【摘要】目的评估结构化教育在自体动静脉内瘘(ateriovenous fistula，AVF)患者自我护理行为中的效果。方法随机分干预组48 例和对照组41 例。对照组接受常规干预，干预组实施结构化教育，对比干预前后患者AVF 自我护理行为情况及满意度。结果干预后：对照组自身前后比较，患者AVF 自我护理行为总分(t=1.836, P=0.059)、症状体征管理(t=1.954, P=0.582) 及并发症预防得分(t=1.768, P=0.611)差异无统计学意义；干预组自身前后比较，患者AVF自我护理行为总分(t=4.699, P=0.032)、症状体征管理(t=3.288, P= 0.027)及并发症预防得分(t=4.005，P=0.025)差异有统计学意义；干预后，干预组与对照组比较，患者AVF 自我护理行为总分(t= 3.847, P=0.013)、症状体征管理(t=2.589，P=0.027)及并发症预防得分(t=3.255，P=0.023)差异有统计学意义；干预组满意度高于对照组，灵活性、自主性、多样性(c2=6.028，P=0.031；c2=5.745，P=0.025；c2=4.321，P=0.032)比较差异有统计学意义。结论在AVF 患者自我护理行为健康教育中，结构化教育效果显著，值得推广。
【Abstract】Objective To evaluate the effect of structured education on self-care behavior towards arteriovenous fistula (AVF) in hemodialysis patients. Methods The hemodialysis patients were randomly divided into the intervention group (n=48) and the control group (n=41). Patients in the control group received routine nursing, and those in the intervention group were treated with structured education. The self-care behavior towards AVF and satisfaction of the patients were compared before and after the intervention. Results In the control group, the total score of self-care behavior towards AVF (t=1.836, P=0.059), symptom and sign management score (t=1.954, P=0.582) and complication prevention score (t=1.768, P=0.611) had no statistically significances as compared with those before and after the intervention. In the intervention group, the total score of self-care behavior towards AVF (t=4.699, P=0.032), symptom and sign management score (t=3.288, P=0.027) and complication prevention score (t=4.005, P=0.025) were statistically significant as compared with those before and after the intervention. After the intervention, the total score of self- care behavior towards AVF (t=3.847, P=0.013), symptom and sign management score (t=2.589, P=0.027) and complication prevention score (t=3.255, P=0.023) were statistically higher in the intervention group than in the control group; the rate of patient satisfaction was higher in the intervention group than in the control group; the flexibility
(c2=6.028, P=0.031), independence (c2=5.745, P=0.025) and diversity (c2=4.321, p=0.032) were also statistically different between the two groups. Conclusion In the health education of self-care behavior for patients with AVF, the structured education has significant effects and can be widely used.
[1] 吕忠美，朱亚梅，顾艳红，等. 动静脉内瘘围手术期患者功能锻炼开始时间的研究[J]. 中华护理杂志, 2019, 54(8): 1224-1228.
[2] 韩丽君，彭幼清，吴倩，等. 血液透析病人动静脉内瘘自我护理能力量表的编制及信效度检验[J]. 全科护理, 2019, 17(34): 4331-4334.
[3] 张丽红，王玉柱. 北美血管通路协会血液透析血管通路标准化定义解读[J]. 中国血液净化, 2013, 12(3): 167-169.
[4] 韦玲，方立明，胡泳，等. 血液透析患者动静脉内瘘闭塞的危险因素及干预措施[J]. 临床内科杂志, 2018, 35(11): 747-748.
[5] 范恩梅，吴燕，杨月，等. 全程点对点护理在改善血液透析患者动静脉内瘘自我护理中的作用[J]. 海军医学杂志, 2020, 41(1): 106-109.
[6] 吉小静,戴欢欢,徐骏. 物理检查在预防自体动静脉内瘘闭塞中的应用[J]. 护理实践与研究, 2016, 13(11): 38-39.
[7] Sousa C N, Paquete A R C, Teles P, et al. Investigating the Effect of a Structured Intervention on the Development of Self-Care Behaviors With Arteriovenous Fistula in Hemodialysis Patients[J]. Clinical Nursing Research, 2020: 1575242315.
[8] Tu W X G D. Structure and content components of self-management interventions that improve health-related quality of life in people with inflammatory bowel disease: A systematic review, meta-analysis and meta-regression. [J]. Journal of Clinical Nursing, 2015, 6(24): 2695-2709.
[9] 杨淼淼,赵慧华. 血液透析病人动静脉内瘘自我护理行为研究进展[J]. 护理研究, 2017, 31(33): 4177-4179.
[10] Sousa C M P T. Self-care behavior profiles with arteriovenous fistula in hemodialysis patients. [J]. Clinical Nursing Research, 2020, 6(29): 363-367.
[11] 杨淼淼 赵慧华. 中文版血液透析患者动静脉内瘘自我护理行为量表信效度初步评价[J]. 中国实用护理杂志, 2017, 33(19): 1467-1470.
[12] 赵咏莉，何春玲，姚新明，等. 结构化教育在2型糖尿病患者中的临床效果评价[J]. 皖南医学院学报, 2020, 39(1): 32-35.
[13] 顾芳臣，林征，尚星辰，等. 结构化教育在慢性病自我管理中的应用研究进展[J]. 护理研究, 2019, 33(19): 3361-3365.
[14] 周冰，陈谊月，谢晓炜，等. 结构化教育对痛风患者慢性病自我效能水平的影响[J]. 广西医学, 2020, 42(5): 637-639, 封3.
