基于赋能理论的维持性血液透析患者饮食管理模式构建及应用

陈科威; 葛玉英; 魏伟; 王秋妹; 郑菊清

doi:10.16766/j.cnki.issn.1674-4152.003800

基于赋能理论的维持性血液透析患者饮食管理模式构建及应用

doi: 10.16766/j.cnki.issn.1674-4152.003800

杭州市第一人民医院血透室，浙江杭州 310006

基金项目:

浙江省自然科学基金公益计划项目 LGF21H050003

详细信息

通讯作者:
陈科威，E-mail：weike04c@163.com

中图分类号: R459.5 R692
计量
- 文章访问数: 14
- HTML全文浏览量: 10
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-01-02
- 网络出版日期: 2025-01-20

Application effect of diet management based on empowerment theory for patients with maintenance hemodialysis

Hemodialysis Room, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, China

摘要

摘要: 目的本研究旨在评估基于赋能理论的饮食管理模式对维持性血液透析(MHD)患者营养状况和饮食治疗态度的改善效果，从而验证赋能理论在提升MHD患者自我管理能力和生活质量方面的有效性。方法回顾性分析2019年1月—2022年1月于杭州市第一人民医院接受治疗的130例MHD患者临床资料，根据患者干预方法分为赋能理论干预组(65例)和常规干预组(65例)，其中常规干预组患者接受常规护理，赋能理论干预组患者接受基于赋能理论的饮食管理。比较2组改良主观全面营养评价表(MQSGN)评分、汉化版血液透析病人饮食治疗态度量表(ASDTH)评分、白蛋白(ALB)、前白蛋白(PAB)、血红蛋白(Hb)、血磷、血钙水平。结果干预后，赋能理论干预组MQSGN总分低于常规干预组[(18.41±4.78)分vs.(21.42±4.31)分，P＜0.05]，ASDTH总分高于常规干预组[(44.07±2.37)分vs.(38.46±2.54)分，P＜0.05]。赋能理论干预组PAB、ALB、Hb水平高于常规干预组，血磷水平低于常规干预组，差异均有统计学意义(P＜0.05)；2组血钙水平比较差异无统计学意义(P＞0.05)。结论基于赋能理论实施饮食管理有助于提高MHD患者饮食治疗依从性，改善患者营养状况。
- 赋能理论 /
- 维持性血液透析 /
- 营养状况 /
- 饮食管理
Abstract: Objective The aim of this study was to evaluate the effect of a dietary management model based on empowerment theory on the improvement of nutritional status and dietary treatment attitudes of maintenance haemodialysis (MHD) patients, so as to validate the effectiveness of empowerment theory in enhancing the self-management ability and quality of life of MHD patients. Methods The clinical data of 130 patients with MHD who were treated in Hangzhou First People's Hospital from January 2019 to January 2022 were retrospectively analyzed. The patients were divided into empowering theory intervention group (n=65) and routine intervention group (n=65) according to patient intervention. The patients in the routine intervention group received routine nursing, and the patients in the empowering theory intervention group received diet management based on empowerment theory. The modified quantitative subjective global assessment of nutrition (MQSGN) score, attitude scale for the dietary therapy of hemodialysis patients (ASDTH) score, albumin (ALB), prealbumin (PAB), hemoglobin (Hb), blood phosphorus and blood calcium were compared. Results The MQSGN score of the empowering theory intervention group was less than the routine intervention group [(18.41±4.78) points vs. (21.42±4.31) points, P < 0.05]. The ASDTH score of the empowering theory intervention group was higher than the routine intervention group [(44.07±2.37) points vs. (38.46±2.54) points, P < 0.05]. Compared with routine intervention group, the levels of PAB, ALB and Hb of empowering theory intervention group were increased, and blood phosphorus was decreased, the differences were statistically significant (P < 0.05). There was no difference in blood calcium between the two groups (P>0.05). Conclusion Diet management based on empowerment theory for MHD patients can help improve compliance and nutritional status.
- Empowerment theory /
- Maintenance hemodialysis /
- Nutritional status /
- Diet manager

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表 1 2组MHD患者一般资料比较

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

项目	赋能理论干预组(n=65)	常规干预组(n=65)	统计量	P值
性别(例)			0.130^a	0.718
男性	39	41
女性	26	24
年龄(例)
＜60岁	23	20	0.313^a	0.576
≥60岁	42	45
尿素清除指数(x±s，mL·min^-1·1.73 m^-2)	1.90±0.17	1.92±0.20	0.218^b	0.830
透析方案(例)			0.144^a	0.704
每周2次	21	19
每周3次	44	46
原发病(例)			0.302^a	0.860
慢性肾小球肾炎	29	31
糖尿病肾病	25	22
肾动脉硬化	11	12
透析时间(例)			0.810^c	0.418
＜6个月	13	11
6~12个月	38	36
＞12个月	14	18
文化程度(例)			0.871^c	0.384
初中及以下	19	16
高中或中专	21	19
大专及以上	25	30
家庭人均月收入(例)			0.599^c	0.549
＜3 000元	5	6
3 000~5 000元	38	40
＞5 000元	22	19
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 2组MHD患者治疗前后MQSGN评分比较(分)

Table 2. Comparison of MQSGN scores between the two groups of MHD patients before and after treatment (points)

组别	例数	体质量改变[M(P₂₅, P₇₅)]		胃肠道症状[M(P₂₅, P₇₅)]		饮食改变[M(P₂₅, P₇₅)]		合并症[M(P₂₅, P₇₅)]
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
赋能理论干预组	65	3(3，4)	2(1，2)^b	3(2，3)	2(1，2)^b	3(3，4)	2(2，3)^b	3(3，4)	3(3，4)
常规干预组	65	3(2，4)	3(2，3)^b	3(2，3)	3(2，3)	3(3，4)	3(2，3)	3(3，4)	3(3，4)
统计量		0.701^a	2.786^a	0.127^a	2.666^a	0.120^a	2.601^a	0.091^a	0.199^a
P值		0.275	0.035	0.912	0.039	0.929	0.041	0.958	0.889

组别	例数	生理功能改变[M(P₂₅, P₇₅)]		肌肉消耗[M(P₂₅, P₇₅)]		皮下脂肪[M(P₂₅, P₇₅)]		总分(x±s)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
赋能理论干预组	65	3(3，4)	3(2，3)^b	3(3，4)	2(2，3)^b	3(2，3)	2(2，3)^b	22.71±6.21	18.41±4.78^b
常规干预组	65	3(3，4)	3(3，3)	3(3，4)	3(2，3)	3(2，3)	2(2，3)	22.33±6.96	21.42±4.31
统计量		0.090^a	2.559^a	0.098^a	2.974^a	0.104^a	1.865^a	4.434^c	14.903^d
P值		0.958	0.045	0.950	0.030	0.946	0.321	0.037	＜0.001
注：^a为Z值，^c为t值，^d为F值；与干预前比较，^bP＜0.05。

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表 3 2组MHD患者治疗前后ASDTH评分比较(x±s，分)

Table 3. Comparison of ASDTH scores between the two groups of MHD patients before and after treatment (x±s, points)

组别	例数	认知行为意向		饮食文化行为意向		饮食改变的消极影响		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
赋能理论干预组	65	14.31±1.86	20.89±2.31^b	10.97±1.68	12.89±1.79^b	5.56±0.98	8.29±0.94^b	30.84±1.92	44.07±2.37^b
常规干预组	65	14.42±1.95	18.06±2.57^b	11.02±1.85	13.17±1.43^b	5.49±1.02	7.23±0.85^b	30.93±1.87	38.46±2.54^b
统计量		0.329^a	44.868^c	0.161^a	0.905^c	0.399^a	50.531^c	0.271^a	173.678^c
P值		0.734	＜0.001	0.872	0.343	0.691	＜0.001	0.787	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.05。

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表 4 2组MHD患者治疗前后营养指标比较(x±s)

Table 4. Comparison of nutritional indexes between the two groups of MHD patients before and after treatment (x±s)

组别	例数	PAB(mg/L)		ALB(g/L)		Hb(g/L)		血钙(mmol/L)		血磷(mmol/L)
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
赋能理论干预组	65	248.36±18.45	312.78±16.29^b	33.47±4.86	45.88±5.51^b	94.62±18.23	111.48±15.13^b	1.85±0.62	2.14±0.36^b	2.21±0.36	1.64±0.41^b
常规干预组	65	250.19±20.44	267.54±17.03^b	34.05±5.12	40.17±4.79^b	93.95±20.54	103.52±16.74^b	1.81±0.54	1.97±0.42	2.27±0.42	1.96±0.49^b
统计量		0.536^a	238.427^c	0.662^a	39.626^c	0.197^a	7.98^c	0.392^a	4.195^c	0.874^a	13.783^c
P值		0.593	＜0.001	0.509	＜0.001	0.844	0.005	0.696	0.043	0.384	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.05。

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参考文献(16)

[1]	章如山, 唐根富, 王瑞, 等. 安庆市农村高血压患者低密度脂蛋白胆固醇与肾功能轻度下降的关系[J]. 中华全科医学, 2022, 20(7): 1226-1229. doi: 10.16766/j.cnki.issn.1674-4152.002564 ZHANG R S, TANG G F, WANG R, et al. Relationship between low density lipoprotein cholesterol and mild decline of renal function in patients with hypertension in rural Anqing city[J]. Chin J Gene Med, 2022, 20(7): 1226-1229. doi: 10.16766/j.cnki.issn.1674-4152.002564
[2]	SHAH M K, PARIKH M, PRAJAPATI D, et al. Safety and tolerability of remdesivir in patients with end-stage renal disease on maintenance hemodialysis[J]. Indian J Crit Care Med, 2022, 26(5): 619-625. doi: 10.5005/jp-journals-10071-24168
[3]	顾勤, 吴桃峰, 陈静芳. 维持性血液透析患者透析期间饮食管理的最佳证据总结[J]. 中华护理杂志, 2021, 56(10): 1485-1489. GU Q, WU T F, CHEN J F. Evidence-based practice of dietetic management in maintenance hemodialysis patients[J]. Chin J Nurs, 2021, 56(10): 1485-1489.
[4]	史倩倩, 荆海红, 刘维, 等. 赋能心理护理干预在青年乳腺癌患者及其配偶中的应用[J]. 中华现代护理杂志, 2022, 28(13): 1773-1776. SHI Q Q, JING H H, LIU W, et al. Application of empowering psychological nursing intervention in young patients with breast cancer and their spouses[J]. Chin J Mod Nurs, 2022, 28(13): 1773-1776.
[5]	中国医师协会肾脏内科医师分会. 中国慢性肾脏病营养治疗临床实践指南(2021版)[J]. 中华医学杂志, 2021, 101(8): 539-559. Chinese Medical Doctor Association renal Physicians Branch. Chinese clinical practice guidelines for nutritional treatment of chronic kidney disease (2021 edition)[J]. Chin Med J, 2021, 101(8): 539-559.
[6]	杨震, 黄燕林, 卢海珍, 等. 维持性血液透析病人饮食状态影响因素及其与生存质量的相关性研究[J]. 护理研究, 2021, 35(14): 2560-2564. YANG Z, HUANG Y L, LU H Z, et al. Study on influencing factors of dietary status and its correlation with quality of life in maintenance hemodialysis patients[J]. Nurs Res, 2021, 35(14): 2560-2564.
[7]	李家琳, 付丽. 血液透析病人饮食治疗态度量表的汉化及信效度考评[J]. 护理研究, 2020, 34(2): 202-207. LI J L, FU L. Sinicization and reliability and validity evaluation of dietary treatment attitude scale for hemodialysis patients[J]. Nurs Res, 2020, 34(2): 202-207.
[8]	侍珍珍, 唐景凤, 庄静. 基于行为转变理论的护理干预对维持性血液透析患者饮食管理依从行为及营养状况的影响[J]. 中国医药导报, 2020, 17(32): 169-172. SHI Z Z, TANG J F, ZHUANG J. Effect of nursing intervention based on Behavior change theory on dietary management compliance behavior and nutritional status of maintenance hemodialysis patients[J]. Chin Med Hera, 2020, 17(32): 169-172.
[9]	孙美兰, 孙新, 杨丽. 维持性血液透析患者的精准饮食管理[J]. 护理学杂志, 2022, 37(10): 20-22. SUN M L, SUN X, YANG L. Management of precision diet in maintenance hemodialysis patients[J]. J Nurs Sci, 2022, 37(10): 20-23.
[10]	罗欢, 卿伟, 唐利群, 等. 智谋训练在行维持性血液透析的中青年慢性肾脏病患者中的应用效果[J]. 广西医学, 2023, 45(11): 1369-1373. LUO H, QING W, TANG L Q, et al. Application of resourcefulness training in maintenance hemodialysis in young and middle-aged patients with chronic kidney disease[J]. Guangxi Med J, 2023, 45(11): 1369-1373.
[11]	王培莉, 林巧红. "互联网+"营养教育在维持性血液透析患者中的应用[J]. 中华护理杂志, 2021, 56(1): 33-36. WANG P L, LIN Q H. Application of "Internet+" nutrition education in maintenance hemodialysis patients[J]. Chin J Nurs, 2021, 56(1): 33-36.
[12]	张娜, 陈海勤, 蒋娟芬, 等. 赋能教育模式在抑郁症患者中的应用效果评价[J]. 护理管理杂志, 2021, 21(6): 451-456. ZHANG N, CHEN H Q, JIANG J F, et al. Evaluation of the application effect of enabling education model in patients with depression[J]. J Nurs Admin, 2021, 21(6): 451-456.
[13]	程丽, 李阿敏. 维持性血液透析病人饮食治疗态度现状及影响因素[J]. 护理研究, 2022, 36(15): 2782-2786. CHENG L, LI A M. Status quo and influencing factors of dietary treatment attitude of maintenance hemodialysis patients[J]. Nurs Res, 2022, 36(15): 2782-2785.
[14]	余祖琳, 胡素君, 潘月瑢, 等. 赋能心理护理干预在癫痫患儿直接照顾者中的应用[J]. 中华现代护理杂志, 2021, 27(13): 1797-1801. YU Z L, HU S J, PAN Y R, et al. Application of empowering psychological nursing intervention in direct caregivers of children with epilepsy[J]. Chin J Mod Nurs, 2021, 27(13): 1797-1801.
[15]	王志敏, 何佩仪, 杜萍. 专科护理门诊延续跟进式赋能教育对鼻咽癌放疗患者康复的影响[J]. 中国护理管理, 2020, 20(1): 107-111. WANG Z M, HE P Y, DU P. Effect of follow-up empowerment education in specialized nursing outpatient Department on rehabilitation of patients with nasopharyngeal carcinoma after radiotherapy[J]. Chin Nurs Manage, 2020, 2(1): 107-111.
[16]	陈钦, 郑昌志, 何祥琨. 维持性血液透析患者的血磷水平与冠状动脉钙化的关系研究[J]. 临床内科杂志, 2022, 39(6): 390-391.