集束化护理在ANCA相关性血管炎肾损害患者中的应用

Application of cluster nursing in patients with anti-neutrophil cytoplasmic antibodies-associated vasculitis and renal impairment

目的探讨集束化护理在抗中性粒细胞胞质抗体(ANCA)相关性血管炎肾损害患者中的应用效果。方法前瞻性选取2022年1月至2023年6月郑州大学第一附属医院收治的110例ANCA相关性血管炎肾损害患者作为研究对象,按随机数表法分为观察组和对照组各55例。对照组患者采用常规护理,观察组患者在常规护理的基础上给予集束化护理。两组患者均护理至出院,比较两组患者护理前和出院时的血压、平均动脉压、血红蛋白(Hb)和C反应蛋白(CRP)水平和肾功能恢复情况[包括尿素氮(BUN)、血清肌酐(CR)、尿β_(2)-微球蛋白(β_(2)-MG)、胱抑素C(Cys-C)、肾小球滤过率(GFR)情况];比较两组患者护理前和出院时的汉密尔顿抑郁量表(HAMD)评分变化;出院时,统计两组患者的不良反应发生率,并采用自制调查问卷调查两组患者出院时的护理满意度。结果出院时,两组患者的收缩压、舒张压、平均动脉压、Hb、CRP均下降,且观察组明显低于对照组,差异均有统计学意义(P<0.05);出院时,两组患者的Cys-C、GFR均升高,且观察组患者的Cys-C、GFR分别为(792.12±43.83)μg/L、(33.32±4.36)g/L,明显高于对照组的(666.94±57.94)μg/L、(32.34±4.35)g/L,BUN、CR、β_(2)-MG均降低,且观察组患者的BUN、CR、β_(2)-MG分别为(4.02±1.33)mmol/L、(328.25±120.55)mmol/L、(0.14±0.04)mmol/L,明显低于对照组的(4.95±2.73)mmol/L、(420.42±130.38)mmol/L、(0.44±0.04)mmol/L,差异均有统计学意义(P<0.05);出院时,两组患者的HAMD评分均降低,且观察组患者的HAMD为(13.24±1.05)分,明显低于对照组的(26.24±3.19)分,差异均有统计学意义(P<0.05);观察组患者的不良反应发生率为10.91%,明显低于对照组的43.64%,护理满意度为98.18%,明显高于对照组的70.91%,差异均有统计学意义(P<0.05)。结论集束化护理应用于ANCA相关性血管炎肾损害患者中,能够控制患者的血压,改善肾功能,改善患者抑郁情绪,同时有助于减少不良反应发生率,提高患者满意度。

Objective To explore the application effect of cluster nursing in patients with anti-neutrophil cytoplasmic antibodies(ANCA)-associated vasculitis and renal impairment.Methods A total of 110 patients with ANCA-related vasculitis with renal impairment admitted to the First Affiliated Hospital of Zhengzhou University from January 2022 to June 2023 were prospectively selected as research objects.They were divided into an observation group and a control group according to random number table method,with 55 patients in each group.The patients in the control group received routine nursing,while the patients in the observation group were given bundled nursing on the basis of the control group.Both groups of patients were cared until discharge.The blood pressure,mean arterial pressure,hemoglobin(Hb),C-reactive protein(CRP)levels,and renal function recovery[including blood urea nitrogen(BUN),serum creatinine(CR),urinaryβ_(2)-microglobulin(β_(2)-MG),cystatin C(Cys-C),and glomerular filtration rate(GFR)]before care and at discharge were compared between the two groups.The changes of Hamilton Depression Scale(HAMD)scores before care and at discharge were compared between the two groups.At discharge,the incidence of adverse reactions between the two groups was counted,and the nursing satisfaction between the two groups was investigated by self-made questionnaire.Results At discharge,systolic blood pressure,diastolic blood pressure,mean arterial pressure,Hb,and CRP of two groups were decreased,and the indexes in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).At discharge,the Cys-C and GFR in two groups were increased,and the Cys-C and GFR in the observation group were(792.12±43.83)μg/L and(33.32±4.36)g/L,respectively,which were significantly higher than(666.94±57.94)μg/L and(32.34±4.35)g/L in the control group;the BUN,CR,andβ_(2)-MG were all decreased,and the BUN,CR andβ_(2)-MG in the observation group were(4.02±1.33)mmol/L,(328.25±120.55)mmol/L,and(0.14±0.04)mmol/L,respectively,significantly lower than(4.95±2.73)mmol/L,(420.42±130.38)mmol/L and(0.44±0.04)mmol/L in the control group;the differences were statistically significant(P<0.05).At discharge,the HAMD score of two groups was decreased,and the HAMD score in the observation group was(13.24±1.05)points,which was significantly lower than(26.24±3.19)points in the control group(P<0.05).The incidence of adverse reactions in the observation group was 10.91%,which was significantly lower than 43.64%in the control group(P<0.05),and the nursing satisfaction was 98.18%,significantly higher than 70.91%in the control group(P<0.05).Conclusion The application of cluster nursing in patients with ANCA-associated vasculitis with renal impairment can control patients'blood pressure,improve kidney function,improve patients'depression,and help reduce the incidence of adverse reactions and improve patients'satisfaction.