目的 分析探讨家属参与护理模式对透析治疗的糖尿病肾病(DN)患者透析质量和生存质量的影响.方法 选取2012年3月至2014年3月于四川省广元市第一人民医院接受治疗的85例DN血液透析患者,按随机数字表法分为观察组(43例)和对照组(42例),观察组接受家属参与护理,对照组接受一般护理.比较2组护理前后一般情况调查表、生活质量量表以及疾病知识评估表评分差异,评估观察组护理前后透极相关指标差异.结果 生活质量得分方面,观察组与对照组患者疼痛、体能、体能影响、社会支持、性功能、工作状态、肾病负担和肾病影响护理前后差值差异无统计学意义(P＞0.05),症状、认知功能、社交质量、睡眠、患者的满意度、医护鼓励、整体健康、情感状态、情感影响、精力、社会功能护理前后差值差异均有统计学意义[27.07(11.00,46.50)分比11.45(-7.00,31.50)分、13.33(-1.50,21.50)分比6.67(-5.00,21.50)分、13.32(-7.50,27.00)分比6.66(-15.00,20.00)分、17.25(-4.50,33.00)分比0.00(-11.00,6.50)分、33.33(21.00,57.50)分比0.00(-3.00,7.50)分、0.00(-21.50,30.00)分比0.00(-15.50,19.50)分、14.50(-5.00,36.00)分比4.50(-12.00,20.50)分、21.50(4.00,35.00)分比11.50(-5.00,20.00)分、0.00(-28.50,23.00)分比0.00(0.00,0.00)分、17.25(-14.00,32.50)分比9.50(3.50,23.50)分、12.25(3.00,19.00)分比6.50(-13.00,31.50)分](均P＜0.05);观察组患者护理后与护理前相比,清蛋白、总蛋白和血红蛋白量提高,尿素氮和肌酐下降率增大,舒张压、收缩压改善,差异均有统计学意义[39.25(36.00,42.50) g/L比37.50(33.50,40.00)g/L、68.15(65.50,71.50)g/L比65.50(62.50,71.00)g/L、88.75(85.50,93.00) g/L比83.25(71.50,92.50)g/L、70.48(65.50,73.00)％比67.37(65.33,72.50)％、65.50(59.50,71.00)％比63.50(59.00,66.50)％、85.00(77.00,93.00) mmHg(1 mmHg=0.133 kPa)比75.00(65.00,84.00) mmHg、131.50(127.00,141.50) mmHg比145.00(134.00,156.00)mmHg](均P＜0.05);观察组患者护理后低血压、低血糖、失衡综合征、心力衰竭、水肿发生率较对照组降低,差异有统计学意义[13.9％(6/43)比42.9％(18/42)、11.6％ (5/43)比28.6％ (12/42)、20.9％(9/43)比42.9％ (18/42)、9.3％ (4/43)比28.6％ (12/42)、16.3％ (7/43)比38.1％(16/42)](P＜0.05);2组患者高血压和内瘘感染发生率的差异无统计学意义(P＞0.05);观察组患者护理后,社会活动的参与度、休息睡眠情况、用药安全、自护技巧和自我观察比例较对照组改善,差异有统计学意义[37.2％ (16/43)比14.3％(6/42)、67.4％ (29/43)比45.2％ (19/42)、90.7％ (39/43)比64.3％ (2742)、83.7％(36/43)比61.9％ (26/42)、86.0％(37/43)比52.4％ (22/42)] (P ＜0.05).结论 家属参与护理模式对行透析治疗的糖尿病肾病患者透析质量及生存质量均有明显的改善作用,有助于提高患者心理素质与遵医行为,同时能够减轻家庭及社会负担.%Objective To explore the effect of nursing model with family's participation on quality of dialysis and quality of life in patients with diabetic nephropathy.Methods Totally 85 patients with diabetic nephropathy from March 2013 to March 2014 were enrolled into observation group (43 cases) given nursing model with family's participation and control group (42 cases) given general care.The general statement questionnaire,life quality scale and disease knowledge assessment form were scored and compared between the two groups.Results After nursing,the scores of the life quality scale,including pain,physical impact,social support,sexual function,work status,kidney disease burden and impact of kidney disease were not statistically different (P ＞ 0.05) between the two groups;the symptoms,cognitive function,social quality,sleep,patient satisfaction,health care,encourage,overall health,emotional state,emotional impact,energy and social function aspects showed statistical differences between observation group and control group [27.07 (11.00,46.50) scores vs 11.45 (-7.00,31.50) scores,13.33 (-1.50,21.50) scores vs6.67 (-5.00,21.50) scores,13.32 (-7.50,27.00) scores vs 6.66 (-15.00,20.00) scores,17.25 (-4.50,33.00) scores vs 0.00 (-11.00,6.50) scores,33.33 (21.00,57.50) scores vs 0.00 (-3.00,7.50) scores,0.00 (-21.50,30.00) scores vs 0.00 (-15.50,19.50) scores,14.50 (-5.00,36.00) scores vs 4.50 (-12.00,20.50) scores,21.50 (4.00,35.00) scores vs 11.50 (-5.00,20.00) scores,0.00 (-28.50,23.00) scores vs 0.00 (0.00,0.00) scores,17.25 (-14.00,32.50) scores vs 9.50 (3.50,23.50) scores,12.25 (3.00,19.00) scores vs 6.50 (-13.00,31.50) scores] (all P ＜ 0.05).The albumin,total protein and hemoglobin in observation group were increased,urea nitrogen and creatinine were increased,the diastolic pressure and systolic blood pressure were improved in observation group [39.25(36.00,42.50)g/L vs 37.50 (33.50,40.00)g/L,68.15(65.50,71.50)g/L vs 65.50(62.50,71.00)g/L,88.75(85.50,93.00)g/L vs 83.25 (71.50,92.50)g/L,70.48(65.50,73.00)％ vs 67.37(65.33,72.50)％,65.50(59.50,71.00)％ vs 63.50 (59.00,66.50) ％,85.00 (77.00,93.00) mmHg (1 mmHg =0.133 kPa) vs 75.00 (65.00,84.00) mmHg,131.50 (127.00,141.50) mmHg vs 145.00 (134.00,156.00) mmHg] (all P ＜ 0.05).The incidence of hypotension,hypoglycemia,disequilibrium syndrome,heart failure and edema in observation group were significantly lower than those in control group [13.9％ (6/43) vs 42.9％ (18/42),11.6％ (5/43) vs 28.6％ (12/42),20.9 ％ (9/43) vs 42.9％ (18/42),9.3 ％ (4/43) vs 28.6％ (12/42),16.3 ％ (7/43) vs 38.1％ (16/42)](P ＜ 0.05).The incidence of hypertension and fistula infection had no significant differences between the two groups (P ＞ 0.05).The participation in social activities,fine rest and sleep,medication safety,fine self-care skills and self-observation in observation group were all significantly improved compared with those in control group [37.2％ (16/43) vs 14.3％ (6/42),67.4％ (29/43) vs45.2％ (19/42),90.7％ (39/43) vs64.3％(27/42),83.7％ (36/43) vs 61.9％ (26/42),86.0％ (37/43) vs 52.4％ (22/42)] (P＜0.05).Conclusions The nursing model with family's participation can significantly improve the quality of dialysis and life in the patients with diabetic nephropathy,which can improve the psychological quality and compliance behavior of patients,and reduce the burden on the family and the society.
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