摘要目的 探讨行为转变理论模式(transtheoretical model and stages of change,TTM)对维持性血液透析(maintenance hemodialysis,MHD)患者自我管理行为及钙磷水平的影响.方法 将140例MHD患者按照随机数字表分成实验组和对照组各70例,实验组共65例患者完成研究,采用TTM干预,对照组共63例患者完成研究,采用常规护理.采用钙磷代谢相关知识问卷及自我管理量表对2组患者进行测评,并比较2组患者钙磷水平差异.结果 实验组患者自我管理行为在干预后3个月得分高于对照组,其中问题解决、执行自我照顾活动、伙伴关系及情绪处理得分分别为(2.97±0.28)、(2.99±0.28)、(3.13±0.35)、(2.80±0.32)分,明显高于对照组同期的(2.63±0.32)、(2.67±0.38)、(2.76±0.42)、(2.44±0.36)分,t值分别为-9.07、-7.68、-6.03和-8.43,差异有统计学意义,P＜0.05.同样,干预后3个月实验组患者血磷水平、钙磷乘积、甲状旁腺激素明显下降,实验组分别为(1.81±0.49) mmol/L、(55.33±14.45) mg2/dl2、238.00(130.35,413.85) ng/L,明显低于对照组同期的(2.56±0.69) mmol/L、(72.35±20.94) mg2/dl2、297.75(155.02,760.37) ng/L,t值分别为11.01和8.43,Z值为-2.09,差异有统计学意义,P＜0.05.结论 TTM干预有利于促进MHD患者行为改变,提高其自我管理行为,并有助于降低血磷水平.

abstractsObjective To investigate effect of the transtheoretical model and stages of change (TTM) on self-management paradigm,serum calcium and phosphorus levels in patients undergoing maintenance hemodialysis (MHD).Methods Total 140 MHD patients were separated into two groups as the intervention group (65 of 70 cases completed with TTM) and the control group (63 of 70 cases completed with routine nursing care) by random number table.Data obtained by using hyperphosphatemia related knowledge questionnaires and Self-management Rating Scale before and after intervention.The levels of serum calcium and phosphorus between the above groups were compared.Results The scores of self-management behavior were higher in control group after 3 months intervention,the differences was statistically significant (P ＜ 0.05),in which the scores of problem solving (2.97 ± 0.28),self care activities (2.99±0.28),relationships (3.13±0.35) and emotional treatment (2.80 ± 0.32) in experimental group was apparently higher than control group at the same time,the scores were (2.63±0.32),(2.67±0.38),(2.76±0.42),(2.44±0.36) respectively in conrtol group,t values were-0.907,-7.68,-6.03 and-8.43,respectively.And also,there was statistically significant difference between the two groups in serum phosphorus level [(1.81±0.49) mmol/L vs.(2.56±0.69) mmol/L],the product of calcium and phosphorus [(55.33±14.45) mg2/dl2 vs.(72.35±20.94) mg2/dl2],serum parathyroid hormone [238.00 (130.35,413.85) ng/L vs.297.75 (155.02,760.37) ng/L] (t=11.01,8.43,Z=-2.09,P＜0.05).Conclusions TTM is conducive to promote behavior change,improve self-management conduct,and also reduce serum phosphorus level in MHD patients.