【摘要】目的观察基于个案管理的查房式交班模式在维持性血液透析(maintenance hemodialysis，MHD)患者中的应用效果。方法选取2019 年1～12 月在苏州大学附属第二医院行规律MHD 的236 例患者，1～6 月采取常规护理干预(对照组)，7～12 月采取基于个案管理的查房式交班护理干预(试验组)，比较2 组干预末期患者自我管理能力、治疗依从性、透析间期体质量增长(inter dialysis weight gain, IDWG)、血磷达标率、血管通路并发症发生率及透析充分性。结果干预6 个月后，患者自我管理能力评分及治疗依从性中饮食依从、液体摄入依从、用药依从、透析方案依从，试验组均高于对照组(t 值分别为8.581，13.093，10.349，10.469，6.022；P 值分别为0.012，0.004，0.011，0.009，0.018)；试验组血磷达标率、透析充分性均优于对照组(t 值分别为26.578，3.716；P 值分别为0.006，0.023)，血管通路并发症发生率低于对照组(χ2=4.594，P=0.032)，IDWG 低于对照组(t=6.819，P=0.021)。结论基于个案管理的查房式交班模式可以提高MHD 患者的自我管理能力和治疗依从性，改善血磷达标率、减少血管通路并发症发生率，提高透析的充分性，更好地控制透析期间体质量，值得在血液透析患者的护理工作中进一步推广。
【Abstract】Objective To explore the effect of case management-based ward round handover mode applied in maintenance hemodialysis (MHD) patients. Methods A total of 236 patients with regular MHD in The Second Affiliated Hospital of Soochow University from January to December in 2019 were enrolled in this study. Routine nursing intervention was taken from January to June as the control group, and then the nursing intervention of case management-based ward round handover mode was taken from July to December as the experimental group. The self-management ability, treatment compliance, inter-dialysis weight gain (IDWG), serum phosphorus compliance rate, incidence of vascular access complications and dialysis adequacy were compared between the two groups. Results After 6 months of intervention, the scores of self-management ability, food compliance, fluid intake compliance, drug compliance and dialysis protocol compliance were higher in the experimental group than in the control group (t=8.581, 13.093, 10.349, 10.469 and 6.022, respectively; P=0.012, 0.004, 0.011, 0.009 and 0.018, respectively). The compliance rate of serum phosphorus and dialysis adequacy were better in the experimental group than in the control group (t=26.578 and 3.716, respectively; P=0.006 and 0.023, respectively). Besides, the incidence of vascular access complications
(χ2=4.594, P=0.032) and the IDWG (t=6.819, P=0.021) were lower in the experimental group than in the control group. Conclusion The case management- based ward round handover mode applied to MHD patients can improve their self-management ability, treatment compliance, compliance rate of serum phosphorus, incidence of vascular access complications, dialysis adequacy and interdialytic weight gain. This nursing intervention mode is worthy of wide use in the nursing work for MHD patients.
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