目的 探究风险分级管理对慢性肾脏病高钾血症患者的影响。方法 选取郑州大学第一附属医院90例慢性肾脏病患者作为研究对象，采用随机抽样法将其分为对照组和试验组，各45例。对照组实施常规护理，试验组在常规护理的基础上实施风险分级管理方案，比较2组干预前后高钾血症发生率、高钾血症认知水平、服药依从性及饮食依从性。 结果 试验组高钾血症发生率低于对照组(χ2=4.444，P=0.035)，试验组高钾血症认知(t=-7.071，P＜0.001)、服药依从性(t=-3.081，P=0.004)及饮食依从性 (t=-8.785，P＜0.001)高于对照组。 结论 对慢性肾脏病患者应用风险分级管理方案，可降低患者高钾血症发生率，提高高钾认知水平，促进患者养成良好的服药及饮食依从行为，有利于降低不良事件的发生。
Objective This paper is to explore the effects of risk grading management scheme on chronic renal disease patients with hyperkalemia. Method A total of 90 patients with chronic kidney disease in the First Affiliated Hospital of Zhengzhou University were selected as the research objects. They were randomly divided into control group and experimental group and 45 cases in each group. The control group was given routine nursing care, while the experimental group was used the risk grading management program in addition to routine nursing care. The incidence and the cognitive level of hyperkalemia, the medication compliance and diet compliance for hyperkalemia were compared before and after intervention between the two groups. Results The incidence of hyperkalemia was significantly lower in experimental group than in control group (c2=4.444,P=0.035); the cognition of hyperkalemia risks (t=-7.071, P<0.001), the medication compliance (t= -3.081, P=0.004) and the diet compliance (t=-8.785, P<0.001) were also higher in experimental group than in control group. Conclusion The application of risk grading management scheme on patients can reduce the incidence of hyperkalemia, improve the cognitive level and help patients develop good behaviors of medication and diet compliance, to reduce the occurrence of adverse events.
参考文献
[1] Rosano G, Tamargo J, Kjeldsen K P, et al. Expert consensus document on the management of hyperkalaemia in patients with cardiovascular disease treated with renin angiotensin aldosterone system inhibitors: coordinated by the Working Group on Cardiovascular Pharmacotherapy of the European Society of Cardiology[J]. Eur Heart J Cardiovasc Pharmacother, 2018,4(3):180-188.
[2] Wetmore J B, Yan H, Horne L, et al. Risk of hyperkalemia from renin-angiotensin-aldosterone system inhibitors and factors associated with treatment discontinuities in a real-world population[J]. Nephrol Dial Transplant, 2021,36(5):826-839.
[3] Kashihara N, Kohsaka S, Kanda E, et al. Hyperkalemia in Real-World Patients Under Continuous Medical Care in Japan[J]. Kidney Int Rep, 2019,4(9):1248-1260.
[4] 梅长林, 陈晓农, 郝传明, 等. 慢性肾脏病高钾血症风险评估及管理专家建议(2020版)[J]. 中华医学杂志, 2020,100(44):3489-3493.
[5] Martel D R, Lysy M, Laing A C. Predicting population level hip fracture risk: a novel hierarchical model incorporating probabilistic approaches and factor of risk principles[J]. Comput Methods Biomech Biomed Engin, 2020,23(15):1201-1214.
[6] 王丽, 王宝彦, 翁艳敏, 等. 导管接触性溶栓患者出血风险分级管理方案的制订及应用[J]. 中华护理杂志, 2020,55(07):982-987.
[7] 汪璐璐, 徐凤玲, 刘钢, 等. 机械通气患者早期肺康复分级方案的构建与应用研究[J]. 中华护理杂志, 2020,55(08):1125-1132.
[8] Erratum: Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl. 2017;7:1-59[J]. Kidney Int Suppl (2011), 2017,7(3):e1.
[9] 中华医学会肾脏病学分会专家组. 中国慢性肾脏病患者血钾管理实践专家共识[J]. 中华肾脏病杂志, 2020,36(10):781-792.
[10] 梅长林, 陈晓农, 郝传明, 等. 慢性肾脏病高钾血症风险评估模型的建立[J]. 中华医学杂志, 2020,100(44):3498-3503.
[11] WS/T 557-2017 慢性肾脏病患者膳食指导[S]. 2017.
[12] 中国医师协会肾脏内科医师分会, 中国中西医结合学会肾脏疾病专业委员会营养治疗指南专家协作组. 中国慢性肾脏病营养治疗临床实践指南（2021版）[J]. 中华医学杂志, 2021,101(8).
[13] Morisky D E, Ang A, Krousel-Wood M, et al. Predictive validity of a medication adherence measure in an outpatient setting[J]. J Clin Hypertens (Greenwich), 2008,10(5):348-354.
[14] Rushe H, McGee H M. Assessing adherence to dietary recommendations for hemodialysis patients: the Renal Adherence Attitudes Questionnaire (RAAQ) and the Renal Adherence Behaviour Questionnaire (RABQ)[J]. J Psychosom Res, 1998,45(2):149-157.
[15] 麦苗, 王红霞, 孙广晓, 等. 分级护理对经皮冠状动脉介入治疗患者治疗认知度及生存质量的影响[J]. 重庆医学, 2016,45(14):1918-1919.
[16] Cupisti A, Kovesdy C P, D'Alessandro C, et al. Dietary Approach to Recurrent or Chronic Hyperkalaemia in Patients with Decreased Kidney Function[J]. Nutrients, 2018,10(3).
[17] Gritter M, Rotmans J I, Hoorn E J. Role of Dietary K(+) in Natriuresis, Blood Pressure Reduction, Cardiovascular Protection, and Renoprotection[J]. Hypertension, 2019,73(1):15-23.
[18] Gilligan S, Raphael K L. Hyperkalemia and Hypokalemia in CKD: Prevalence, Risk Factors, and Clinical Outcomes[J]. Adv Chronic Kidney Dis, 2017,24(5):315-318.
[19] Kashihara N, Kohsaka S, Kanda E, et al. Hyperkalemia in Real-World Patients Under Continuous Medical Care in Japan[J]. Kidney Int Rep, 2019,4(9):1248-1260.
