目的 探讨基于认知负荷理论的内瘘管理模式对首次建立内瘘的血液透析患者的影响。 方法 选择2019年6月～2020年5月首次建立内瘘的血液透析患者42例为观察组，实施基于认知负荷理论的内瘘管理；以2018年6月～2019年5月实施常规内瘘管理的44例为对照组。 结果 干预后，观察组内瘘相关知识得分为95(90.00，100.00)分，高于对照组的80(75.00，85.00)分(Z=-6.709，P＜0.001)；2组遵医行为的比较有统计学差异(x2=29.951，P＜0.001)，其中观察组完全依从率为59.5%，高于对照组的6.8%(x2=27.185，P＜0.001)；观察组手术后1年内瘘一次性穿刺成功率为99.7%，高于对照组的99.4%(x2=6.496，P=0.011)；观察组手术后1年血栓和血流量不足的发生率分别为7.1%和2.4%，低于对照组的22.7%和13.6%(x2分别为4.067和5.726，P分别为0.044和0.017)。 结论 基于认知负荷理论的内瘘管理模式有助于提高血液透析患者健康教育质量和内瘘一次性穿刺成功率，从而减少内瘘并发症的发生，值得推广。
bjective To explore the effect of arteriovenous fistula (AVF) management based on cognitive load theory in maintenance hemodialysis (MHD) patients with AVF established for the first time. Method A total of 42 MHD patients who had AVF for the first time from June 2019 to May 2020 were selected as the observation group to implement AVF management based on cognitive load theory; a total of 44 MHD cases with conventional AVF management from June 2018 to may 2019 were taken as the control group. Result After the intervention, the AVF related knowledge score was 95 (90.00, 100.00) in the observation group and was 80 (75.00, 85.00) in the control group (Z=-6.709, P<0.001). There was significant difference in compliance behavior between the two groups (χ2=29.951, P<0.001); the complete compliance rate in the observation group was 59.5% and was 6.8% in the control group (χ2=27.185, P<0.001). The success rate of first internal fistula puncture within one year after the operation was 99.7% in the observation group and was 99.4% in the control group (χ2=6.496, P=0.011). The rates of thrombosis and insufficient blood flow within one year after the operation were 7.1% and 2.4% respectively in the observation group and were 22.7% and 13.6% respectively in the control group (χ2=4.067 and 5.726, P= 0.044 and 0.017). Conclusion The AVF management model based on cognitive load theory is helpful to improve the quality of health education and the success rate of first internal fistula puncture in MHD patients. Therefore, this management model can reduce the AVF complications and is worthy of promotion in clinical practice.
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