基于聚焦解决模式的肾移植受者自我管理干预方案的构建与应用

Construction and application of a self-management intervention program for kidney transplant recipients based on a focused solution approach

目的构建基于聚焦解决模式的肾移植受者自我管理干预方案,并评价实施效果。方法在前期现状调查的基础上,采用文献检索与专家会议初步拟定方案,并通过预试验形成最终的干预方案。选择2020年9月至2021年6月在遵义医科大学附属医院进行肾脏移植手术的75例受者作为研究对象,采用随机数字表法将患者分为试验组38例和对照组37例,对照组予以常规的肾移植护理,试验组在此基础上实施聚焦解决模式自我管理干预方案。测量两组患者干预前、术后1、3、6个月时自我管理能力、BMI、血压及非计划再入院率并进行评价。结果试验组在1、3、6个月饮食管理、躯体活动管理和社会心理管理得分均高于对照组,试验组6个月时治疗管理得分高于对照组,差异均具有统计学意义(P<0.05);试验组6个月时平均BMI低于对照组,BMI≥24的人数少于对照组,差异具有统计学意义(P<0.05);两组患者收缩压(SBP)、舒张压(DBP)均呈下降趋势,试验组6个月时平均DBP低于对照组,且高血压患病人数少于对照组,差异具有统计学意义(P<0.05);试验组6个月内非计划再入院率低于对照组,差异具有统计学意义(P<0.05)。结论构建基于聚焦解决模式的肾移植受者自我管理干预方案科学可靠,应用该方案能有效提高肾移植受者自我管理能力,使其BMI、血压控制在更合适范围,降低其非计划再入院率,改善患者预后。

Objective To construct a self-management intervention program for kidney transplant recipients based on a focused solution approach,and its application was also evaluated.Methods On the basis of a preliminary status survey,a literature search and expert meeting were combined to initially develop a protocol,and the final intervention protocol was formed by pretesting.Seventy-five kidney transplant recipients from a tertiary care hospital in Guizhou Province,who underwent transplantation between September 2020 and June 2021,were selected as study subjects,and they were randomly divided into experimental group(38 cases)and control group(37 cases).The control group received conventional renal transplant care,while the experimental group received the Focused Solution Approach self-management intervention program in addition to the standard care.The self-management ability,BMI,blood pressure and unplanned readmission rate were measured and evaluated before the intervention,and at the 1st,3rd and 6th months after the operation in both groups.Results The experimental group scored higher than the control group in dietary management,physical activity management and psychosocial management at the 1st,3rd and 6th months,and the experimental group scored higher than the control group in treatment management at the 6th month,all with statistically significant differences(P<0.05);At the 6th month,the experimental group exhibited a lower mean BMI compared to the control group,along with a reduced number of individuals with BMI≥24,demonstrating statistically significant differences(P<0.05).Both groups displayed a decreasing trend in SBP and DBP,and the experimental group had a lower mean DBP than the control group at the 6th month.Additionally,the experimental group had a lower incidence of hypertension compared to the control group,with a statistically significant difference(P<0.05).Moreover,the experimental group demonstrated a lower rate of unplanned readmissions at the 6th month(P<0.05).Conclusion A scientifically sound self-management intervention program based on a focused solution model was built for kidney transplant recipients,and its application can effectively improve the self-management ability,control the BMI and blood pressure to a more appropriate range,reduce the unplanned readmission rate,and improve the prognosis for kidney transplant recipients.