【作者】 李晓微；

【导师】 陆萍静；

【作者基本信息】 吉林大学 ， 护理学， 2014， 硕士

【摘要】 目的本研究旨在了解维持性血液透析患者生存质量现状，探讨家庭跟进护理对维持性血液透析患者生存质量及自我管理行为的影响，为今后该护理方式在社区的推广提供参考依据。方法方便抽取符合条件的长春市某三甲医院血液净化中心的维持性血液透析患者共62例，按患者透析计划分组，周一、周三、周五透析的患者为干预组，周二、周四、周六透析的患者为对照组，两组患者各31例。两组患者在透析期间均接受常规护理，且两组患者回归家庭后均由家人指导、照顾。干预组在此基础上接受家庭跟进护理，由接受正规培训的研究组成员进行入户指导1次、每次不少于1小时，电话跟踪3次或因特殊情况可增加电话跟踪次数，干预持续5个月；研究组成员通过入户与患者交谈，评估患者存在的主要问题并制定干预计划，为后续入户指导及电话随访工作提供依据；干预内容主要包括对干预对象进行健康宣教、饮食指导、体重监测、心理护理、动静脉瘘的护理、医疗监测、并发症的预防等方面的相关指导及教育。干预前、干预后对两组患者发放世界卫生组织生存质量测定量表（WHOQOL-BREF）及血液透析患者自我管理行为问卷，并于干预前对两组患者发放一般资料问卷。运用Excel2003建立数据库并进行数据录入，采用SPSS17.0统计软件进行数据分析。结果（1）干预前，对照组生存质量总分为83.32±16.35，干预组生存质量总分为87.02±15.19，两组患者的总分比较，差异无统计学意义（P>0.05）；干预后，对照组生存质量总分为84.73±15.48，干预组生存质量总分为101.03±16.32，两组患者的总分比较，差异有统计学意义（P<0.001）。（2）干预前，两组患者的生存质量各领域得分比较，差异均无统计学意义（P>0.05）；干预后，两组患者生理领域、心理领域及社会关系领域得分比较，具有显著性统计学差异（P<0.001），环境领域得分比较，差异有统计学意义（P<0.05）。（3）干预前，对照组自我管理行为总分为78.78±11.03，干预组自我管理行为总分为80.74±11.52，两组总分比较，差异无统计学意义（P>0.05）；干预后，对照组自我管理行为总分为77.83±11.91，干预组自我管理行为总分为89.48±11.18，两组总分比较，差异有统计学意义（P<0.05）。（4）干预前，两组患者自我管理行为各维度得分比较，差异均无统计学意义（P>0.05）；干预后，两组患者各维度得分比较，差异有统计学意义（P<0.05）。（5）干预前、后，两组患者生存质量总分自身比较，对照组差异无统计学意义（P>0.05），干预组差异有统计学意义（P<0.05）；干预前、后，两组患者自我管理行为总分自身比较，对照组差异无统计学意义（P>0.05），干预组差异有统计学意义（P<0.05）。结论（1）维持性血液透析患者生存质量普遍偏低。（2）家庭跟进护理能够提高血液透析患者生存质量，在患者的生理、心理及社会关系方面效果比较显著。（3）维持性血液透析患者自我管理能力普遍较低。（4）家庭跟进护理能够改善血液透析患者自我管理行为。更多还原

【Abstract】 ObjectiveThis study aims to understand the status of maintenance hemodialysis patients’quality of life, to explore the effect of family follow-up service on the quality of lifeand self-management behaviors in maintenance hemodialysis patientsMethodsIn this study,62clients were selected from the hemodialysis center of a hospitalin Changchun. They were set into the control group and the intervention groupaccording to the hemodialysis plan, each were31clients. Both of the two groups weregiven general care, and they were attended by their families. On this basis, theintervention group received follow-up service. The patients received family follow-upone time and telephone follow-up three times or more each month. The interventionlasted for5months, family follow-up intervention lasted for no less than an hour eachtime. The interventions includes health education, diet education, weight monitoring,psychological care and so on. All of the clients were given the WHOQOL-BREF andthe self-management behavior scale before and after the intervention. They were alsogiven the general information questionnaire before the intervention. We established adatabase with Excel2003and analyzed the data with SPSS17.0.Results(1) Before the intervention, the quality of life score of the control group was83.32±16.35, the intervention group was87.02±15.19, the difference was notstatistically significant (P>0.05); After the intervention, the quality of life score of thecontrol group was84.73±15.48, the intervention group was101.03±16.32, thedifference was statistically significant (P <0.001).. (2) There was no statistical significance(P>0.05) on the scores of each field oftheir quality of life before the intervention.There was great significance(P <0.001) onthe scores of each field after the intervention after the intervention, especially in thephysiology, psychology and social relations fields(P <0.001).(3)Before the intervention, the self-management score of the control group was78.78±11.03the intervention group was80.74±11.52, the difference was notstatistically significant (P>0.05); After the intervention, the self-management score ofthe control group was77.83±11.91, the intervention group was89.48±11.18.(4)There was no statistical significance(P>0.05) on the scores of each field ontheir self-management before the intervention.There had great significance(P <0.05)on the scores of each field after the intervention after the intervention.(5)The quality of life score of the control group was no statisticalsignificance(P>0.05),and the intervention group had great significance(P <0.05)before or after the intervention. The self-management score of the control group wasno statistical significance(P>0.05),and the intervention group had great significance(P<0.05) before or after the intervention.Conclusions(1) Maintenance hemodialysis patients’ quality of life is generally low.(2) Family follow-up service can improve the quality of life in hemodialysispatients，especially in physical, psychological and social relationships fields.(3) Maintenance hemodialysis patients’ self-management ability is generally low.(4) Family follow-up service can improve the self-management behavior inhemodialysis patients.更多还原