糖尿病肾病维持性血液透析患者便秘的影响因素及护理分析

Influencing factors and nursing analysis of constipation in maintenance hemodialysis patients with diabetes nephropathy

目的分析糖尿病肾病维持性血液透析患者发生便秘的危险因素,并探讨有效的护理措施。方法回顾性分析驻马店市中心医院2020年1月-2022年7月收治的138例糖尿病肾病患者的临床资料,均实施维持性血液透析治疗,根据便秘的发生情况分为发生便秘组(57例)与未发生便秘组(81例)。整理汇总两组患者的临床资料信息,并进行对比统计分析,然后进行多因素Logistic回归分析,以筛选出影响糖尿病肾病维持性血液透析患者发生便秘的危险因素。结果138例糖尿病肾病长期行维持性血液透析患者中,便秘的发生率为41.30%(57/138);且发生便秘组年龄≥60岁、透析方式为血液透析+血液透析滤过、透析龄>60个月、以肉类饮食为主、未规律运动的患者占比与Kt/V、血清硫酸吲哚酚水平均高于未发生便秘组;血清甲状旁腺激素水平低于未发生便秘组(均P<0.05),两组性别、每周透析时间、使用碳酸钙、铁剂、体质量指数及血清生化指标(钙、磷、钾、血红蛋白、总蛋白)等资料比较,无明显差异(P>0.05)。以糖尿病肾病患者长期维持性血液透析发生便秘作为因变量,回归分析,结果显示,年龄大(OR=1.762,95%CI:1.477-6.144)、硫酸吲哚酚蓄积(OR=1.280,95%CI:1.276-1.954)均为便秘发生的危险因素(P<0.05);而运动(OR=0.526,95%CI:0.205-0.623)、高水平Kt/V(OR=0.706,95%CI:0.489-0.979)、透析龄短(OR=0.237,95%CI:0.026-0.559)均为保护因素(P<0.05)。结论糖尿病肾病长期行维持性血液透析患者便秘发生率较高,年龄大、硫酸吲哚酚蓄积为危险因素,而规律运动、高水平Kt/V、透析龄短为保护因素,临床应密切关注患者是否存在上述的情况,及时予以针对性的护理干预,以降低便秘的发生,减少透析并发症,提升患者生存质量。

Objective To analyze the risk factors of constipation in patients with diabetes nephropathy and undergoing maintenance hemodialysis,and to explore effective nursing measures.Methods The clinical data of 138 patients with diabetes nephropathy admitted to Zhumadian central Hospital from January 2020 to July 2022 were retrospectively analyzed.All patients were treated with maintenance hemodialysis.According to the occurrence of constipation,they were divided into constipation group(57 cases)and non constipation group(81 cases).The clinical data of two groups of patients were collected and summarized,and statistical analysis was carried out.Then,multiple factor logistic regression analysis was carried out to screen out the risk factors affecting constipation in maintenance hemodialysis patients with diabetes nephropathy.Results The incidence of constipation was 41.30%(57/138)in 138 patients with diabetes nephropathy who underwent long-term maintenance hemodialysis.The proportion of patients with constipation,KT/V,and serum indole phenol sulfate levels were higher than those without constipation,who were≥60 years old,who had hemodialysis combined with hemodialysis filtration,who were carried out dialysis more than 60 months,who had meat diet and did not exercise regularly.The level of serum parathyroid hormone was lower than that of the group without constipation(all P<0.05).With constipation in long-term maintenance hemodialysis patients with diabetes nephropathy as the dependent variable,regression analysis showed that older age(OR=1.762,95%CI:1.477-6.144)and indophenol sulfate accumulation(OR=1.280,95%CI:1.276-1.954)were the risk factors for constipation(P<0.05).While exercise(OR=0.526,95%CI:0.205-0.623),high level Kt/V(OR=0.706,95%CI:0.489-0.979),and short dialysis age(OR=0.237,95%CI:0.026-0.559)were all protective factors(P<0.05).Conclusion The incidence of constipation in patients with diabetes nephropathy undergoing long-term maintenance hemodialysis is high.Older age and accumulation of indolyl sulfate are risk factors,while regular exercise,high level of Kt/V and short dialysis age are protective factors.Clinicians should pay close attention to whether the above situation exists in patients,and timely targeted nursing intervention should be given to reduce the occurrence of constipation,reduce dialysis complications and improve the quality of life of patients.