个案跟踪式康复管理+感恩拓延-建构理论疗法改善腹膜透析患者代谢水平及自我管理能力的临床实践

目的探讨个案跟踪式康复管理+感恩拓延-建构理论疗法对行腹膜透析患者代谢水平及自我管理能力的影响,为腹膜透析患者获得良好的预后提供科学依据。方法选择深圳市中医院于2021年3月至2022年3月收治的腹膜透析患者64例作为研究对象,根据随机数字表法将其分为研究组和对照组,各32例。对照组进行常规管理,研究组在常规管理的基础上进行个案跟踪式康复管理+感恩拓延-建构理论疗法干预,两组患者均持续干预3个月。比较两组患者干预前后人体水分、钙磷代谢、血压水平、生化指标、治疗依从性、自我管理能力及并发症发生情况。结果①干预前,两组患者细胞外液(ECW)、细胞内液(ICW)、总体水(TBW)比较,差异无统计学意义(均P>0.05);干预后,两组ECW、ICW均较同组干预前提高,TBW较同组干预前下降(均P<0.05),但两组ECW比较差异无统计学意义(P>0.05),而研究组ICW较对照组高、TBW较对照组低(均P<0.05)。②干预前,两组患者收缩压、舒张压及钙磷代谢水平比较,差异无统计学意义(均P>0.05);干预后,两组患者收缩压、舒张压、钙磷指标均较同组干预前降低,且研究组收缩压、舒张压低于对照组,钙、磷指标高于对照组(P<0.05)。③干预前,两组患者尿素氮(BUN)、血肌酐(Scr)、血红蛋白(Hb)、白蛋白(ALB)比较,差异无统计学意义(均P>0.05);干预后,研究组的BUN、Scr水平低于对照组,Hb和ALB水平高于对照组(均P<0.05)。④干预前,两组肾脏病饮食依从性量表各维度评分比较,差异无统计学意义(均P>0.05);干预后,两组肾脏病饮食依从性量表各维度评分均高于同组干预前,且研究组评分高于对照组(均P<0.05)。⑤干预前,两组ESCA各维度评分比较,差异无统计学意义(均P>0.05);干预后,两组ESCA各维度评分均高于同组干预前,且研究组评分高于对照组(P<0.05)。⑥研究组并发症发生率(3/32,9.37%)低于对照组(10/32,31.25%)(P<0.05)。结论个案跟踪式康复管理+感恩拓延-建构理论疗法有助于改善腹膜透析患者的代谢水平,提高自我管理能力,降低并发症发生率,提高透析治疗效果。

Clinical practice of case tracking rehabilitation management combined with gratitude extension construction theory therapy to improve metabolic level and self-care ability of peritoneal dialysis patients

Objective To explore the influence of case tracking rehabilitation management combined with gratitude extension construction theory on metabolic levels and self-management abilities of peritoneal dialysis patients, and to provide scientific basis for achieving good prognosis for peritoneal dialysis patients. Methods A total of 64 peritoneal dialysis patients admitted to Shenzhen Traditional Chinese Medicine Hospital from March 2021 to March 2022 were selected. They were randomly divided into study group and control group based on the number table method, with 32 patients in each group. The control group received routine management, while the research group received case tracking rehabilitation management combined with gratitude extension construction theory intervention. Patients in both groups received continuous intervention for three months. Body water content, calcium and phosphorus metabolism, blood pressure levels, biochemical indicators, treatment compliance, self-management ability, and incidence of complications were compared. Results The score of ECW and ICW in both groups were increased, while the score of TBW decreased (P<0.05). However, the ICW in the study group was higher than that in the control group, while TBW was lower than that in the control group (P<0.05); After intervention, the systolic blood pressure, diastolic blood pressure, and calcium phosphorus indicators in both groups decreased, and the systolic blood pressure and diastolic blood pressure in the study group were lower than those in the control group, while the calcium phosphorus indicators were higher than those in the control group (P<0.05); The BUN and Scr levels in the study group were lower than those in the control group, while the Hb and ALB levels were higher than those in the control group (P<0.05); The scores of all dimensions of the renal disease dietary compliance scale in both groups were higher than those in the same group, but the scores in the study group were higher than those in the control group (P<0.05); The scores of ESCA in all dimensions in both groups were higher than those in the same group, but the scores in the study group were higher than those in the control group (P<0.05); The incidence of complications in the study group (3/32, 9.37%) was lower than that in the control group (10/32, 31.25%) (P<0.05). Conclusions The combination of case tracking rehabilitation management and gratitude extension construction theory therapy can improve the metaboilic level and self-care ability of peritoneal dialysis patients, reduce the risk of complications, and improve the effectiveness of dialysis treatment.