基于MDT模式的5E康复方案在老年维持性血液透析患者中的干预效果

刘冰燕; 王莉; 张莉; 徐闪闪; 尹晓丽; 张继强

doi:10.16766/j.cnki.issn.1674-4152.003636

基于MDT模式的5E康复方案在老年维持性血液透析患者中的干预效果

doi: 10.16766/j.cnki.issn.1674-4152.003636

1.
淮北矿工总医院血液净化中心，安徽淮北 235000
2.
蚌埠医科大学第一附属医院肾内科，安徽蚌埠 233004

基金项目:

安徽省教育厅重点项目 KJ2020A0592

蚌埠医学院人文社科重点项目 BYKY2019199SKZD

详细信息

通讯作者:
张继强，E-mail：zhangji99@126.com

中图分类号: R459.5
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出版历程
- 收稿日期: 2023-12-11
- 网络出版日期: 2024-11-19

5E rehabilitation program based on MDT model effect of intervention on elderly maintenance hemodialysis patients

1.
Blood Purification Center, Huaibei Miners General Hospital, Huaibei, Anhui 235000, China

摘要

摘要: 目的探讨多学科诊疗团队模式的5E康复方案对老年维持性血液透析患者的影响，为5E康复方案的制定提供临床依据。方法选择2021年1月—2022年12月在淮北矿工总医院血透室收治的老年维持性血液透析患者82例为研究对象，采用随机数字法分为对照组40例和观察组42例。对照组实施血液透析常规护理干预，观察组在常规护理的基础上实施基于多学科诊疗团队模式的5E康复方案。比较2组患者干预前后自我管理能力、治疗依从性和营养状态的差异，比较观察组干预前后透析效果指标变化。结果组间比较显示，干预后3个月和6个月观察组患者自我管理行为4个维度评分及总分均高于对照组(P < 0.05)，治疗依从性总体改善程度优于对照组(P < 0.05)，血红蛋白、血清白蛋白、前白蛋白和BMI均高于对照组(P < 0.05)。组内比较显示，干预后3个月和6个月患者的血钾、血磷、肌酐和尿素氮[(21.25±4.13)mmol/L、(18.86±3.92)mmol/L vs. (23.43±4.35)mmol/L]均较干预前下降(P < 0.05)。结论基于多学科诊疗团队模式的5E康复方案在老年维持性血液透析患者临床应用中，能提升患者的自我管理能力和治疗依从性，对改善营养状态和提高透析效果有一定的作用。
- 多学科诊疗团队 /
- 5E康复方案 /
- 血液透析 /
- 老年人 /
- 干预
Abstract: Objective To explore the influence of the 5E rehabilitation program of multidisciplinary diagnosis and treatment team model on elderly maintenance hemodialysis patients, and to provide a clinical basis for the formulation of the 5E rehabilitation program. Methods A total of 82 elderly maintenance hemodialysis patients admitted to the Hemodialysis Department of Huaibei Miners General Hospital from January 2021 to December 2022 were selected as the study objects and were divided into a control group (40 cases) and an observation group (42 cases) by random number method. The control group received the routine nursing intervention of hemodialysis, and the observation group received a 5E rehabilitation program based on a multidisciplinary diagnosis and treatment team model on the basis of routine nursing. The differences in self-management ability, treatment compliance, and nutritional status between the two groups were compared before and after the intervention, and the changes in dialysis effect indexes in the observation group were compared before and after the intervention. Results Inter-group comparison showed that 3 months and 6 months after intervention, the scores of 4 dimensions of self-management behavior and total scores in the observation group were higher than those in the control group (P < 0.05), the overall improvement of treatment compliance in the observation group was better than that in the control group (P < 0.05), and the values of hemoglobin, serum albumin, prealbumin and BMI in the observation group were higher than those in the control group (P < 0.05). Intra-group comparison showed that the serum potassium, blood phosphorus, serum creatinine and blood urea nitrogen [(21.25±4.13) mmol/L, (18.86±3.92) mmol/L vs. (23.43±4.35) mmol/L] of patients at 3 and 6 months after intervention were decreased compared with those before intervention (P < 0.05). Conclusion The 5E rehabilitation program based on the multidisciplinary diagnosis and treatment team model can improve patients ' self-management ability and treatment compliance in the clinical application of elderly maintenance hemodialysis patients, and has a certain role in improving nutritional status and improving dialysis effects.
- Multidisciplinary medical team /
- 5E rehabilitation program /
- Hemodialysis /
- The aged /
- Intervention

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表 1 2组老年MHD患者一般资料比较

Table 1. Comparison of general data between the two groups of elderly MHD patients

项目	对照组(n=40)	观察组(n=42)	统计量	P值
年龄(x±s，岁)	69.98±5.23	70.26±6.78	0.214^a	0.831
性别(男/女，例)	27/13	32/10	0.767^b	0.381
BMI(x±s)	22.27±3.42	22.65±3.61	0.489^a	0.626
受教育程度(例)			0.574^b	0.902
小学及以下	24	26
初中	11	9
高中	3	4
大学及以上	2	3
透析龄[M(P₂₅, P₇₅)，年]	5(1, 6)	4(1，5)	0.923^c	0.675
原发病(例)			1.360^b	0.715
糖尿病肾病	17	14
慢性肾炎	13	16
高血压肾病	8	11
其他	2	1
婚姻状况(例)			0.214^b	0.644
已婚	36	39
未婚或丧偶	4	3
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 2组老年MHD患者自我管理行为得分比较(x±s，分)

Table 2. Comparison of self-management behavior scores between the two groups of elderly MHD patients (x±s, points)

组别	例数	伙伴关系
组别	例数	干预前	干预后3个月	干预后6个月
对照组	40	8.43±2.33	10.38±3.24^a	12.51±3.87^ab
观察组	42	8.35±2.47	12.64±3.34^a	14.72±4.46^ab
F值		0.151	3.108	2.392
P值		0.881	0.003	0.019

组别	例数	执行自我管理
组别	例数	干预前	干预后3个月	干预后6个月
对照组	40	14.47±4.53	16.38±5.32^a	17.95±5.28^ab
观察组	42	14.52±4.61	19.66±5.87^a	24.83±6.47^ab
F值		0.049	2.654	5.261
P值		0.961	0.008	< 0.001

组别	例数	问题解决
组别	例数	干预前	干预后3个月	干预后6个月
对照组	40	9.67±3.22	10.95±3.51	12.67±4.53^ab
观察组	42	9.55±3.17	14.58±4.04^a	16.85±5.36^ab
F值		0.170	4.334	3.805
P值		0.865	< 0.001	< 0.001

组别	例数	情绪处理
组别	例数	干预前	干预后3个月	干预后6个月
对照组	40	8.17±2.75	9.69±3.55^a	11.38±3.82^ab
观察组	42	8.21±2.68	12.83±3.74^a	14.72±4.13^ab
F值		0.067	3.895	3.797
P值		0.947	< 0.001	< 0.001

组别	例数	总分
组别	例数	干预前	干预后3个月	干预后6个月
对照组	40	40.85±6.74	47.62±7.23^a	54.59±8.06^ab
观察组	42	40.72±6.81	59.81±8.34^a	71.16±9.27^ab
F值		0.087	7.057	8.619
P值		0.931	< 0.001	< 0.001
注：伙伴关系比较，F_组间=51.776，F_时间=72.512，F_交互=100.036，均P < 0.01；执行自我管理比较，F_组间=27.141，F_时间=45.268，F_交互=95.526，均P < 0.01；问题解决比较，F_组间=17.172，F_时间=91.450，F_交互=119.623，均P < 0.01；情绪处理比较，F_组间=21.470，F_时间=44.862，F_交互=84.864，均P < 0.01；自我管理行为总分比较，F_组间=20.290，F_时间=173.808，F_交互=220.202，均P < 0.01。与同组干预前比较，^aP < 0.05；与同组干预后3个月比较，^bP < 0.05。

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表 3 2组老年MHD患者治疗依从性等级比较(例)

Table 3. Comparison of treatment compliance grades between the two groups of elderly MHD patients (cases)

组别	例数	干预前			干预后3个月			干预后6个月
组别	例数	良好	中等	较差	良好	中等	较差	良好	中等	较差
对照组	40	3	20	17	8	23	9	11	24	5
观察组	42	2	19	21	17	21	4	28	14	0
Z值		0.663			2.185			3.377
P值		0.507			0.029			0.001

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表 4 2组老年MHD患者营养评价指标比较(x±s)

Table 4. Comparison of nutritional evaluation indexes between the two groups of elderly MHD patients (x±s)

组别	例数	Hb(g/L)
组别	例数	干预前	干预后3个月	干预后6个月
对照组	40	95.57±12.33	97.32±13.68	101.27±13.96^ab
观察组	42	94.85±12.08	104.64±14.12^a	109.52±15.13^ab
F值		0.267	2.382	2.563
P值		0.790	0.019	0.012
组别	例数	ALB(g/L)
组别	例数	干预前	干预后3个月	干预后6个月
对照组	40	32.76±4.66	33.59±4.73	35.63±4.88^ab
观察组	42	32.44±4.26	35.84±4.69^a	38.31±4.93^ab
F值		0.325	2.162	2.473
P值		0.746	0.033	0.015

组别	例数	PA(mg/L)
组别	例数	干预前	干预后3个月	干预后6个月
对照组	40	263.15±30.64	275.63±32.27	281.57±33.52^ab
观察组	42	264.32±30.43	293.74±34.85^a	314.56±36.49^ab
F值		0.173	2.438	4.256
P值		0.863	0.017	< 0.001
组别	例数	MAMC(cm)
组别	例数	干预前	干预后3个月	干预后6个月
对照组	40	18.75±3.63	19.69±3.84	19.54±3.36
观察组	42	18.84±3.58	20.16±3.49	20.45±3.61
F值		0.113	0.581	1.180
P值		0.910	0.563	0.241

组别	例数	BMI
组别	例数	干预前	干预后3个月	干预后6个月
对照组	40	20.34±2.51	20.38±2.57	20.56±2.61
观察组	42	20.31±2.56	21.69±2.62^a	22.37±2.72^ab
F值		0.105	2.284	3.072
P值		0.917	0.025	0.003
注：Hb比较，F_组间=16.139，F_时间=74.384，F_交互=61.978，均P < 0.01；ALB比较，F_组间=14.145，F_时间=64.826，F_交互=139.839，均P < 0.01；PA比较，F_组间=27.435，F_时间=102.832，F_交互=91.827，均P < 0.01；MAMC比较，F_组间=0.786，F_时间=1.309，F_交互=0.136，均P < 0.01；BMI比较，F_组间=32.852，F_时间=18.514，F_交互=45.060，均P < 0.01。与同组干预前比较，^aP < 0.05；与同组干预后3个月比较，^bP < 0.05。

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表 5 观察组42例老年MHD患者透析效果评价指标比较(x±s)

Table 5. Comparison of evaluation indexes of dialysis effect in 42 elderly MHD patients in observation group (x±s)

时间	K (mmol/L)	P (mmol/L)	Scr (μmol/L)	BUN (mmol/L)
干预前	4.95±0.56	1.87±0.41	971.41±249.07	23.43±4.35
干预后3个月	4.36±0.47^a	1.51±0.34^a	874.25±216.44^a	21.25±4.13^a
干预后6个月	4.05±0.42^ab	1.36±0.27^ab	762.46±179.62^ab	18.86±3.92^ab
F值	37.056	24.273	138.713	12.820
P值	< 0.001	< 0.001	< 0.001	< 0.001
注：与干预前比较，^aP < 0.05；与干预后3个月比较，^bP < 0.05。

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参考文献(22)

[1]	王雪, 薛贵方. 维持性血液透析患者健康素养与治疗依从性的相关性研究[J]. 中国血液净化, 2020, 19(2): 88-91. WANG X, XUE G F. Correlation between health literacy and treatment compliance in maintenance hemodialysis patients[J]. Chinese Journal of Blood Purification, 2019, 19(2): 88-91.
[2]	FLEISHMAN T T, DREIHER J, SHVARTZMAN P. Patient-reported outcomes in maintenance hemodialysis: a cross-sectional, multicenter study[J]. Qual Life Res, 2020, 29(9): 2345-2354. doi: 10.1007/s11136-020-02508-3
[3]	刘媛媛, 何荣华, 张程珑. 老年维持性血液透析患者衰弱、心理弹性与生活质量的相关性研究[J]. 湖北医药学院学报, 2022, 41(2): 195-198. LIU Y Y, HE R H, ZHANG C L. Relationship between frailty, mental resilience and quality of life in elderly maintenance hemodialysis patients[J]. Journal of Hubei University of Medicine, 2022, 41(2): 195-198.
[4]	孙慧娟, 孙超, 王霞, 等. 五E模式在慢性肾脏病透析患者中的应用研究[J]. 护理管理杂志, 2021, 21(7): 515-519. SUN H J, SUN C, WANG X, et al. Application of five-E mode in dialysis patients with chronic kidney disease[J]. Journal of Nursing Administration, 2021, 21(7): 515-519.
[5]	POINEN K, VAN D H M, COPLAND M, et al. Perceptions of multidisciplinary renal team members toward home dialysis therapies[J]. Kidney360, 2021, 2(10): 1592-1599. doi: 10.34067/KID.0006222020
[6]	IMAMURA Y, TAKAHASHI Y, UCHIDA S, et al. Effect of multidisciplinary care of dialysis initiation for outpatients with chronic kidney disease[J]. Int Urol Nephrol, 2021, 53(7): 1435-1444. doi: 10.1007/s11255-021-02787-w
[7]	ZHANG Q, WAN L, CHEN Q, et al. Prevention of severe respiratory tract infection and prognosis in neurosurgical patients with severe tracheotomy based on 5E rehabilitation nursing model[J]. Comput Math Methods Med, 2022. DOI: 10.1155/2022/2727679.
[8]	INDAHL T C, PLANCHARD M, HAMMERLUND M E M, et al. Extension- a novel approach to inquiry learning with the 5E ' s[J]. Essays Educ, 2021, 27(1): 6.
[9]	张莉, 马迎春, 左力. 我国成人血液透析患者康复治疗的专家共识[J]. 中国血液净化, 2021, 20(11): 721-727. ZHANG L, MA Y C, ZUO L. Expert consensus on rehabilitation treatment of adult hemodialysis patients in China[J]. China Blood Purification, 2021, 20(11): 721-727.
[10]	中国医师协会康复医师分会肾康复专业委员会. 我国成人慢性肾脏病患者运动康复的专家共识[J]. 中华肾脏病杂志, 2019(7): 537-543. Renal Rehabilitation Professional Committee, Rehabilitation Physician Branch, Chinese Medical Doctor Association. Expert consensus on exercise rehabilitation in Chinese adult patients with chronic kidney disease[J]. Chinese Journal of Nephrology, 2019(7): 537-543.
[11]	李慧, 曹迎东, 姜亚芳, 等. 血液透析患者自我管理量表的引进及信效度检测[J]. 中华护理杂志, 2015, 50(11): 1392-1395. LI H, CAO Y D, JIANG Y F, et al. Reliability and validity tests of hemodialysis self-management instrument[J]. Chinese Journal of Nursing, 2015, 50(11): 1392-1395.
[12]	张艳, 黄金. 终末期肾病维持性血液透析患者治疗依从性量表的编制[J]. 中国全科医学, 2013, 16(34): 3312-3316. ZHANG Y, HUANG J. The development of medical treatment adherence scale for the end-stage renal disease patients with maintenance hemodialysis[J]. Chinese General Practice, 2013, 16(34): 3312-3316.
[13]	WILLS O, PROBST Y. Understanding lifestyle self-management regimens that improve the life quality of people living with multiple sclerosis: a systematic review and meta-analysis[J]. Health Qual Life Outcomes, 2022, 20(1): 153. doi: 10.1186/s12955-022-02046-1
[14]	LUO Y, HUANG Y, CHEN X, et al. Effects of multidisciplinary team care based on 5E ' s renal rehabilitation for peritoneal dialysis patients in Guangxi Zhuang Autonomous Region of China: a randomized controlled trial[J]. Blood Purif, 2019, 48(2): 115-123. doi: 10.1159/000496823
[15]	郑梦蕾, 舒亮辉. 5E康复模式对维持性血液透析患者微炎症状态及生活质量的影响[J]. 中国血液净化, 2023, 22(1): 68-72. ZHENG M L, SHU L H. Effects of 5E rehabilitation mode on microinflammatory status and quality of life in maintenance hemodialysis patients[J]. Chinese Journal of Blood Purification, 2019, 22(1): 68-72.
[16]	DELAVAR F, PASHAEYPOOR S, NEGARANDEH R. The effects of self-management education tailored to health literacy on medication adherence and blood pressure control among elderly people with primary hypertension: a randomized controlled trial[J]. Patient Educ Couns, 2020, 103(2): 336-342. doi: 10.1016/j.pec.2019.08.028
[17]	刘丽, 金莉, 金程, 等. 5E模式下持续质量改进管理对腹膜透析患者治疗效果和预后的影响[J]. 护士进修杂志, 2021, 36(23): 2135-2139. LIU L, JIN L, JIN C, et al. Effect of continuous quality improvement management on treatment and prognosis of peritoneal dialysis patients under 5E model[J]. Journal of Advanced Nursing, 2021, 36(23): 2135-2139.
[18]	何莉, 黄燕林, 侯璐蒙, 等. 基于5E康复模式的延续性护理在慢性肾脏病矿物质与骨异常患者血液透析治疗中的应用效果[J]. 广西医学, 2020, 42(5): 651-655. HE L, HUANG Y L, HOU L M, et al. Application effect of continuous nursing based on 5E rehabilitation model in hemodialysis treatment of patients with mineral and bone abnormalities in chronic kidney disease[J]. Guangxi Medical Journal, 2020, 42(5): 651-655.
[19]	DANIEL S, AZUERO A, GUTIERREZ O, et al. Examining the relationship between nutrition, quality of life, and depression in hemodialysis patients[J]. Qual Life Res, 2021, 30(3): 759-768. doi: 10.1007/s11136-020-02684-2
[20]	HEADLEY S, CHAPMAN D, GERMAIN M, et al. The effects of 16-weeks of prebiotic supplementation and aerobic exercise training on inflammatory markers, oxidative stress, uremic toxins, and the microbiota in pre-dialysis kidney patients: a randomized controlled trial-protocol paper[J]. BMC Nephrol, 2020, 21(1): 517.
[21]	蒋维连, 李芳, 杨平, 等. 老年慢性心力衰竭患者的多学科健康素养管理实践[J]. 中华全科医学, 2021, 19(3): 416-420. doi: 10.16766/j.cnki.issn.1674-4152.001825 JIANG W L, LI F, YANG P, et al. Practice of multidisciplinary health literacy management in elderly patients with chronic heart failure[J]. Chinese Journal of General Practice, 2021, 19(3): 416-420. doi: 10.16766/j.cnki.issn.1674-4152.001825
[22]	张玲, 李淮安, 周进. 芪柏塌渍方联合"5E"理念综合护理对海蜇蜇伤性急性皮炎及炎症因子的影响[J]. 中华全科医学, 2021, 19(1): 150-153. doi: 10.16766/j.cnki.issn.1674-4152.001753 ZHANG L, LI H A, ZHOU J. Effect of Qibaizaifang combined with "5E" concept on acute dermatitis and inflammatory factors of jellyfish stings[J]. Chinese Journal of General Practice, 2021, 19(1): 150-153. doi: 10.16766/j.cnki.issn.1674-4152.001753