延伸护理服务改善维持性血液透析联合腹膜透析患者营养不良状况的应用效果  

Application effect of extended nursing service in improving malnutrition status of patients undergoing maintenance hemodialysis combined with peritoneal dialysis

作　　者：赵静[1] 罗红梅[1] 蒋佳[1] 惠蓉[2] 薛小红[3] Zhao Jing;Luo Hongmei;Jiang Jia;Hui Rong;Xue Xiaohong(Nephropathy Hemodialysis Center,Shaanxi Provincial People′s Hospital,Xi′an 710068,China;Department of Nursing,Shaanxi Provincial People′s Hospital,Xi′an 710068,China;Department of Hemodialysis,Xi′an Jiaotong University First Affiliated Hospital,Xi′an 710061,China)

机构地区：[1]陕西省人民医院肾病血液透析中心,西安710068 [2]陕西省人民医院护理部,西安710068 [3]西安交通大学第一附属医院血液透析科,710061

出　　处：《中国实用护理杂志》2020年第1期16-21,共6页Chinese Journal of Practical Nursing

基　　金：软科学研究计划-面上项目(2017KRM182);陕西省人民医院院内护理科研资助项目(2017HL-01)。

摘　　要：目的探讨延伸护理服务改善维持性血液透析联合腹膜透析患者营养不良状况的应用效果。方法选择2015年3月至2019年3月行维持性血液透析联合腹膜透析营养不良患者124例,利用抽签法将患者分为干预组和对照组各62例。对照组在院透析期间均接受常规专科护理和健康教育,干预组在此基础上接受6个月的延伸护理服务,包括电话随访、知识讲座和微信互动。对2组患者在实施延伸护理服务前1 d、实施延伸护理服务后3个月及6个月分别采用改良主观全面营养评估法(MQSGA)对营养状况进行测评,同时测定体质量指数(BMI)、白蛋白、前白蛋白、血红蛋白、血清钙和血清磷值。结果干预前2组营养状态、BMI、血液指标差异无统计学意义(P>0.05)。干预3个月、6个月后干预组MQSGA评分分别为(13.28±3.99)、(10.17±3.43)分,明显低于对照组的(15.32±3.52)、(14.37±3.73)分,2组比较差异有统计学意义(t=2.946、6.336,P<0.01);BMI分别为(18.29±2.27)、(20.27±2.09)kg/m2,明显高于对照组的(16.41±2.32)、(16.49±2.26)kg/m2,2组比较差异有统计学意义(t=-4.430、-9.372,P<0.01)。干预3个月后干预组白蛋白、前白蛋白、血红蛋白、血清钙、血清无机磷分别为(35.63±4.24)g/L、(277.57±29.52)mg/L、(102.03±11.21)g/L、(2.01±0.19)mmol/L、(1.74±0.37)mmol/L,对照组分别为(33.19±4.89)g/L、(216.81±24.06)mg/L、(92.58±13.79)g/L、(1.91±0.21)mmol/L、(2.05±0.49)mmol/L;干预6个月后干预组分别为(41.49±6.14)g/L、(344.60±30.56)mg/L、(111.34±10.09)g/L、(2.28±0.18)mmol/L、(1.45±0.33)mmol/L,对照组分别为(34.16±4.71)g/L、(218.63±24.85)mg/L、(94.36±11.21)g/L、(1.99±0.24)mmol/L、(1.95±0.41)mmol/L,2组比较差异有统计学意义(t=-24.484~7.220,P<0.01)。结论实施延伸护理服务,可明显改善维持性血液透析联合腹膜透析患者的营养状况。Objective To explore the effect of extended nursing service on malnutrition in patients undergoing maintenance hemodialysis combined with peritoneal dialysis.Methods According to the formula,124 patients with malnutrition in maintenance hemodialysis combined with peritoneal dialysis were divided into intervention group and control group by lottery,62 in intervention group and 62 in control group.The control group received routine specialist nursing and health education during hospital dialysis,while the intervention group received extended nursing services for 6 months,including telephone follow-up,knowledge lectures and Wechat interaction.The nutritional status of two groups of patients was assessed by modified subjective comprehensive nutrition assessment(MQSGA)one day before the implementation of extended nursing service,three months and six months after the implementation of extended nursing service,and the body mass index(BMI),albumin,prealbumin,hemoglobin,serum calcium and serum phosphorus were measured at the same time.Results There was no significant difference in nutritional status,BMI and blood index between the two groups before intervention(P>0.05).After 3 months and 6 months of intervention,MQSGA scores of intervention group were(13.28±3.99),(10.17±3.43)respectively,which were significantly lower than those of control group(15.32±3.52),(14.37±3.73).There were significant differences between the two groups(t=2.946,6.336,P<0.01).After 3 months and 6 months of intervention,BMI was(18.29±2.27),(20.27±2.09)kg/m2,respectively,which were significantly higher than those of control group(16.41±2.32),(16.49±2.26)kg/m2.The difference between the two groups was significant(t=-4.430,-9.372,P<0.01).After 3 months of intervention,albumin,preaalbumin,hemoglobin,serum calcium,and serum inorganic phosphorus in intervention group were(35.63±4.24)g/L,(277.57±29.52)mg/L,(102.03±11.21)g/L,(2.01±0.19)mmol/L,(1.74±0.37)mmol/L;and the control group were(33.19±4.89)g/L,(216.81±24.06)mg/L,(92.58±13.79)g/L,(1.91

关 键 词：血液透析联合腹膜透析 延伸护理 营养不良 社区护理 

分 类 号：R473[医药卫生—护理学]