行为分阶段转变理论在血液透析营养不良患者中的应用

目的应用行为分阶段转变理论模型，探讨血液透析营养不良患者的健康教育方法，帮助患者建立科学的行为方式，提高自我管理能力，减少并发症的发生。，方法选择72例血液透析患者为研究对象，以行为分阶段转变理论模型为干预手段，分别对患者在干预前和干预后1、3、6个月的营养状况及定量主观评估（MQSGA）进行比较，并进行统计学分析。结果与干预前相比，干预后1个月，血红蛋白（HGB）水平升高（q=2．08，P〈0．05），血清白蛋白（ALB）水平无显著变化（q=1．22，P〉0．05），超敏C反应蛋白（hs—CRP）水平下降（q=3．06，P〈0．01），尿素清除指数（Kt／V）升高（q=4．12，P〈0．01）；干预后3个月，HGB和Kt／V水平明显升高（q分别为8．20，6．13；P均〈0．01），ALB水平升高（q=2．81，P〈0．05），hs—CRP水平明显下降（q=8．85，P〈0．01）；干预后6个月，HGB、ALB水平和Kt／V明显升高（q分别为10．89，7．06，9．68；P均〈0．01），hs—CRP水平明显下降（q=13．26，P〈0．01）。干预前MQSGA评估营养良好者9例（12．5％），干预后3个月21例（29．2％），干预后6个月62例（86．1％），干预后3、6个月与干预前比较，差异均有统计学意义（χ^2分别为15．84，86．26；P均〈0．01）。结论应用行为分阶段转变理论模型，可以改变血液透析患者的生活方式，使其营养状况得到改善，生活质量显著提高。

Application of transtheoretical model and stages of change in malnutrational hemodialysis patients

Objective To explore the health education methods in malnutritional patients on maintenance hemodialysis using the transtheoretical model and stages of change （TTM）. And also to help patients to set up scientific behavioral patterns to improve their self - management ability and reduce the incidence of complications. Methods 72 maintenance hemodialysis patients were included in this study. Taking TTM as intervention, we compared the nutritional status and the modified quantitative subjective global assessment （MQSGA） at 4 different time points： before intervention, 1 month,3 months and 6 months after intervention respectively, and statistically analyzed the data. Results Compared with before intervention, HGB level elevated significantly 1 month after intervention （ q = 2.08, P 〈 0. 05 ）, while ALB was not changed significandy（q = 1.22, P 〉 0.05 ）, HCRP dropped significantly （ q = 3.06, P 〈 0.01 ） and Kt/V increased significantly （ q = 4.12, P 〈 0.01 ）. HGB and Kt/V level increased significantly 3 months after intervention （ q = 8.20,6.13 ;P 〈 0.01 ）, ALB level increased （ q = 2.81, P 〈 0.05 ）, while HCRP dropped significantly （ q = 8.85 ,P 〈0.01 ）. HGB, ALB and Kt/V levels all increased significantly 6 months after intervention compared with 3 months after intervention （ q = 10.89,7.06,9.68, respectively; All P 〈 0.01 ）, and HCRP dropped signifieanfly（q = 13.26, P 〈 0.01 ）. The MQSGA improved significantly at both 3 months （X2 = 15.84, P 〈 0.01 ） and 6 months （ χ^2 = 86.26 ,P 〈 0.01 ） after intervention compared with before intervention. Conclusions By using the TIM, we can change the life style of the hemodialysis patients, and improve their nutritional status and life quality.