多学科团队干预对维持性血液透析患者生活质量的影响

doi:10.3969/j.issn.1004-583X.2024.09.006

摘要/Abstract

摘要：

目的研究维持性血液透析 (maintenance hemodialysis, MHD)患者在多学科团队干预下生活质量改善的有效性。方法纳入2020年1月-2022年12月在上海市浦东医院血液透析室行MHD治疗患者100例。按随机数字表1∶1分为干预组(n=50)和对照组(n=50)。干预组由肾科医生、营养师和护士组成的医护团队干预,对照组由护理团队采用日常标准护理。干预12个月,干预组和对照组各退出1例,最终干预组和对照组各49例。比较两组自我管理能力、生活质量和营养状况等。结果干预前两组一般资料、生活质量、自我管理能力和营养状况差异均无统计学意义(P>0.05)。干预后,干预组自我管理评分和生活质量评分均高于对照组(P<0.05);体质指数、血清白蛋白、血清铁蛋白、总胆固醇均优于对照组(P<0.05)。结论对MHD患者进行多学科团队干预,可以改善患者的营养状况, 提高患者的自我管理能力和生活质量。

关键词: 肾功能衰竭, 慢性, 连续性肾替代疗法, 多学科团队, 生活质量

Abstract:

Objective To investigate the effect of a multidisciplinary intervention on the quality of life in patients with maintenance hemodialysis (MHD). Methods A total of 100 MHD patients admitted to the Department of Hemodialysis, Shanghai Pudong Hospital from January 2020 to December 2022 were included. They were randomly assigned 1∶1 into the intervention group (n=50) and control group (n=50). A multidisciplinary team which comprised nephrologists, nutritionists, and nurses was responsible for managing MHD patients the intervention group, while those in the control group received a standard daily care from the nursing team. After 12 months of intervention, 1 case in each group withdrew, and finally, 49 eligible cases were included in each group. The self-management ability, quality of life, and nutritional status were compared between two groups. Results There were no significant differences in general information, quality of life, self-management ability, and nutritional status between the two groups before intervention (P>0.05). After intervention, the self-management score and quality of life score of the intervention group were significantly higher than those of the control group (P<0.05). Body mass index, serum albumin, serum ferritin, and total cholesterol were significantly better than those in the control group (P<0.05). Conclusion A multidisciplinary intervention effectively improves the nutritional status, self-management ability and quality of life of MHD patients.

Key words: kidney failure, chronic, continuous renal replacement therapy, multidisciplinary team, quality of life

中图分类号:

R692.5

郭晓翠, 禹小娟, 沈霞, 叶水英, 周东池, 赖碧红. 多学科团队干预对维持性血液透析患者生活质量的影响[J]. 临床荟萃, 2024, 39(9): 803-807.

Guo Xiaocui, Yu Xiaojuan, Shen Xia, Ye Shuiying, Zhou Dongchi, Lai Bihong. Effect of a multidisciplinary intervention on the quality of life in maintenance hemodialysis patients[J]. Clinical Focus, 2024, 39(9): 803-807.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.09.006

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I9/803

图/表 3

表1 2组一般资料比较

Tab.1 General data between the two groups

组别	例数	年龄(岁)	性别[例(%)]		HD时间(年)
组别	例数	年龄(岁)	男	女	HD时间(年)
干预组	49	55.80±8.20	29(59.2)	20(40.8)	2.40±0.70
对照组	49	53.60±5.80	30(61.2)	19(38.8)	2.80±0.80
$t$ /χ²值		1.121	0.218		1.052
P值		0.115	0.891		0.291

表1 2组一般资料比较

Tab.1 General data between the two groups

组别	例数	年龄(岁)	性别[例(%)]		HD时间(年)
组别	例数	年龄(岁)	男	女	HD时间(年)
干预组	49	55.80±8.20	29(59.2)	20(40.8)	2.40±0.70
对照组	49	53.60±5.80	30(61.2)	19(38.8)	2.80±0.80
$t$ /χ²值		1.121	0.218		1.052
P值		0.115	0.891		0.291

表2 2组自我管理和SF-36健康调查量表评分比较( x -±s)

Tab.2 Self-management and SF-36 health survey scales scores between the two groups

组别	例数	自我管理评分(分)		SF-36评分健康调查量表(分)
组别	例数	干预前	干预12个月后	干预前	干预12个月后
干预组	49	58.51±6.53	64.76±8.05	527.16±95.36	632.48±106.24
对照组	49	57.12±6.32	59.98±6.99	492.32±102.43	541.56±121.67
$t$ 值		1.082	3.170	1.760	3.980
P值		0.282	0.002	0.082	<0.001

表2 2组自我管理和SF-36健康调查量表评分比较( x -±s)

Tab.2 Self-management and SF-36 health survey scales scores between the two groups

组别	例数	自我管理评分(分)		SF-36评分健康调查量表(分)
组别	例数	干预前	干预12个月后	干预前	干预12个月后
干预组	49	58.51±6.53	64.76±8.05	527.16±95.36	632.48±106.24
对照组	49	57.12±6.32	59.98±6.99	492.32±102.43	541.56±121.67
$t$ 值		1.082	3.170	1.760	3.980
P值		0.282	0.002	0.082	<0.001

表3 2组营养状况比较( x -±s)

Tab.3 Nutritional status between the two groups

组别	例数	BMI(kg/m²)		ALB(g/L)		SF(g/L)		TC(mol/L)
组别	例数	干预前	干预12个月后	干预前	干预12个月后	干预前	干预12个月后	干预前	干预12个月后
干预组	49	16.39±4.12	19.43±5.58	34.25±5.62	39.12±5.36	1.37±0.26	1.69±0.37	4.12±1.45	5.66±2.16
对照组	49	16.14±3.97	17.21±4.36	33.98±5.25	36.68±4.12	1.42±0.31	1.51±0.42	3.85±1.26	4.58±2.24
$t$ 值		0.309	2.217	0.248	2.552	0.874	2.274	0.994	0.323
P值		0.758	0.029	0.805	0.012	0.384	0.025	2.454	0.016

表3 2组营养状况比较( x -±s)

Tab.3 Nutritional status between the two groups

组别	例数	BMI(kg/m²)		ALB(g/L)		SF(g/L)		TC(mol/L)
组别	例数	干预前	干预12个月后	干预前	干预12个月后	干预前	干预12个月后	干预前	干预12个月后
干预组	49	16.39±4.12	19.43±5.58	34.25±5.62	39.12±5.36	1.37±0.26	1.69±0.37	4.12±1.45	5.66±2.16
对照组	49	16.14±3.97	17.21±4.36	33.98±5.25	36.68±4.12	1.42±0.31	1.51±0.42	3.85±1.26	4.58±2.24
$t$ 值		0.309	2.217	0.248	2.552	0.874	2.274	0.994	0.323
P值		0.758	0.029	0.805	0.012	0.384	0.025	2.454	0.016

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