基于老年综合评估的延续护理方案在维持性血液透析患者中的应用

目的 探讨基于老年综合评估的维持性血液透析(maintenance hemodialysis,MHD)患者延续护理实践方案并评价其效果。 方法 选取2018年1—12月南京鼓楼医院收治的老年MHD患者94例,用随机数字表法分为对照组与观察组,每组各47例。2组患者透析期间均实施血液透析常规护理;非透析期间,对照组给予常规护理随访,观察组基于老年综合评估结果实施个性化延续护理。比较2组干预前、干预6个月后的血液生化检验指标、并发症发生率、生活质量评分及生活自理能力评分。 结果 干预前,2组患者以上指标差异均无统计学意义(均P>0.05)。干预后,观察组的总蛋白(69.59±14.39)g/L]、血红蛋白(100.34±9.49)g/L]高于对照组(60.22±16.73)g/L、(88.51±10.39)g/L],尿素氮(100.21±4.43)mg/dL]、血肌酐(878.50±117.18)μmol/L]低于对照组(110.79±5.47)mg/dL、(1 012.23±61.92)μmol/L],差异具有统计学意义(t=18.524、18.336、18.471、18.549,均P<0.05);观察组高血压发生率低于对照组,2组比较差异有统计学意义(P<0.05);观察组生活质量评分(72.44±4.82)分、(67.84±11.42)分、(63.72±11.37)分、(74.79±9.68)分]、生活自理能力评分(87.82±9.14)分]的改善均优于对照组(60.43±5.69)分、(54.63±5.67)分、(58.42±9.91)分、(68.73±9.38)分、(54.56±5.47)分],差异有统计学意义(t=7.542、6.770、8.613、7.243、6.770,均P<0.05)。 结论 基于老年综合评估的MHD患者延续护理,有利于改善患者预后、减少并发症发生,提升患者的自理能力及生活质量。 

Application of a continuous nursing program for elderly maintenance hemodialysis patients based on comprehensive geriatric assessment

Objective To explore the continuous nursing practice program of maintenance hemodialysis(MHD) patients based on comprehensive geriatric assessment and evaluate its effect. Methods From January to December 2018, 94 elderly patients with MHD in Nanjing Drum Tower Hospital were enrolled in this study. According to the random number table method, they were divided into two groups, 47 cases in each group. Routine hemodialysis nursing was carried out in both groups during dialysis. During the non-dialysis period, the control group was given routine continuous nursing, and the observation group was given personalized continuous nursing based on the comprehensive geriatric assessment results of the elderly. Blood biochemical test indexes, complications, quality of life score and ADL score of the two groups were compared before and 6 months after intervention. Results Before intervention, there was no statistically significant difference in the above indexes between the two groups(all P>0.05). After intervention, the total protein (69.59±14.39) g/L], hemoglobin(100.34±9.49) g/L] of the observation group were higher than those of the control group (60.22±16.73) g/L,(88.51±10.39) g/L], urea nitrogen (100.21±4.43) mg/dL], serum creatinine (878.50±117.18) μmol/L] were lower than those of the control group (110.79±5.47) mg/dL,(1 012.23±61.92) μmol/L], the difference was statistically significant(t=18.524, 18.336, 18.471, 18.549, all P<0.05). The incidence of hypertension in the observation group was lower than that in the control group, and the difference between the two groups was statistically significant(P<0.05). The improvement of quality of life scores(72.44±4.82, 67.84±11.42, 63.72±11.37, 74.79±9.68) and ADL score(87.82±9.14) in the observation group were better than those in the control group(60.43±5.69, 54.63±5.67, 58.42±9.91, 68.73±9.38, 54.56±5.47), respectively(t=7.542, 6.770, 8.613, 7. 243, 6.770, all P<0.05). Conclusion The continuous nursing of MHD patients based on the comprehensive geriatric assessment is beneficial to improve the prognosis of patients, reduce the occurrence of complications, and improve the self-care ability and quality of life of patients.