背景:在接受肾移植前后的终末期肾衰竭患者大多要做血液透析治疗,此时患者的不依从现象是比较常见的,不依从行为与患者的死亡率密切相关,改善血液透析患者的自我管理行为有益于改善生存率,并提高生活质量.目的:调查分析护理干预对实施肾移植前后血液透析患者自我管理行为和健康相关生活质量的影响.设计:随机对照,对比分析.单位:中国医科大学附属第一医院护理部和血液透析室.对象:选择2006-02/04在中国医科大学附属第一医院血液透析室因肾功能衰竭进行血液透析的患者48例,其中男29例,女19例;年龄22～77岁.均能读懂问卷并愿意参加;患者对治疗和调查项目知情同意;实验经医院伦理委员会批准.采用随机抽签法将患者分为2组:干预组和对照组,各24例.方法:干预组给予6个月的护理干预,即根据患者的实际情况采用发放健康宣传材料、个别指导、集中指导等多种形式进行健康教育.对照组给予常规健康教育.主要观察指标:分别在护理干预前和干预3,6个月后采用自我管理行为问卷和简明健康调查问卷评估患者的自我管理行为和健康相关生活质量.结果:血液透析患者48例均进入结果分析.护理干预前和干预3个月后干预组和对照组的自我管理行为问卷和简明健康调查问卷总分比较,差异无显著性意义(P＞0.05).干预6个月后两组的自我管理行为问卷评分和简明健康调查问卷总分比较,差异有显著性意义(P＜0.01,0.05).干预组干预6个月后的自我管理行为问卷总分较干预前有显著提高(P＜0.01).结论:护理干预明显改善了肾移植前后血液透析患者的自我管理行为,提高健康相关生活质量.%BACKGROUND:Most end-stage renal failure patients must undergo hemodialysis before and after kidney transplantation.Noncompliance is common in patients who undergo hemodialysis,and it correlated with mortality.The improvement in self-management behavior is beneficial to the improvement of survival rate and quailty of life of hemodialysis patients.OBJECTIVE:To investigate and analyze the effect of nursing intervention on self-management behavior and health-related quality of life in hemodialysis patients before and after kidney transplantation.DESIGN:A randomized and controlled analysis.SETTING:Department of Nursing and Hemodialysis Center,First Affiliated Hospital of China Medical University.PARTICIPANTS:Forty-eight renal failure patients who underwent hemodialysis in the Hemodialysis Center,First Affiliated Hospital of China Medical University between February and April 2006 were recruited in this study.The involved patients.including 29 males and 19 females,aged 22-77 years,able to read and write the questionnaires,voluntarily participated in this study.Written informed consents of treatments and investigation items were obtained from each patient.The study was approved by the Ethics Committee of the hospital.The involved patients were randomly assigned into 2 groups with 24 patients in each:intervention group and control group.METHODS:Patients in the intervention group were given 6 months of nursing(i.e.according to actual conditions,each patient was given health education by handing out health promoting stuffs,giving individual or centralized guidance as well as other modalities).Patients in the control group were given routine health education.MAIN OUTCOME MEASURES:Self-management behavior and health-related quality of life were assessed before,3 and 6 months after nursing intervention using self-management behavior questionnaire and short-form 36 health survey.RESULTS:Forty-eight patients who underwent hemodialysis participated in the final analysis.There were no significant differences in the total scores of self-management behavior questionnaire and short-form 36 health survey between intervention group and control group before and 3 months after nursing intervention(P＞0.05).Significant difference in the total scores of self-management behavior questionnaire and short-form 36 health survey existed in each group 6 months after nursing intervention in comparison with baseline(P＜0.01,0.05).The total scores of self-management behavior questionnaire of intervention group were significantly increased 6 months after nursing intervention in comparison with the baseline (P＜0.01).CONCLUSION:Nursing intervention markedly improve the self-management behavior and quailty of life of patients who undergo hemodialysis before and after kidney transplantation.
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