陳愛(ài)娥 蔣曉珍 彭健韞 翁曉華
[關(guān)鍵詞] 糖尿病腎病;血液透析;優(yōu)質(zhì)化護(hù)理;血肌酐;尿素氮
[中圖分類號(hào)] R473.5? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] B? ? ? ? ? [文章編號(hào)] 1673-9701(2021)23-0173-04
Analysis on the application value of high-quality service in nursing care of elderly patients with diabetic nephropathy undergoing hemodialysis
CHEN Ai′e? ?JIANG Xiaozhen? ?PENG Jianyun? ?WENG Xiaohua
Department of Blood Purification,Lishui People′s Hospital,Lishui? ?323000,China
[Abstract] Objective To explore the application value of high-quality services in the nursing of elderly patients with diabetic nephropathy undergoing hemodialysis. Methods From January 2018 to October 2019,120 elderly patients with diabetic nephropathy undergoing hemodialysis in our hospital were enrolled.The patients were randomly divided into two groups of 60 cases each (random number table method).The control group was given routine nursing care,and the observation group was given high-quality nursing care.The treatment compliance,blood glucose level,renal function indices,negative mood score,quality of life score,and nursing satisfaction were compared between the two groups. Results The total treatment compliance rate was 93.33% in the observation group and 78.33% in the control group.The observation group was higher than the control group (P<0.05). The fasting blood glucose,2h postprandial blood glucose, blood creatinine, and urea nitrogen after nursing were lower than those before nursing in the both groups (P<0.05). The fasting blood glucose, 2 h postprandial blood glucose,blood creatinine,and urea nitrogen after nursing in the observation group were all lower than those in the control group (P<0.05). Anxiety and depression scores were compared between the two groups,and they were lower in the observation group after nursing than those in the control group (P<0.05). The quality of life score was compared between the two groups,and it was higher in the observation group after nursing than that in the control group (P<0.05). There was significant difference between the observation group and the control group in the overall satisfaction rate with nursing care (96.67% vs 83.33%, P<0.05). Conclusion The implementation of high-quality nursing services during hemodialysis in elderly patients with diabetic nephropathy can effectively enhance patients′ compliance with treatment,help improve blood glucose control,and better improve renal function.It can also improve patients' mental conditions,quality of life,and nursing satisfaction.
[Key words] Diabetic nephropathy;Blood hemodialysis;High-quality nursing;Blood creatinine;Urea nitrogen
糖尿病腎病是糖尿病患者最常見的并發(fā)癥類型之一,由于患者血糖長(zhǎng)期處于高水平狀態(tài),患者腎功能受到損傷,隨著病情進(jìn)展,患者腎功能損傷加重,是威脅糖尿病患者生命安全的重要原因[1-3]。血液透析是糖尿病腎病臨床治療時(shí)常用的一種手段,可對(duì)血液中毒素分子進(jìn)行清除,從而控制患者病情[4],但由于血液透析治療周期長(zhǎng),受病情影響,患者易出現(xiàn)焦慮、抑郁等不良情緒,治療依從性較差,不利于治療效果,合理的護(hù)理措施必不可少。優(yōu)質(zhì)化護(hù)理是一種近年來(lái)臨床護(hù)理方面大力提倡的理念,其護(hù)理目標(biāo)為“實(shí)現(xiàn)優(yōu)質(zhì)化醫(yī)療服務(wù)”,為探討優(yōu)質(zhì)化護(hù)理在老年糖尿病腎病血液透析患者護(hù)理中的應(yīng)用價(jià)值,本研究對(duì)120例老年糖尿病腎病患者進(jìn)行觀察。
1資料與方法
1.1 一般資料
將2018年1月至2019年10月入住我院的120例血液透析老年糖尿病腎病患者采用隨機(jī)數(shù)字表法分為兩組,每組各60例。對(duì)照組:平均(71.43±9.14)歲,男女分別為33例和27例,平均病程(3.82±0.23)年;觀察組:平均(71.68±9.32)歲,男女分別為32例和28例,平均病程(3.82±0.23)年。兩組患者年齡、性別無(wú)統(tǒng)計(jì)學(xué)差異(P>0.05),具有可比性。本研究獲醫(yī)學(xué)倫理委員會(huì)批準(zhǔn)和患者知情同意。
1.2 方法
對(duì)照組患者給予常規(guī)護(hù)理,透析時(shí)注意監(jiān)測(cè)患者生命體征,并為其耐心講解相關(guān)注意事項(xiàng)。
觀察組患者給予優(yōu)質(zhì)化護(hù)理,具體措施為:(心理護(hù)理:收集患者文化水平信息,邀請(qǐng)心理科醫(yī)師認(rèn)真聆聽患者的傾訴,在聆聽過(guò)程中了解患者心理動(dòng)態(tài),分析負(fù)性情緒原因,針對(duì)原因?qū)颊哌M(jìn)行安撫,并及時(shí)給患者提供病情信息,消除焦慮、抑郁等負(fù)面情緒。(2)飲食護(hù)理:由醫(yī)生、護(hù)士及營(yíng)養(yǎng)師對(duì)患者飲食認(rèn)知進(jìn)行評(píng)估,根據(jù)血液透析治療特點(diǎn),為患者制定飲食方案,向患者強(qiáng)調(diào)合理飲食的重要性,為患者及其家屬詳細(xì)講解飲食相關(guān)知識(shí),傳遞飲食信息;患者可記錄自身連續(xù)3天的飲食,根據(jù)患者飲食日記,對(duì)其不規(guī)范飲食行為進(jìn)行糾正,與患者家屬協(xié)作,做好患者的飲食監(jiān)督工作。(3)親情護(hù)理:與患者家屬進(jìn)行溝通,為其講解血液透析治療期間的注意事項(xiàng),囑咐家屬陪伴患者進(jìn)行血液透析,向患者傳遞鼓勵(lì)、關(guān)心[5-6]。
1.3觀察指標(biāo)
①治療依從性:依從率=完全依從率+部分依從率,患者自覺(jué)配合治療歸為“完全依從”,患者經(jīng)醫(yī)護(hù)人員督促后對(duì)治療無(wú)抵觸情緒歸為“部分依從”,患者始終存在抵觸情緒歸為“不依從”[7]。②血糖水平:包括空腹血糖、餐后2 h血糖??崭寡鞘撬谢颊呓? h以上選用無(wú)熱原真空采血管采集肘靜脈血,餐后2 h血糖是所有患者禁食2 h選用無(wú)熱原真空采血管采集肘靜脈血,然后采用強(qiáng)生穩(wěn)豪血糖儀進(jìn)行檢測(cè)。③腎功能指標(biāo):包括血肌酐、尿素氮,所有患者禁食4 h以上選用無(wú)熱原真空采血管采集肘靜脈血,然后采用全自動(dòng)生化分析儀進(jìn)行檢測(cè)。④不良情緒評(píng)分:采用SAS量表評(píng)估患者焦慮,SDS量表評(píng)估抑郁,總分100分,得分越高表示患者越焦慮/抑郁,評(píng)分均采用4分法評(píng)估患者癥狀出現(xiàn)頻次,其標(biāo)準(zhǔn)為:1分表示沒(méi)有或很少出現(xiàn);2分表示有時(shí)出現(xiàn);3分表示大部分時(shí)間出現(xiàn);4分表示大部分或全部時(shí)間都有。20個(gè)條目中有15項(xiàng)是用負(fù)性詞陳述的,按上述l~4順序評(píng)分。其余5項(xiàng)(第5,9,13,17,19),是用正性詞陳述的,按4~1順序反向計(jì)分[8]。⑤生活質(zhì)量評(píng)分:選擇WHOQOL-BREF簡(jiǎn)表(由世界衛(wèi)生組織制訂),量表分為生理、心理、環(huán)境、社會(huì)關(guān)系,單項(xiàng)最低為0分,最高為100分,得分越高生活質(zhì)量越高[9-10];⑥護(hù)理滿意度:選擇自制調(diào)查問(wèn)卷(效度為0.90,信度為0.88)調(diào)查患者滿意度,調(diào)查問(wèn)卷最高100分,劃分3個(gè)范圍(<60分為不滿意、60~80分為一般滿意、>80分為很滿意),總滿意率=很滿意率+一般滿意率[11]。
1.4 統(tǒng)計(jì)學(xué)方法
應(yīng)用SPSS 26.0軟件,計(jì)數(shù)資料表示為[n(%)],行χ2檢驗(yàn),計(jì)量資料表示為均數(shù)±標(biāo)準(zhǔn)差(x±s),行t檢驗(yàn),P<0.05時(shí)表示差異有統(tǒng)計(jì)學(xué)意義。
2結(jié)果
2.1 兩組治療依從性比較
在患者總依從率方面,與對(duì)照組比較,觀察組更高(93.33% vs. 78.33%,P<0.05)。見表1。
2.2兩組患者護(hù)理前后血糖水平、腎功能指標(biāo)比較
兩組的空腹血糖、餐后2 h血糖、血肌酐、尿素氮在護(hù)理后均較護(hù)理前降低(P<0.05),而護(hù)理后的空腹血糖、餐后2 h血糖、血肌酐、尿素氮在觀察組中均低于對(duì)照組(P<0.05)。見表2。
2.3兩組患者護(hù)理前后不良情緒評(píng)分比較
組內(nèi)比較,兩組患者護(hù)理后焦慮和抑郁評(píng)分均較護(hù)理前降低(P<0.05);兩組間比較,護(hù)理前無(wú)統(tǒng)計(jì)學(xué)差異(P>0.05),護(hù)理后觀察組均低于對(duì)照組(P<0.05)。見表3。
2.4兩組患者護(hù)理前后生活質(zhì)量評(píng)分比較
組內(nèi)比較,兩組患者護(hù)理后生活質(zhì)量評(píng)分均較護(hù)理前增高(P<0.05);組間比較,護(hù)理前無(wú)統(tǒng)計(jì)學(xué)差異(P>0.05),護(hù)理后觀察組高于對(duì)照組(P<0.05)。見表4。
2.5兩組護(hù)理滿意度比較
護(hù)理總滿意率觀察組與對(duì)照組比較差異有統(tǒng)計(jì)學(xué)意義(96.67% vs. 83.33%,P<0.05)。見表5。
3討論
糖尿病腎病是糖尿病累及腎臟后引發(fā)的并發(fā)癥,是導(dǎo)致糖尿病患者死亡的重要原因,多發(fā)生于老年人群,患者腎功能處于進(jìn)行性損傷狀態(tài),需積極治療[12-14]。臨床針對(duì)糖尿病患者的腎功能損傷主張實(shí)施血液透析治療,血液透析可通過(guò)持續(xù)的血液凈化治療,清除患者血液中毒素,減少毒素對(duì)腎功能的損傷,還可糾正酸堿平衡,減輕腎臟炎癥反應(yīng)[15-17]。但在血液透析治療期間,由于血液透析需長(zhǎng)期治療,患者易產(chǎn)生焦慮、緊張等不良情緒,從而會(huì)影響到治療效果[18-19]。且隨著人們生活水平的不斷提高,患者對(duì)護(hù)理提出了更高的要求,目前優(yōu)質(zhì)護(hù)理在多種臨床疾病中應(yīng)用,然而在老年糖尿病腎病血液透析中鮮有報(bào)道。
常規(guī)血透護(hù)理主要以健康宣教為主,對(duì)患者心理狀態(tài)針對(duì)性不足,護(hù)理效果差強(qiáng)人意。近年來(lái),優(yōu)質(zhì)化醫(yī)療服務(wù)的倡議在臨床上逐漸推廣開來(lái),而在臨床護(hù)理方面,形成了優(yōu)質(zhì)化護(hù)理模式,其主張優(yōu)化原本的護(hù)理措施,針對(duì)患者具體需求,優(yōu)化護(hù)理服務(wù)的各個(gè)細(xì)節(jié),實(shí)現(xiàn)優(yōu)質(zhì)化護(hù)理服務(wù)[20-21]。優(yōu)質(zhì)化護(hù)理模式下的護(hù)理措施充分考慮到患者的護(hù)理需求和實(shí)際情況,不僅靈活性、針對(duì)性更強(qiáng),還具有個(gè)性化的特點(diǎn),可對(duì)患者護(hù)理需求進(jìn)行滿足,對(duì)實(shí)際存在或潛在的護(hù)理問(wèn)題進(jìn)行解決。本研究結(jié)果顯示:(1)治療總依從率觀察組93.33%高于對(duì)照組78.33%(P<0.05),護(hù)理后的空腹血糖、餐后2 h血糖、血肌酐、尿素氮在觀察組中均低于對(duì)照組(P<0.05),說(shuō)明優(yōu)質(zhì)化護(hù)理可切實(shí)提高患者對(duì)血液透析治療的配合度,更好地控制血糖和腎功能損傷進(jìn)展;(2)護(hù)理后,與對(duì)照組相比,焦慮和抑郁評(píng)分觀察組均更低,生活質(zhì)量評(píng)分和護(hù)理總滿意率觀察組均更高(P<0.05),說(shuō)明優(yōu)質(zhì)化護(hù)理還可減輕不良情緒,提升生活質(zhì)量,使患者更加滿意于護(hù)理服務(wù),這主要是因?yàn)閮?yōu)質(zhì)化護(hù)理模式下,心理護(hù)理幫助患者改善了其心理狀況,而心理護(hù)理與其他護(hù)理措施落實(shí)后使患者病情(血糖增高、腎功能損傷等)得到了有效控制,減輕病情給患者生活質(zhì)量造成的影響。2019年李永秀等[22]學(xué)者在糖尿病腎病透析患者中應(yīng)用個(gè)體化的護(hù)理,其護(hù)理措施與本研究相似,結(jié)果顯示個(gè)體化護(hù)理組患者的治療依從性大大提高,且患者出現(xiàn)心血管等并發(fā)癥的發(fā)生率也明顯低于常規(guī)護(hù)理組,再一次證明優(yōu)質(zhì)化護(hù)理服務(wù)在老年糖尿病腎病患者血液透析期間的應(yīng)用效果。
綜上所述,在老年糖尿病腎病患者血液透析期間實(shí)施優(yōu)質(zhì)化護(hù)理服務(wù),可有效增強(qiáng)患者的治療依從性,有利于提高血糖控制效果,更好地改善腎功能,還可對(duì)患者心理狀況、生活質(zhì)量、護(hù)理滿意度起到改善作用。
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(收稿日期:2021-02-25)