艾灸联合个案管理延缓慢性肾脏病3~4期进展的效果

Application of Moxibustion Combined with Case Management in Delaying the Progression of Stage 3-4 Chronic Kidney Disease

目的探讨艾灸联合个案管理在慢性肾脏病(chronic kidney disease,CKD)3~4期患者病情控制的应用效果。方法选择上海健康医学院附属嘉定区中心医院2019年1月至2020年4月收治的120例CKD 3~4期患者为研究对象。采用随机数表法分为A组、B组及C组,各40例。A组采用常规干预,B组采用个案管理模式干预,C组采用个案管理模式联合艾灸疗法干预。比较三组干预前后自我管理能力(ESCA评分)、生化指标[血红蛋白(hemoglobin,Hb)、肌酐(serum creatinine,SCr)、血磷、血钾、24 h尿蛋白定量(24 h Upro)]变化及临床满意度。结果干预前,三组ESCA评分、Hb、SCr、血磷、血钾、24 h Upro比较差异均无统计学意义(P均>0.05);干预后,A组ESCA评分、Hb、SCr、血磷、血钾、24 h Upro无明显变化(P均>0.05),B组及C组ESCA评分、Hb均升高,SCr、血磷、血钾、24 h Upro均降低(P均<0.05);C组干预后ESCA评分、Hb均高于A组和B组,SCr、血磷、24 h Upro均低于A组和B组(P均<0.05);B组、C组干预后血钾比较差异无统计学意义(P>0.05);C组干预效果满意度(97.50%)高于B组(80.00%)及A组(50.00%),出院6个月内再入院发生率(57.50%)低于B组(65.00%)及A组(87.50%)(P均<0.05)。结论艾灸联合个案管理可提高CKD 3~4期患者自我管理能力,改善肾功能,延缓病情进展,降低出院后再入院率,临床干预效果满意。

Objective To explore the effect of moxibustion combined with case management in the control of chronic kidney disease(CKD)stage 3-4.Methods A total of 120 patients with CKD stage 3-4 admitted in Jiading Distvict Central Hospital from January 2019 to April 2020 were selected as the research objects.They were randomly divided into group A,group B and group C,with 40 cases in each group.Group A adopted routine nursing,group B adopted case management mode intervention,group C adopted case management mode combined with moxibustion therapy intervention.The changes of self-management ability(ESCA score),biochemical indexes(Hb,SCr,blood phosphorus,blood potassium,24 h Upro)and clinical satisfaction were compared before and after the intervention.Results Before the intervention,there was no significant difference in ESCA score,Hb,SCr,blood phosphorus,blood potassium and 24 h Upro among the three groups(P all>0.05).After intervention,there were no significant changes in ESCA score,Hb,SCr,blood phosphorus,blood potassium and 24 h Upro in group A(P all>0.05);the scores of ESCA and Hb in group B and group C were all increased,and SCr,blood phosphorus,blood potassium and 24 hours Upro decreased(P all<0.05).After intervention,ESCA score and Hb in group C were higher than those in group A and group B,and SCr,blood phosphorus and 24 h Upro were lower than those in group A and group B(P all<0.05);There was no significant difference in blood potassium between group B and group C(P>0.05);The satisfaction rate of intervention effect in group C was 97.50%,higher than 80.00%in group B and 50.00%in group A.The incidence of readmission after 6 months after discharge was 57.50%,lower than 65.00%in group B and 87.50%in group A(P all<0.05).Conclusion Moxibustion combined with case management can significantly improve the self-care and management ability of CKD stage 3-4 patients,improve renal function,delay the progress of the disease,reduce the readmission rate after discharge,and the clinical intervention effect is satisfactory.