多学科协作下路径护理对老年糖尿病肾病维持性血液透析肌少症患者的效果  

Effect of multidisciplinary collaborative care for elderly patients with diabetic nephropathy and sarcopenia undergoing maintenance hemodialysis

作　　者：郭志梅 王明明 Guo Zhimei;Wang Mingming(Second Ward Division,Department of Nephrology,Zhoukou Central Hospital,Zhoukou 466000,China;Second Department of Neurology,Zhoukou Central Hospital,Zhoukou 466000,China)

机构地区：[1]周口市中心医院肾内科二病区,周口466000 [2]周口市中心医院神经内二科,周口466000

出　　处：《国际医药卫生导报》2025年第2期208-213,共6页International Medicine and Health Guidance News

基　　金：国家卫生健康委“十四五”规划全国重点课题(YYWS4832)。

摘　　要：目的探讨多学科协作下路径护理对老年糖尿病肾病维持性血液透析肌少症患者自护能力和生活质量的影响。方法选取2021年5月至2023年10月于周口市中心医院就诊的70例老年糖尿病肾病维持性血液透析肌少症患者进行随机对照试验。采用随机数字表法将其分为对照组和观察组,各35例。对照组男16例,女19例,年龄(65.64±5.76)岁,病程(5.47±1.38)个月,透析时间(8.18±1.74)个月。观察组男17例,女18例,年龄(66.87±5.42)岁,病程(5.64±1.23)个月,透析时间(8.96±1.74)个月。对照组实施常规护理,观察组实施多学科协作下路径护理。两组均干预3个月。比较两组患者干预前后血糖和肾功能指标、肌肉和运动能力、生活质量和自护能力以及激惹、抑郁和焦虑量表(IDA)评分。采用t检验进行统计分析。结果干预后,观察组空腹血糖、糖化血红蛋白、血肌酐水平和尿蛋白/肌酐比值分别为(8.05±0.62)mmol/L、(7.25±0.42)%、(54.89±13.37)μmol/L、(58.46±3.52)ml/min,对照组分别为(8.96±0.47)mmol/L、(8.12±0.64)%、(75.06±14.49)μmol/L、(55.63±2.64)ml/min,差异均有统计学意义(t=6.920、6.724、6.052、3.805,均P<0.05)。干预后,观察组日常步行速度、优势手握力分别为(1.26±0.33)m/s、(25.34±3.24)kg,对照组分别为(1.02±0.27)m/s、(22.38±2.76)kg,差异均有统计学意义(t=3.330、4.114,均P<0.05)。干预后,观察组世界卫生组织生存质量测定简表、自我护理能力测定简表评分均高于对照组[(56.46±6.38)分比(48.63±5.91)分、(135.36±13.54)分比(126.35±13.45)分],差异均有统计学意义(t=5.326、2.793,均P<0.05)。干预后,观察组负性情绪4个维度(外向刺激、内向刺激、焦虑、抑郁)得分及总分均低于对照组[(4.32±1.44)分比(5.16±1.33)分、(4.25±1.52)分比(5.45±1.46)分、(7.21±1.56)分比(8.36±1.37)分、(6.61±1.35)分比(8.15±1.32)分、(21.56±3.27)分比(25.62±2.96)分],差异均有统计学意义(t=2.535、3.3Objective To investigate the effect of multidisciplinary collaborative care on self-care ability and quality of life in elderly patients with diabetic nephropathy and sarcopenia undergoing maintenance hemodialysis.Methods Seventy elderly patients with diabetic nephropathy and sarcopenia undergoing maintenance hemodialysis at Zhoukou Central Hospital from May 2021 to October 2023 were selected for the randomized controlled trial,and were divided into a control group and an observation group by the random number table method,with 35 cases in each group.There were 16 men and 19 women in the control group;they were(65.64±5.76)years old;their disease course was(5.47±1.38)months;their dialysis time was(8.18±1.74)months.There were 17 men and 18 women in the observation group;they were(66.87±5.42)years old;their disease course was(5.64±1.23)months;their dialysis time was(8.96±1.74)months.The control group took routine nursing care,while the observation group multidisciplinary collaborative care.Both groups were intervened for 3 months.The blood glucose and renal function indicators,muscle and exercise ability,quality of life,self-care ability,and scores of Irritability,Depression,and Anxiety Scale(IDA)were compared between the two groups before and after the intervention by t test.Results After the intervention,the levels of fasting blood glucose,glycosylated hemoglobin,and serum creatinine and urine albumin-to-creatinine ratio in the observation group were better than those in the control group[(8.05±0.62)mmol/L vs.(8.96±0.47)mmol/L,(7.25±0.42)%vs.(8.12±0.64)%,(54.89±13.37)μmol/L vs.(75.06±14.49)μmol/L,and(58.46±3.52)ml/min vs.(55.63±2.64)ml/min],with statistical differences(t=6.920,6.724,6.052,and 3.805;all P<0.05).After the intervention,the daily walking speed and hand grip strength in the observation group were better than those in the control group[(1.26±0.33)m/s vs.(1.02±0.27)m/s and(25.34±3.24)kg vs.(22.38±2.76)kg],with statistical differences(t=3.330 and 4.114;both P<0.05).After the interventi

关 键 词：糖尿病肾病 多学科协作 维持性血液透析 肌少症 自护能力 

分 类 号：R47[医药卫生—护理学]