本文選題：腹膜透析　切入點(diǎn)：跨理論模型　出處：《錦州醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的探討跨理論模型在腹膜透析患者維持容量平衡、提高自身容量管理能力等方面中的應(yīng)用效果,降低心力衰竭的發(fā)生,為長(zhǎng)期居家的腹膜透析患者形成良好的健康教育模式,以提高患者居家生活的自我管理能力,為護(hù)理人員制定針對(duì)腹膜透析患者的健康教育策略提供參考依據(jù)。方法選擇沈陽(yáng)軍區(qū)總醫(yī)院腎內(nèi)科腹膜透析中心持續(xù)非臥床腹膜透析患者70例作為研究對(duì)象,將研究對(duì)象分為干預(yù)組和對(duì)照組每組各35例。對(duì)照組患者給以常規(guī)健康教育;干預(yù)組患者在常規(guī)健康教育的基礎(chǔ)上給予跨理論模型為依據(jù)的水鹽攝入綜合干預(yù),觀察時(shí)間3個(gè)月,比較患者在基線、1個(gè)月、3個(gè)月的容量管理行為能力及容量狀態(tài)指標(biāo)。容量管理能力評(píng)估運(yùn)用容量管理行為量表,容量狀態(tài)指標(biāo)包括體重、收縮壓、舒張壓、24小時(shí)尿量、24小時(shí)超濾量、水腫程度。結(jié)果1、干預(yù)前后患者的行為階段比較:干預(yù)3個(gè)月干預(yù)組患者較干預(yù)前行為階段發(fā)生正向遞進(jìn),多半患者處于行動(dòng)及維持階段,較干預(yù)前患者各行為階段的人數(shù)有顯著性差異(P0.05)。2、兩組患者干預(yù)前后相關(guān)指標(biāo)的比較:兩組患者在基線水平時(shí),差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);干預(yù)1個(gè)月及3個(gè)月,兩組患者的收縮壓差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3、兩組患者干預(yù)前后相關(guān)指標(biāo)的交互作用:經(jīng)重復(fù)測(cè)量方差分析,對(duì)兩組患者容量指標(biāo)進(jìn)行組間效應(yīng)、時(shí)間效應(yīng)、時(shí)間與分組交互作用進(jìn)行分析。結(jié)果顯示,兩組患者容量指標(biāo)在時(shí)間和組間效應(yīng)中存在交互作用(P0.05),時(shí)間作用隨著干預(yù)因素的改變而改變,兩組間的差異隨著觀察時(shí)間的延長(zhǎng)而愈加明顯,即兩組患者容量控制趨勢(shì)不同,干預(yù)組容量控制狀況優(yōu)于對(duì)照組,組間效應(yīng)差異有統(tǒng)計(jì)學(xué)意義(F值為5.321;P0.05)。4、兩組患者基線與干預(yù)3個(gè)月水腫程度比較:干預(yù)前兩組患者的水腫程度差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);干預(yù)組患者經(jīng)過(guò)3個(gè)月的綜合干預(yù),水腫程度較對(duì)照組明顯降低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。5、兩組患者干預(yù)前后于容量管理行為評(píng)分量表進(jìn)行比較:干預(yù)前兩組患者容量管理行為評(píng)分比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);干預(yù)3個(gè)月后干預(yù)組患者容量管理行為評(píng)分均高于基線水平,兩組患者比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論通過(guò)應(yīng)用跨理論模型為框架的水鹽攝入護(hù)理干預(yù),可以促進(jìn)患者行為階段的正向遞進(jìn),提高患者的容量管理能力。進(jìn)而預(yù)防或糾正腹膜透析患者容量相關(guān)性疾病的發(fā)生,減少心衰的發(fā)生,提高患者生存質(zhì)量。制定既遵循治療原則又利于患者接受的干預(yù)策略,為居家腹膜透析患者制定良好的健康教育方案,完善在臨床中優(yōu)質(zhì)可行的延續(xù)護(hù)理模式。
[Abstract]:Objective to investigate the transtheoretical model to maintain the balance of capacity in peritoneal dialysis patients, improve their application ability and other aspects of capacity management, reduce the occurrence of heart failure, the formation of good health education mode for peritoneal dialysis patients with long-term home, Ju Jiasheng live to improve patient self management ability, to provide reference for health education strategies in peritoneal dialysis patients the nursing staff development. Methods the General Hospital of Shenyang Military Department of Nephrology peritoneal dialysis center of continuous ambulatory peritoneal dialysis in 70 patients as the research object, the research object will be divided into intervention group and control group, 35 cases in each group. The control group were given conventional health education; patients in the intervention group were given on the basis of routine health education the transtheoretical model for water and salt intake on the basis of comprehensive intervention, the observation time of 3 months, compared with patients at baseline, 1 months, 3 months of capacity management Capacity and capacity of state capacity management ability evaluation index. The use of capacity management behavior scale, capacity status indicators including body weight, systolic blood pressure, diastolic blood pressure, urine volume in 24 hours, 24 hours, ultrafiltration volume, edema. Results 1 patients before and after the intervention phase comparison behavior: intervention 3 months intervention group compared with the intervention the behavior of positive progressive stage, most patients in the operation and maintenance phase, there is significant difference compared with the number of patients before the intervention phase (P0.05).2, compared two groups of patients before and after intervention related indicators: two groups of patients in the baseline level, the difference was not statistically significant (P0.05); intervention for 1 months and 3 months, the two groups of patients with systolic blood pressure difference was statistically significant (P0.05.3), the interaction of the two groups before and after intervention related indicators: the repeated measures analysis of variance between groups of patients in the two group effect, time effect when the capacity index. With the group interaction were analyzed. The results showed that two groups of patients with capacity index there is interaction between time and group effects (P0.05), time changes with the intervention factors change, the difference between the two groups with prolonged observation time became more and more obvious that the two groups of patients with different volume control trend, intervention capacity control status is better than the control group, the difference was statistically significant between group effect (F-measure 5.321;.4, P0.05) were compared between the two groups at baseline and 3 months of intervention: edema degree of statistical significance between the two groups of patients with edema before intervention (P0.05); patients in the intervention group after intervention for 3 months the degree of edema was significantly lower than the control group, the difference was statistically significant (P0.05.5), two groups of patients before and after intervention in capacity management behavior scale comparison: two groups before intervention capacity management behavior scores were compared, no difference Statistical significance (P0.05); 3 months after the intervention, patients in the intervention group were higher than that of the capacity management behavior at baseline, the two groups were statistically significant difference (P0.05). Conclusion through the application of the trans theoretical model for water and salt intake framework of nursing intervention can promote patients to stage positive progression, improve the patient's capacity management ability. Then preventive or corrective related diseases in patients with peritoneal dialysis capacity, reduce the occurrence of heart failure, improve the quality of life of patients. Both follow the principle of treatment and to formulate intervention strategies for patients, making health education a good solution for home peritoneal dialysis patients, improve the quality of continued nursing mode in the clinical work.

【學(xué)位授予單位】：錦州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.5

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