维持性血液透析患者运动康复的循证实践

Evidence-based practice of exercise rehabilitation in maintenance hemodialysis patients

目的基于维持性血液透析患者运动康复的证据,实施循证实践,并验证其在改善维持性血液透析患者机体功能、运动耐力和生活质量中的作用。方法基于证据的持续质量改善模型为研究框架,于2021年1月~12月通过证据获取、现状审查、证据引入,构建维持性血液透析患者运动康复的循证方案;选取2022年1月~3月在江苏省中医院肾内科住院且维持性血液透析患者80例,随机分为试验组和对照组,各40例,比较运动干预后2组患者肌肉质量、肌肉力量、6分钟步行试验、生活质量指标的差异,同时比较循证实践前后医务人员对运动康复证据的知晓率变化。结果最终纳入9条证据,共7条审查指标。运动干预后,试验组较对照组患者肌肉质量提高(t=-3.302,P<0.01)、肌肉力量提升(t=-2.825,P<0.001)、6分钟步行增加(t=-5.529,P<0.001);试验组健康调查简表各维度总分均较对照组提高(P<0.05);循证实践前后医护人员运动康复证据的知晓率提高40.74%,差异有统计学意义(P<0.001)。结论基于证据的运动康复循证实践能够改善维持性血液透析患者机体功能、运动耐力,提高生活质量。

Objective To implement evidence-based practice based on the evidences from exercise rehabilitation in maintenance hemodialysis(MHD)patients,and to validate the role of exercise rehabilitation in improving physical function,exercise tolerance,and quality of life in MHD patients.Methods The evidence-based continuous quality improvement model was used as the research framework,and an evidence-based program for exercise rehabilitation in MHD patients was conducted from January to December 2021 through evidence acquisition,status review and evidence introduction.A total of 80 MHD patients hospitalized in the Department of Nephrology,Jiangsu Provincial Hospital of Traditional Chinese Medicine from January to March 2022 were then recruited and randomly divided into experimental group(n=40)and control group(n=40).After the exercise intervention,the muscle mass,muscle strength,6-minute walking test,and quality of life were compared between the two groups.The awareness of sport rehabilitation evidence in medical staff was also compared before and after the evidence-based practice.Results Nine pieces of evidences were finally included,with a total of seven reviewed indicators.After exercise intervention,muscle mass(t=-3.302,P<0.01),muscle strength(t=-2.825,P<0.001),and 6-minute walking(t=-5.529,P<0.001)increased more in experimental group than in control group.The total scores of each dimension in the Health Survey Short Form increased more in experimental group than in control group(P<0.05).The awareness rate of sport rehabilitation evidence among medical staff increased by 40.74% before and after evidence-based practice,which has a statistical significance(P<0.001).Conclusion The evidence-based exercise rehabilitation practice can improve the body function,exercise endurance and quality of life in MHD patients.