费曼式学习法对提高居家腹膜透析患者的自我管理依从性及透析充分性的影响

Effects of Feynman learning method on self-management compliance and dialysis adequacy in patients performing peritoneal dialysis at home

目的探讨费曼式学习法对提高居家腹膜透析患者自我管理依从性及透析充分性的影响。方法抽取2019年1月~2019年6月在陆军军医大学大坪医院肾内科腹膜透析中心行规律门诊随访的居家腹膜透析患者146名和123名为研究组和对照组。对照组采用的是指导型教育法管理,研究组采用费曼式学习法管理方式,半年后对比2组患者自我管理依从性以透析充分性。结果研究组患者饮食依从性态度总分、饮食依从行为总分明显高于对照组(t值分别为4.374,3.055;P值分别为<0.001,0.007);研究组患者2,3级水肿的发生率显著低于对照组(χ^(2)=26.576,P<0.001);研究组患者内生肌酐清除率(creatinine clearance,Ccr)、Ccr达标率、透析充分性指标Kt/V和Kt/V达标率明显优于对照组(t/χ^(2)值分别为3.925,7.065,2.623,5.834;P值分别为0.001,0.011,0.016,0.018)。结论费曼式学习法能提高居家腹膜透析患者的自我管理依从性及透析充分性。

Objective To explore the effects of Feynman learning method on self-management compliance and dialysis adequacy in patients performing peritoneal dialysis(PD)at home.Methods We recruited269(PD)patients performing PD at home and regularly followed-up as the outpatients in the Peritoneal Dialysis Center of our hospital from January 2019 to June 2019.They were divided into research group(n=146)and control group(n=123).Patients in the research group were treated with the Feynman learning method,while those in the control group with the guidance education method.The self-management compliance and dialysis adequacy were compared between the two groups after the treatment for 6 months.Results The total score of diet attitude compliance was higher in the research group than in the control group(85.70±3.13 vs.80.60±5.25,t=4.374,P<0.001),and so was the total score of diet behavior compliance(73.65±4.02 vs.69.30±4.46,t=3.055,P=0.007).The incidence of grade 2 and grade 3 edema in the research group was 10.96%,significantly lower than that in the control group(32.52%,χ^(2)=26.576,P<0.001).The parameters of creatinine clearance(Ccr),compliance rate of Ccr,dialysis adequacy Kt/V value and compliance rate of Kt/V value were all better in the research group than in the control group(67.11±9.65 vs.58.61±10.77,76.71%vs.61.79%,1.83±0.21 vs.1.71±0.23 and 65.75%vs.51.22%respectively;t=3.925,7.065,2.623,andχ^(2)=5.834 respectively;P=0.001,0.011,0.016 and 0.018 respectively).Conclusion The Feynman learning method can improve self-management compliance and dialysis adequacy in patients performing PD at home.