摘要目的 探讨以协同护理为核心理念的延续性护理对维持性血液透析( Maintenance Hemodia1ysis, MHD)患者生活质量及自我管理行为的影响.方法 2016年1月~2017年8月该中心连续性收集行MHD治疗患者154例的临床资料作为研究对象.根据患者来院透析周的单双日将患者分为对照组与干预组,各77例.对照组行常规护理,干预组在常规护理基础上行以协同护理为核心理念的延续性护理.从生理指标、生活质量评分等方面探讨协同护理模式在MHD患者中的应用价值.结果 ①与体检人群比较,MHD患者生活质量的各个维度得分均显著较低,差异有统计学意义(均P<0. 05).②合并存在抑郁、白蛋白<3. 5g/L、透析≥6年的患者总评得分显著较低,差异有统计学意义(P<0. 05).经济状况对患者生理健康总评无明显影响,但与心理健康总评相关,差异有统计学意义( P<0. 05) ,收入越低,患者心理健康总评得分越低.③干预前,对MHD患者进行自我管理行为评分,4个维度中,得分从高到低依次为伙伴关系维度、自护行为维度、问题解决维度、情绪处理维度.④与对照组比较,干预组患者SBP、SCr、BUN、K+、P3+、HB、AIb等指标在干预后3个月、6个月两个时间点均明显好转,Ca2+仅在干预后6个月才明显好转,差异有统计学意义(P<0. 05).⑤干预组患者生活质量总分、GH、SF、BP、EF、MH等指标在干预后3个月、6个月两个时间点均明显优于对照组,差异有统计学意义(均P<0. 05) .结论抑郁、白蛋白水平、透析年限是影响MHD患者生活质量的主要危险因素.与常规护理比较,改良的协同护理模式可有效地改善患者生理指标、提高患者生活质量与治疗依从性,值得临床推广应用.

abstractsObjective To exp1ore the inf1uence of continuous nursing with co11aborative nursing as the core concept on the qua1ity of 1ife and se1f-management of patients with Maintenance Hemodia1ysis ( MHD) . Methods From January 2016 to August 2017, the center continuous1y co11ected c1inica1 data of 154 patients receiving MHD treat-ment as the research objects. The patients were divided into contro1 group and intervention group according to the sing1e or doub1e days of patients coming to the hospita1 for dia1ysis week, with 77 cases in each group. The contro1 group re-ceived routine nursing, whi1e the intervention group received continuous nursing with co11aborative nursing as the core concept on the basis of routine nursing. The app1ication va1ue of co11aborative nursing mode1 in MHD patients from physi-o1ogica1 indicators, qua1ity of 1ife score and other aspects were disscussed. Results ①Compared with the physica1 ex-amination popu1ation, scores of a11 dimensions of MHD patientsˊqua1ity of 1ife were significant1y 1ower, with statistica11y significant differences (P<0. 05) . ②Patients with depression, a1bumin 1ess than 3. 5g/L, and dia1ysis greater than or equa1 to 6 years had significant1y 1ower overa11 scores, with statistica11y significant differences ( P<0. 05) . Economic status had no significant effect on patientsˊphysica1 hea1th assessment, but it was corre1ated with their menta1 hea1th as-sessment, and the difference was statistica11y significant (P<0. 05). The 1ower the income, the 1ower the menta1 hea1th score. ③Before intervention, MHD patients were scored for se1f-management behavior. Among the four dimensions, the scores were ranked from high to 1ow for partnership, se1f-care behavior, prob1em so1ving and emotiona1 processing ( P<0. 05). ④Compared with the contro1 group, patients in the intervention group showed significant improvement in SBP, SCr, BUN, K+, P3+, HB, AIb and other indicators at the two time points of 3 months and 6 months after the inter-vention, whi1e Ca2+ showed significant improvement on1y at 6 months after the intervention, with statistica11y significant differences (P<0. 05). ⑤The tota1 1ife qua1ity score, GH, SF, BP, EF, MH and other indicators in the interven-tion group were significant1y better than those in the contro1 group at 3 and 6 months after the intervention, with statisti-ca11y significant differences ( P<0. 05) . Conclusion Depression, a1bumin 1eve1 and dia1ysis duration are the main risk factors affecting the qua1ity of 1ife of MHD patients. Compared with conventiona1 nursing, the improved co11abora-tive nursing mode1 can effective1y improve the physio1ogica1 indicators of patients, improve the qua1ity of 1ife of patients and treatment comp1iance, worthy of c1inica1 app1ication.