5E模式下持续质量改进管理对腹膜透析患者治疗效果和预后的影响

Influence of CQI management on treatment and prognosis of peritoneal dialysis patients under 5E mode

目的分析5E模式下持续质量改进(Continuous quality improvement,CQI)管理对腹膜透析患者治疗效果和预后的影响。方法将我院2020年4-11月收治的86例行腹膜透析治疗的患者按照随机信封法分为观察组和对照组,每组43例;对照组接受CQI护理管理干预,观察组接受5E模式下CQI护理管理干预;记录患者血压、体质量、尿量、钙磷代谢紊乱、并发症和再入院发生率情况;出院前和出院后采用自我管理能力问卷调查表(Self-management ability questionnaire survey,SMBQ)对患者自我管理质量进行评估;采用自我效能量表(General self-efficacy scale,GSES)和肾脏病生活质量表(Kidney disease quality of life scale,KDQOL)对患者出院前和出院后的自我效能和生活质量进行评估;采用焦虑自评量表(Self-rating anxiety scale,SAS)和抑郁自评量表(Self-rating depression scale,SDS)对患者焦虑和抑郁量表进行评。结果治疗后观察组血压、体质量、尿量、血清甲状旁腺激素、高磷血症、高钙血症、低钙血症、血管钙化发生率腹膜炎和再入院发生率显著低于对照组(P<0.05);治疗后观察组自我效能评估均明显高于对照组,且差异有统计学意义(P<0.05);治疗后观察组透析依从性、透析行为、透析知识、透析态度明显高于对照组,且差异有统计学意义(P<0.05);治疗后观察组患者心理健康、躯体健康、肾脏疾病的影响、症状与不适、肾脏负担评分明显高于对照组,治疗后观察组SAS评分和SDS评分显著低于对照组(P<0.05)。结论5E模式下CQI管理对腹膜透析患者干预后可显著提高患者预后质量,降低不良反应发生率,改善患者自我效能、生活质量和心理状态。

Objective To analyze the influence of CQI management on treatment and prognosis of peritoneal dialysis patients under 5E mode.Methods 86 patients with peritoneal dialysis in our hospital from April to November 2020 were randomly divided into the observation group and the control group.The control group received CQI nursing management intervention,and the observation group received CQI nursing management intervention under 5E mode.The blood pressure,body mass,urine volume,calcium and phosphorus metabolism disorder,complications and readmission incidence of patients were recorded.Before discharge and after discharge self-management ability questionnaire survey(SMBQ)was used to evaluate the quality of self-management.Self-efficacy scale(GSEs)and kidney disease quality of life scale(KDQOL)were used to evaluate the self-efficacy and quality of life of patients before and after discharge.Self-rating anxiety scale(SAS)and self-rating depression scale(SDS)were used to evaluate the anxiety and depression of patients.Results After treatment,the blood pressure,body mass,urine volume,Spth,hyperphosphatemia,hypercalcemia,hypocalcemia and vascular calcification of the observation group were significantly lower than that of the control group(P<0.05).The self-efficacy evaluation of the observation group after treatment was significantly higher than that of the control group.After treatment,the dialysis compliance,dialysis behavior,dialysis knowledge and dialysis attitude of the observation group were significantly higher than the control group(P<0.05);After treatment,the scores of mental health,physical health,influence of kidney disease,symptoms and discomfort,and renal burden in the observation group were significantly higher than those in the control group,while the SAS and SDS scores in the observation group were significantly lower than those in the control group(P<0.05).After treatment,the SAS score and SDS score of the observation group were significantly lower than the control group(P<0.05);the incidence of peritonitis and readmission of the observation group was significantly lower than the control group(P<0.05).Conclusion CQI management under 5E mode can significantly improve the quality of prognosis,reduce the incidence of adverse reactions,improve the self-efficacy,quality of life and psychological state of patients with peritoneal dialysis.