【摘要】目的探讨行为转变理论模式(the transtheoretical model and stages of change,TTM)对腹膜透析患者临床症状以及生活质量的影响。方法纳入陆军特色医学中心大坪医院284 名患者，随机分成研究组和对照组。2 组患者均接受相同的标准治疗方案、饮食指导和常规活动指导建议。实验组采用TTM 干预方法, 通过无意图阶段、意图阶段、准备阶段、行动阶段和维持阶段5 个步骤进行干预。12 月后比较2 组患者行为改变，临床症状发生率和程度，生活质量评分。结果入组12 月后研究组运动量明显高于对照组(t= -3.011,P＜0.001)，吸烟和饮酒率明显低于对照组(χ2值分别为34.841,11.170；P 值分别为＜0.001，＜0.001)。入组12月后研究组皮肤干燥(χ2=0.271，P=0.697；t=1.325，P=0.166)、易醒(χ2=0.147，P=0.797；t=0.484，P =0.881)、疲倦(χ2= 0.147；P =0.798；t=0.345，P=0.667)、皮肤痒(χ2=0.138，P=0.804；t=0.251,P=0.487)、入睡困难(χ2=0.135, P=0.807；t= 1.298, P=0.214)、下肢水肿(χ2=0.059，P=0.903；t=0.244，P=0.491)、口干(χ2=0.014，P=0.905；t=1.137，P=0.202)、骨关节痛(χ2=0.057,P=0.905；t=0.631，P=0.587)、咳嗽(χ2=0.057，P=0.905；t=0.635，P=0.399)、气短(χ2=0.018，P=0.895；t= 1.229，P=0.111)、头昏(χ2=0.059，P=0.903；t=1.363，P=0.269)发生率和程度评分均明显高于对照组；入组时2 组患者的生活质量量表(the medical outcomes study 36 item short from health survey,SF-36)的8个维度评分均较低，入组6 个月后研究组躯体症状、由躯体问题所造成的角色限制、情感角色分值显著高于对照组(t 值分别为2.542, 3.778, 2.741；P 值分别为0.016,＜0.001，0.003)，入组12 个月后研究组的躯体功能、由躯体问题所造成的角色限制、躯体不适、健康总体自评、活力、情感角色分值均高于对照组(t 值分别为4.207, 1.921, 2.532, 2.921, 2.214, 2.031；P 值分别为＜0.001,＜0.001，0.017，0.027，0.027，0.019,)。结论TTM 可改变其不良行为和生活方式，减少透析患者症状群的发生率，并且提高其生活质量。

【Abstract】Objective To investigate the effect of the transtheoretical model and stages of change (TTM) on improving the symptoms and quality of life in patients with peritoneal dialysis (PD). Methods A total of 284 PD patients treated in our hospital were recruited and randomly divided into study group or control group. Both groups received the standard protocol of treatment plan, dietary and general activity guidance; the study group used TTM intervention in addition to the standard protocol. Interventions were carried out through five steps: unintended phase, intent phase, preparation phase, action phase and maintenance phase. Behavior change, incidence and degree of clinical symptoms, and quality of life score were compared between the two groups after the intervention for 12 months. Results There were no significant differences in the incidence and degree of clinical symptoms between the two groups before the intervention (P>0.05). After the intervention for 12 months, exercise increased (t=-3.011, P＜0.001), and the rates of smoking (χ2=34.841, P<0.001) and drinking (χ2=11.17, P=0.001) decreased in study group compared to those in control group; the incidence and severity of dry skin (χ2=0.271, P=0.697; t=1.325, P=0.166), insomnia (χ2=0.147, P=0.797; t=0.484,P=0.881), fatigue (χ2=0.147, P=0.798; t=0.345, P=0.667), skin itch (χ2=0.138, P=0.804; t=0.251, P=0.487), lower extremity edema (χ2=0.059, P=0.903; t=0.244, P=0.491), dry mouth (χ2=0.014, P=0.905; t=1.137, P=0.202), joint pain (χ2=0.057, P=0.905; t=0.631, P=0.587), cough (χ2=0.057, P=0.905; t=0.635, P=0.399), breath shortness (χ2=0.018, P=0.895; t=1.229, P=0.111) and dizziness (χ2=0.059, P=0.903; t=1.363, P=0.269) were significantly lower in study group than in control group. At the time of enrollment, scores of the 8 dimensions in the quality of life SF- 36 scale were lower in both groups. After the enrollment for 6 months, the scores of PF (t= 2.542, P=0.016), RP (t=3.778, P＜0.001) and REP (t=2.741, P=0.003) were significantly higher in study group than in control group. After the enrollment for 12 months, the scores of PF (t=4.207, P＜0.001), RP (t=1.921, P＜0.001), BP (t= 2.532, P=0.017), GHP (t=2.921, P=0.027), VT (t=2.214, P=0.027)and REP (t=2.031, P=0.019) were significantly higher in study group than in control group. Conclusion TTM can change the abnormal behavior and lifestyle, reduce the incidence of symptom groups, and improve quality of life in PD patients.