维持性血液透析患者透析期间饮食管理循证实践及效果评价

Evidence-based practice and effect evaluation of diet management in patients with Maintenance Hemodialysis during hemodialysis

目的:构建维持性血液透析患者透析期间饮食管理方案并评价应用效果。方法:以渥太华研究应用模式为指导,根据现场审查确定方案构建的促进和障碍因素,从基于证据的变革、潜在采纳者及实践环境3个方面构建循证实践方案,通过两轮循证实践,完善维持性血液透析患者透析期间饮食管理方案并评价应用效果。结果:经过两轮临床证据转化实践,在系统方面,组建了多学科协作团队,逐步建立并完善饮食管理方案,开展流程及培训方案;在潜在采纳者方面,医生、护士的饮食管理执行率有提升;在患者方面,透析期间低血压及其他并发症发生率下降,营养指标提升,血清磷水平下降。结论:应用维持性血液透析患者透析期间饮食管理方案有利于降低患者透析期间低血压的发生率,改善钙磷代谢及营养状态,该方案具有临床推广应用价值。

Objective:To construct a diet management program for the patients with Maintenance Hemodialysis(MHD)and evaluate its effects during dialysis.Methods:The Ottawa Model of Research is used as a guidance,the promotions factors and obstacles were determined according to the on-site review,and the evidence-based practice program was constructed from three aspects:evidence-based changes,potential adopters and practice environment.The Diet management program for patients with MHD during dialysis was improved and the effects were evaluated by two rounds of evidence-based practice.Results:After two rounds of practice of clinical evidence translation,a multidisciplinary collaborative team has been formed,the diet management implementation has improved,and the incidence of hypotension and other complications decreased,nutritional indexes increased and blood phosphorus decreased during dialysis.Conclusion:The application of dietary management program in MHD patients during dialysis is beneficial to reduce the incidence of hypotension,improve calcium and phosphorus metabolism and nutritional status,and this program has clinical application value.