基于行为阶段转变理论对腹膜透析患者实施容量管理的效果
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摘要
目的探讨基于行为阶段转变理论的容量管理干预对腹膜透析患者水盐控制的影响。方法将110例腹膜透析患者随机分为观察组和对照组各55例。对照组采用常规护理干预,观察组在常规护理基础上实施基于行为阶段转变理论的多阶段容量管理干预,连续6个月后评价效果。结果干预后观察组容量管理行为显著优于对照组,液体摄入量、食盐摄入量显著低于对照组,食欲减退、水肿、气促、胸闷等症状发生率显著低于对照组,口渴评分、体质量显著低于对照组(P<0.05,P<0.01);两组尿量均逐渐减少;干预前后两组超滤量无明显改变(均P>0.05)。结论基于行为阶段转变理论的容量管理干预能够促进患者容量管理行为转变,提高患者的水盐摄入依从性,改善患者容量状况。
Objective To assess the influence of volume management intervention based on transtheoretical model(stages of change theory) on water-salt control in patients on peritoneal dialysis.Methods Totally,110 patients on peritoneal dialysis were randomly divided into a control group(n=55),who received routine nursing intervention, and an intervention group(n=55), who received volume management intervention based on transtheoretical model(stages of change theory).The effect measures were compared after 6 months.Results After intervention, the intervention group had better volume management behaviors, less fluid intake and salt intake than the control group; the former also had lower incidence rates of anorexia, edema, shortness of breath, chest tightness,etc., and fewer thirsty scores and body weights than the latter(P<0.05,P<0.01). The urine volume of the two groups decreased gradually, and there was no significant difference in ultrafiltration in both groups before and after intervention(P>0.05 for all).Conclusion Volume management intervention based on transtheoretical model(stages of change theory) could strengthen patients′ behavior change of volume management,improve their water and salt adherence,and improve patient volume associated conditions.
Objective To assess the influence of volume management intervention based on transtheoretical model(stages of change theory) on water-salt control in patients on peritoneal dialysis.Methods Totally,110 patients on peritoneal dialysis were randomly divided into a control group(n=55),who received routine nursing intervention, and an intervention group(n=55), who received volume management intervention based on transtheoretical model(stages of change theory).The effect measures were compared after 6 months.Results After intervention, the intervention group had better volume management behaviors, less fluid intake and salt intake than the control group; the former also had lower incidence rates of anorexia, edema, shortness of breath, chest tightness,etc., and fewer thirsty scores and body weights than the latter(P<0.05,P<0.01). The urine volume of the two groups decreased gradually, and there was no significant difference in ultrafiltration in both groups before and after intervention(P>0.05 for all).Conclusion Volume management intervention based on transtheoretical model(stages of change theory) could strengthen patients′ behavior change of volume management,improve their water and salt adherence,and improve patient volume associated conditions.
引文
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[11] 郑蔚,李俊玲,史小艳,等.家属参与式个案管理对糖尿病肾病腹膜透析患者容量负荷和血糖控制的影响[J].广东医学,2014,35(14):2304-2306.
[12] 谌璐,刘云.腹膜透析患者液体摄入依从性研究进展[J].护理学杂志,2014,29(7):95-97.
[13] Magden K,Hur E,Yildiz G,et al.The effects of strict salt control on blood pressure and cardiac condition in end-stage renal disease:prospective-study[J].Ren Fail 2013,35(10):1344-1347.
[14] 赵彩萍,马小琴,王艳,等.糖尿病腹膜透析患者液体摄入健康信念及容量负荷状况研究[J].中国全科医学,2016,19(23):2776-2779.
[15] Ok E.How to successfully achieve salt restriction in dialysis patients?What are the outcomes?[J].Blood Purif,2010,29(2):102-104.
[16] 吕晶,薛武军,尹爱萍,等.容量负荷对腹膜透析患者营养状况的影响研究[J].中国全科医学,2013,16(18):1655-1657.
[17] 王晶,刘宬博,周亦伦,等.个体化健康管理对维持性血液透析患者水钠控制依从性的影响[J].中华护理杂志,2016,51(10):1188-1192.
[18] 侯璐蒙,黄燕林,邹宝林.基于奥马哈系统的个案管理在血液透析患者水盐控制中的应用[J].实用医学杂志,2017,33(16):2795-2798.
[2] 郑庆发,石咏军,刘冠贤.腹膜透析患者容量超负荷问题的研究进展[J].广东医学,2011,32(6):808-811.
[3] 侯璐蒙,黄燕林,滕艳娟,等.基于5E模式的个案管理对腹膜透析患者水盐控制的影响[J].重庆医学,2018,47(7):906-909.
[4] Zhu L X,Ho S C,Sit J W.The effects of a transtheore-tical model-based exercise stage-matched intervention on exercise behavior in patients with coronary heart disease:a randomized controlled trial[J].Patient Educ Couns 2014,95(3):384-392.
[5] Guicciardi M,Lecis R,Anziani C,et al.Type 2 diabetes mellitus,physical activity,exercise self-efficacy,and body satisfaction.An application of the transtheoretical model in older adults[J].Health Psychol Behav Med,2014,2(1):748-758.
[6] 贲洪玲,宋璐璐,任彤.行为分阶段转变理论在老年糖尿病肾病腹膜透析患者健康教育中的应用[J].护理学报,2015,22(4):62-65.
[7] Loprinzi P D,Kane C,Sigler S,et al.Free-living physical activity characteristics,activity-related air trapping and breathlessness,and utilization of transtheoretical constructs in COPD:a pilot study[J].Physiol Behav,2015,152(PtA):79-84.
[8] 王永华,张娅,龚加庆,等.行为分阶段改变理论在保肛术后患者肛门功能训练中的应用[J].护理学杂志,2012,27(10):30-32.
[9] 许义,汪小华,杨益群 .持续非卧床腹膜透析患者容量管理自我体验的质性研究[J].护理学杂志,2016,31(21):40-42.
[10] 许戎,董捷.腹膜透析患者的容量控制——老问题新注解[J].中国血液净化,2014,13(2):109-112.
[11] 郑蔚,李俊玲,史小艳,等.家属参与式个案管理对糖尿病肾病腹膜透析患者容量负荷和血糖控制的影响[J].广东医学,2014,35(14):2304-2306.
[12] 谌璐,刘云.腹膜透析患者液体摄入依从性研究进展[J].护理学杂志,2014,29(7):95-97.
[13] Magden K,Hur E,Yildiz G,et al.The effects of strict salt control on blood pressure and cardiac condition in end-stage renal disease:prospective-study[J].Ren Fail 2013,35(10):1344-1347.
[14] 赵彩萍,马小琴,王艳,等.糖尿病腹膜透析患者液体摄入健康信念及容量负荷状况研究[J].中国全科医学,2016,19(23):2776-2779.
[15] Ok E.How to successfully achieve salt restriction in dialysis patients?What are the outcomes?[J].Blood Purif,2010,29(2):102-104.
[16] 吕晶,薛武军,尹爱萍,等.容量负荷对腹膜透析患者营养状况的影响研究[J].中国全科医学,2013,16(18):1655-1657.
[17] 王晶,刘宬博,周亦伦,等.个体化健康管理对维持性血液透析患者水钠控制依从性的影响[J].中华护理杂志,2016,51(10):1188-1192.
[18] 侯璐蒙,黄燕林,邹宝林.基于奥马哈系统的个案管理在血液透析患者水盐控制中的应用[J].实用医学杂志,2017,33(16):2795-2798.