叙事医学对老年慢性肾脏病患者的干预效果

Intervention analysis of narrative medicine in the nursing of elderly patients with chronic kidney disease

目的探讨叙事医学在老年慢性肾脏病(CKD)患者护理中的干预效果。方法采用前瞻性随机对照分析,研究对象纳入2021年2月至2023年1月医保内科/老年医学科收治的110例老年CKD患者,分为对照组和干预组,每组55例。对照组患者给予常规护理干预,干预组在此基础上采用叙事医学护理干预,比较2组患者护理前、护理后焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、欧洲五维健康量表(EQ-5D)评分及肾脏病和生活质量问卷(KDQOL-36)评分。结果干预前,2组患者SAS、SDS、EQ-5D、EQ-VAS、KDQOL-36评分比较,差异无统计学意义(P>0.05);干预后,干预组SAS、SDS评分低于对照组(P<0.05);干预组EQ-5D效用值、EQ-VAS评分高于对照组(P<0.05);干预组肾病影响、肾病负担评分明显低于对照组,社交质量、认知功能评分高于对照组(P<0.05)。结论叙事医学护理干预在老年CKD患者护理中的干预效果较好,可明显缓解患者负面情绪,改善健康状况及肾病相关负担水平,提高生活质量。

Objective To explore the intervention effect of narrative medicine on the nursing of elderly patients with chronic kidney disease(CKD).Methods It was a prospective randomized controlled analysis involving 110 elderly CKD patients admitted to Department of Medical Insurance/Geriatric Medicine from February 2021 to January 2023.They were randomly divided into the control group and intervention group,with 55 patients per group.Patients in both groups were given routine nursing intervention,and those in the intervention group were additionally given nursing care based on narrative medicine.The scores of the Self-rating Anxiety Scale(SAS),the Self-rating Depression Scale(SDS),European quality of life 5 dimensions(EQ-5D)and the Kidney Disease Quality of Life 36-Item(KDQOL-36)before and after intervention were compared between the two groups.Results Before intervention,there were no significant differences in the SAS,SDS,EQ-5D,the EQ visual analogue scale(EQ-VAS)and KDQOL-36 scores between the two groups(P>0.05).After intervention,SAS and SDS scores in the intervention group were significantly lower than those of the control group(P<0.05),while the EQ-5D utility value and EQ-VAS score were significantly higher(P<0.05).The scores of nephrotic influence and burden in the intervention group were significantly lower than those of the control group,while the scores of social quality and cognitive function were significantly higher(P<0.05).Conclusion Nursing care based on narrative therapy has a good efficacy on elderly CKD patients,which can significantly alleviate the negative emotions and CKD-associated burden level,and improve the health status and the quality of life.