动机性访谈在慢性肾病3~4期患者营养管理中的应用  

Application of motivational interviewing on nutrition management among patients with stage Ⅲ-Ⅳchronic kidney disease

作　　者：林萍[1] 刘树军[1] 张瑜[2] 杨哲[3] 

机构地区：[1]吉林大学第二医院肾病内科,长春130041 [2]吉林大学第二医院老年病科,长春130041 [3]吉林大学第二医院放射线科,长春130041

出　　处：《中华现代护理杂志》2015年第8期877-880,共4页Chinese Journal of Modern Nursing

摘　　要：目的：探讨动机性访谈技术在慢性肾病3~4期患者营养管理中应用的效果。方法于2013年3—9月选择在吉林大学第二医院肾病内科门诊接受治疗及复查的慢性肾病3~4期患者64例,根据编号随机分为对照组和观察组各32例,对照组实施常规健康教育,干预组实施动机性访谈健康教育,各干预6个月。采用一般情况评估表、肾脏病患者改良 SGA 评分法、行为改变及自我效能问卷进行调查,比较两组患者干预前后的营养状况以及相关指标的变化情况。结果干预后,观察组患者的营养状况及各营养成分摄入情况均优于对照组,差异有统计学意义（P＜0.05）。干预后,观察组患者的血红蛋白、白蛋白、血钙水平较干预前提高,血肌酐、尿素氮、总胆固醇、甘油三酯、血磷水平均下降,差异均与统计学意义（t 值分别为3.8642,5.6481,11.5730,2.2853,9.1684,6.6541,8.8659,8.2657；P＜0.05）,肾小球滤过率改变差异无统计学意义（t =0.1954,P＞0.05）；对照组的血红蛋白、白蛋白、总胆固醇、甘油三酯、血磷、血钙水平变化差异无统计学意义（P＞0.05）,血肌酐、尿素氮水平升高,肾小球滤过率降低,差异有统计学意义（P＜0.05）。干预后,两组患者的行为改变及自我效能均有所改善,但观察组高于对照组,差异有统计学意义（P＜0.05）。结论动机性访谈提高患者行为改变及自我效能,增加患者饮食改变依从性,有效延缓肾脏病进展。Objective To explore the effect of motivational interviewing on nutrition management among patients with stage Ⅲ-Ⅳ chronic kidney disease. Methods A total of 64 patients with stage Ⅲ-Ⅳ chronic kidney disease were averagely divided into experimental group （routine health education） and control group （ health education of motivational interviewing） by random sequence number for 6 months intervention. We utilized general evaluation scale, SGA improvement scale of kidney patients, behavior change and self-efficacy scale to investigate and compared the change of nutrition status and related indexes before and after intervention. Results After intervention, the nutrition status and nutrition ingredient intake status of experimental group was better than these of the control group （P 〉 0. 05）. Hemoglobin, albumin, total cholesterol, glycerin trilaurate, and serium inorganic phosphorus decreased in the experimental group after intervention （t = 3. 864 2,5. 648 1,11. 573 0, 2. 285 3,9. 168 4,6. 654 1,8. 865 9,8. 265 7, respectively; P 〈 0. 05）, but these of control group had no statistical differences （P 〉 0. 05）. The change of glomerulus filtration rate （GFR） in the experimental group had no statistical difference （ t = 0. 195 4, P 〉 0. 05）. Serum creatinine, usea nitrogen of control group increased, but GFR decreased after intervention （ P 〈 0. 05）. After intervention, behavior change and self-efficacy in both two groups improved and this of experimental group were higher than them in the control group （P 〈 0. 05）. Conclusions The motivational interviewing can enhance patient′s behavior change, self-efficacy, and the compliance of patients′ diet change, and delay the process of kidney disease.

关 键 词：肾病 营养管理 生活质量 动机性访谈 

分 类 号：R473.6[医药卫生—护理学]