中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (05): 353-358.doi: 10.3969/j.issn.1671-4091.2017.05.019

• 护理研究 • 上一篇    下一篇

基于Omaha系统的延续性护理模式对维持性血液透析患者行为依从性和钙磷代谢的影响

罗怡欣1,黄燕林1   

  1. 1. 广西医科大学第一附属医院肾内科
  • 收稿日期:2016-11-30 修回日期:2017-03-29 出版日期:2017-05-12 发布日期:2017-05-19

The effects of Omaha system on treatment compliance and calcium and phosphorus metabolism in maintenance hemodialysis patients

  • Received:2016-11-30 Revised:2017-03-29 Online:2017-05-12 Published:2017-05-19

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摘要： 目的探讨基于Omaha 系统的延续性护理模式对终末期肾病维持性血液透析(maintenance hemodialysis，MHD)患者行为依从性和钙磷代谢的影响。方法选取于2015 年9 月～2016 年9 月在广西医科大学第一附属医院血液透析中心进行维持性血液透析(maintenance hemodialysis，MHD)的80 名患者作为研究对象，为避免组间沾染，根据患者透析日程分为实验组和对照组各40 例，对照组接受常规护理，实验组在常规护理的基础上接受奥马哈系统延续护理模式干预。比较干预前和干预6 个月后2 组患者治疗依从性量表得分、每日液体摄入量、每日食盐摄入量、主观综合评估量表(subjective global assessment,SGA)得分、血清白蛋白(serum albumin,ALB)、前白蛋白(prealbumin,PA)、血红蛋白(hemoglobin, Hb)、三酰甘油(triacylglyceride,TAG)、总胆固醇(total cholesterol,TC)、低密度脂蛋白 (low density lipoprotein,LDL)、高密度脂蛋白(high density lipoprotein,HDL)、钙(calcium，Ca)、磷(phosphorus,P)、血清肌酐(serum creatinine,Scr)、血尿素氮(blood urea nitrogen,BUN)、尿素清除指数(urea clearance index,Kt/V)以及急性并发症发生率等指标的变化情况。结果干预前2 组患者以上指标差异均无统计学意义(P＞0.05)，干预6 个月后，实验组患者依从性量表得分(饮食依从：t=4.903,P=0.000；液体摄入依从：t=2.630,P =0.010；用药依从：t=3.491,P=0.001；透析方案依从：t=3.510,P=0.001)高于对照组，SGA 量表得分(t=-2.615,P =0.011)、液体摄入量(t=-5.443,P =0.000)、食盐摄入量(t=-5.160,P =0.000)、血磷(P)(t=2.183, P= 0.032)、Scr(t=-2.563,P=0.012)、BUN(t=-2.277, P=0.025)、急性并发症发生率(t=4.013,P=0.045)减少，PA(t=2.263,P =0.026)、HB(t=2.047,P =0.044)、Ca (t= 2.183, P=0.032)、Kt/V(t=1.991,P =0.050)增加，与对照组比较差异有统计学意义。结论Omaha 系统延续性护理模式能够有效提高维持性血液透析患者行为依从性，改善患者营养状态和透析充分性，维持钙、磷平衡，减少相关并发症发生率。

关键词: Omaha系统, 血液透析, 依从性, 钙磷代谢

Abstract: Objective To explore the effects of Omaha system on treatment compliance and calcium and phosphorus metabolism in maintenance hemodialysis (MHD) patients. Methods A total of 80 patients were enrolled in this survey. They were divided into intervention group (n=40) and control group (n=40) according to date of the dialysis. The intervention group accepted Omaha system care, while the control group was only provided regular care. The Treatment Compliance Scale scores, daily fluid intake, daily salt intake, subjective global assessment (SGA) scores, serum albumin (Alb), prealbumin (PA), hemoglobin (Hb), triacylglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), Ca and P were compared before and after intervention between the two groups. Results Before intervention, the Treatment Compliance Scale scores, daily fluid intake, daily salt intake, SGA scores, Alb, PA, Hb, TG, TC, LDL, HDL, Ca and P were not significantly different between the two groups (P＞0.05). After the intervention, the intervention group had higher Treatment Compliance Scale scores (t=4.903, P=0.000 for diet compliance; t=2.630, P=0.010 for liquid intake compliance; t=3.491, P=0.001 for medication compliance; t=3.510, P=0.001 for dialysis treatment compliance), and lower daily fluid intake (t=-5.443, P=0.000) and daily salt intake (t=-5.160, P=0.000) as compared with those of control group. Patients in intervention group also had a better nutritional statue (t=-2.615, P=0.011 for SGA; t=2.263, P=0.026 for PA; t=2.047, P=0.044 for Hb) and improved calcium (t=2.183, P=0.032) and phosphorus metabolism (t=2.183, P=0.032), Scr (t=-2.563, P=0.012), BUN (t=-2.277, P=0.025) and Kt/V (t=1.991, P=0.050) than those of control group. Conclusion Omaha system can effectively improve treatment compliance and calcium and phosphorus metabolism in MHD patients, thus deserves further application.

Key words: Omaha system, maintenance hemodialysis, compliance, calcium and phosphorus metabolism