法:采用便利抽样法,选取2017年7月—2019年5月郑州大学第一附属医院收治的120例行血管通路术的血液透析患者,采用随机数字表法分为对照组和观察组,每组60例。对照组采用常规护理干预,观察组采用基于Donabedian质量理论的护理干预,两组均干预3个月。比较两组的血管通路构成比以及干预前后的营养状况和干预后尿素清除指数(Kt/V)和尿素下降率(URR)、再循环发生率、血管通路并发症发生率。结果:观察组的中心静脉导管通路比例(10.00%,6/60)低于对照组(25.00%,15/60),差异有统计学意义(P<0.05)。干预后,两组的白蛋白、血红蛋白、前白蛋白水平高于干预前,观察组干预后的白蛋白、血红蛋白、前白蛋白水平高于对照组,差异均有统计学意义(P<0.05)。干预后,观察组患者的透析后Kt/V和URR均高于对照组,再循环发生率(10.00%,6/60)低于对照组(21.67%,13/60),血管通路并发症发生率(5.00%,3/60)低于对照组(16.67%,10/60),差异均有统计学意义(P<0.05)。结论:基于Donabedian质量理论的护理干预应用于血液净化患者血管通路术中能改善患者的营养状况和凝血功能,降低并发症的发生率,值得推广使用。

Objective To explore the effect of nursing intervention based on Donabedian quality theory in blood purification patients undergoing vascular access.Methods From July 2017 to May 2019,convenience sampling was used to select 120 hemodialysis patients undergoing vascular access who were admitted to the First Affiliated Hospital of Zhengzhou University.All patients were divided into control group and observation group with the method of random number table,with 60 cases in each group.Control group carried routine nursing,and observation group implemented nursing intervention based on Donabedian quality theory,both of which were treated for three months.The composition ratio of vascular access,nutritional status before and after nursing intervention,urea clearance index(Kt/V)and urea decline rate(URR),incidence of recirculation,and incidence of vascular access complications after nursing intervention were compared between two groups.Results The proportion of central venous catheter access in observation group(10.00%,6/60)was lower than that in control group(25.00%,15/60),and the difference was statistically significant(P<0.05).After intervention,the albumin,hemoglobin,and prealbumin levels of two groups were higher than those before intervention,and the albumin,hemoglobin and prealbumin levels of observation group after intervention were higher than those of control group,and the differences were statistically significant(P<0.05).After intervention,post-dialysis Kt/V and URR of observation group were higher than those of control group,and the incidence of recirculation(10.00%,6/60)was lower than at of control group(21.67%,13/60),and the incidence of vascular access complications(5.00%,3/60)was lower than that of control group(16.67%,10/61),and the differences were statistically significant(P<0.05).Conclusions Nursing intervention based on Donabedian quality theory applied to blood purification patients undergoing vascular access can improve the nutritional status and coagulation function of patients,reduce the incidence of complications which is worthy of popularization.