个体及集体干预对维持性血液透析患者生存质量的影响

摘要

背景：随着血液透析技术的不断改进，维持性血液透析患者的长期生存率亦不断上升，如何提高其生存质量，已经引起患者乃至全社会的广泛关注，也逐渐成为综合评价透析效果的可靠指标。目的：探讨个体化干预与集体化干预对维持性血液透析患者生存质量的影响。方法：选择透析时间大于3个月的维持性血液透析患者80例，采用随机数字表法分为试验组和对照组，每组40例。对照组患者在血液透析常规护理的基础上，按预先制定的周计划进行个体化护理干预，为期6周；试验组患者在对照组干预基础上，按预先制定的周计划进行集体化护理干预，为期6周。干预前后，均采用简明健康状况调查表(MOS 36-item short form health survey，SF-36)和终末期肾脏疾病透析患者调查简表(kidney disease quality of life short form，KDQOL-SFTM)评价2组患者生存质量变化。结果与结论：干预后2组患者SF-36及KQQOL-SF评分均高于干预前(P<0.01)；试验组患者SF-36体能影响、整体健康、情感状态、情感影响、社会功能、精力等6个维度评分高于对照组干预后水平(P<0.01)；试验组患者KQQOL-SF社交质量、睡眠、社会支持、患者满意度4个维度评分高于对照组同期水平(P<0.01)。提示个体化干预及在个体化干预基础上进行集体化干预均能提高维持性血液透析患者的生存质量，同时后者能从生理、心理、社会等多个方面更好的改善患者生存质量。%BACKGROUND:With the improvement of hemodialysis technology, the long-term survival rate of maintenance hemodialysis patients has been increased continual y. Nowadays, how to improve the quality of life in maintenance hemodialysis patients has been aroused widespread concern, and gradual y become the reliable indicator for comprehensive evaluation of the effect of hemodialysis. OBJECTIVE: To evaluate the effect of individualized intervention and col ective intervention on quality of life in maintenance hemodialysis patients. METHODS:Eighty maintenance hemodialysis patients, who had accepted more than 3 months of dialysis, were randomly divided into two groups (40 cases in the experimental group and 40 patients in the control group). Al the patients in the control group received 6 weeks of individualized intervention according to the pre-established schedule based on the hemodialysis routine care. Patients in the experimental group also have a period of six weeks of col ective intervention according to the pre-established weekly schedule based on the hemodialysis routine care. The quality of life of the patients was evaluated with MOS 36-item short form health survey and kidney disease quality of life short form before and after intervention. RESULTS AND CONCLUSION:After the intervention, both of the experimental group and the control group achieved significantly greater improvement than before in MOS 36-item short form health survey and kidney disease quality of life short form (P<0.01). The physical impact, overal health, emotional state, emotional impact, social function and energy of MOS 36-item short form health survey in the patients of the experimental group were higher than those of the control group after intervention (P<0.01);and the social quality, sleep, social support and patient satisfaction of kidney disease quality of life short form in the experimental group were higher than those in the control group (P<0.01). The results show that both individualized intervention and the col ective intervention based on the individualized intervention are effective in improving quality of life in maintenance hemodialysis patients and the col ective intervention can better improve the quality of life from physical, psychological and social aspects.