认知负荷理论在维持性血液透析患者体重管理中的应用

Effect of Health Education Based on Cognitive Load Theory on Weight Management of Hemodialysis Patients

目的探究基于认知负荷理论的健康宣教对维持性血液透析(MHD)患者体重管理行为及控制效果的影响.方法纳入广东省阳江市人民医院实施基于认知负荷理论的健康宣教后(2018年7月至2020年1月)MHD患者30例作为观察组,实施基于认知负荷理论的健康宣教前(2017年1月至2018年6月)MHD患者30例作为对照组.比较两组患者健康宣教前后体重管理"知""信""行"问卷评分,依从性评分(每日测量体重、严格限制每日液体摄入、透析当日严格控制饮水量),干体重控制情况[透析间期体重增长/干体重比值(IWGR%)],透析相关并发症发生情况.结果①干预6个月后,对照组患者体重管理"知""信""行"问卷评分较干预前差异无统计学意义(P>0.05),观察组则均较干预前提高(P<0.05),两组差异有统计学意义(P<0.05);②依从性:对照组患者每日测量体重、严格限制每日液体摄入、透析当日严格控制饮水量各项依从性评分较干预前差异无统计学意义(P>0.05),观察组则均较干预前提高(P<0.05),两组差异有统计学意义(P<0.05);③干体重控制情况:观察组IWGR%低于对照组(P<0.05);④透析相关并发症:6个月内,观察组肌肉痉挛、心律失常、高血压、低血压发生率低于对照组(P<0.05).结论基于认知负荷理论的健康宣教可促进MHD患者体重管理认知、态度、行为及治疗依从性改善,提高体重控制效果,减少透析相关并发症.

Objective To explore the effect of health education based on cognitive load theory on weight management behavior and control effect of maintenance hemodialysis(MHD)patients.Methods 30 patients with MHD after the health education based on cognitive load theory(July 2018 to January 2020)were selected as the observation group,and 30 MHD patients before the implementation of health education based on cognitive load theory(January 2017 to June 2018)in Yangjiang People’s Hospital in Guangdong were selected as the control group.The scores of"knowledge","belief"and"practice"of weight management,compliance score(daily measurement of body weight,strict restriction of daily fluid intake,strict control of water intake on the same day of dialysis),dry weight control(weight gain/dry weight ratio(iwgr%)during dialysis)and dialysis related complications were compared between the two groups before and after health education.Results①after 6 months of intervention,there was no significant difference in the scores of"knowledge","belief"and"practice"in the control group compared with those before the intervention(P>0.05),while those in the observation group were higher than those before the intervention(P<0.05),and the difference between the two groups was statistically significant(P<0.05);②compliance:the patients in the control group measured their body weight every day,strictly limited daily liquid intake,and on the day of dialysis The compliance scores of strict control of drinking water volume had no significant difference compared with before intervention(P>0.05),while the observation group was higher than that before intervention(P<0.05),and the difference between the two groups was statistically significant(P<0.05);③dry weight control:the iwgr%of the observation group was lower than that of the control group(P<0.05);④dialysis related complications:within 6 months,the observation group had muscle spasm,arrhythmia,high blood pressure The incidence of blood pressure and hypotension in the control group was lower than that in the control group(P<0.05).Conclusion Health education based on cognitive load theory can improve cognition,attitude,behavior and treatment compliance of MHD patients,improve weight control effect and reduce dialysis related complications.