The Intervention Of Mindfulness-based Stress Reduction On Sleep Quality In Maintenance Hemodialysis Patients

ObjectiveTo construct an intervention program for Mindfulness-based Stress Reduction(MBSR)with maintenance hemodialysis patients and verify the feasibility and effectiveness of the program.MethodsThis study consists of two stages:1.The construction of intervention program of Mindfulness-based Stress Reduction:under the guidance of previous research,literature review,three-axis model of Mindfulness training and group dynamics theory,the preliminary draft of intervention program is formed,and further expert consultation is carried out to revise it,and select the research object to carry out the pre-experiment,and finally form the draft of the intervention program.2.Objective:to evaluate the intervention effect of Mindfulness-based Stress Reduction on maintenance hemodialysis patients.Patients with end-stage Renal Disease(ESRD)receiving maintenance hemodialysis at two blood purification centers in Zhengzhou from March to August 2019 were divided into two groups by coin-flipping,one group is the intervention group and the other is the control group.The patients in the control group were given routine nursing care,while the patients in the intervention group were given 8 weeks’intervention of Mindfulness-based Stress Reduction.Pittsburgh Sleep Quality Index(PSQI),Hamilton Anxiety Scale(HAMA),Hamilton Depression Scale(HAMD),Medical outcomes study 12-item short-form health survey(SF-12)and interdialysis weight gain(%),systolic blood pressure,diastolic blood pressure and ALB before dialysis were used to evaluate the intervention effect of Mindfulness-based Stress Reduction therapy.The data were analyzed by using IBM SPSS 21.0 software,including descriptive statistics,t-test,chi-square test,Kruskal-Wallis test and so on,Process 3.3 plug-in was used to analyze the intermediary effect with bootstrap method.Results1.The main contents of the intervention program are:2 hours group meeting once a week,including 0.5 hours of teaching,1 hour of individual practice,0.5 hours of discussion and communication,then arrange family exercises;At the same time,through the wechat group guide patients themselves to use "Rui Xin Meditation" for 30 to 60 minutes of family practice,Wechat group communication practice experience,upload practice video;for 8 weeks.2.In the intervention program phase,84 subjects were included,3 were lost,41 were in the control group and 40 in the intervention group.①The effect of Mindfulness-based Stress Reduction on anxiety and depression scores of the two groups:Before intervention,there was no significant difference between the two groups(P>0.05);After intervention:the total scores of anxiety and depression in the intervention group and the control group were significantly different(P<0.05).The difference value of total score of anxiety and total score of depression in the intervention group was significantly lower than that in the control group(P<0.05).②The influence of Mindfulness-based Stress Reduction on sleep quality score:There was no significant difference in PSQI total score and scores of each dimension between the two groups before intervention(P>0.05);After intervention:There were significant differences in sleep quality,sleep latency,sleep time,daytime dysfunction and total sleep score between intervention group and Control Group(P<0.05).The difference value of sleep quality,sleep latency,sleep time,daytime dysfunction and total sleep score in the intervention group were significantly lower than those in the control group(P<0.05).③The influence of Mindfulness-based Stress Reduction on the quality of life scores of the patients:There was no significant difference between the two groups before the intervention(P>0.05);After intervention,the general health,physical functioning,role-physical,role-emotional,bodily pain,vitality,social functioning,physical component summary and mental component summary of the intervention group were higher than those of the control group(P<0.05).The difference value of general health,physical functioning,role-physical,role-emotional and vitality of the intervention group was significantly lower than that of the control group(P<0.05).④The influence of Mindfulness-based Stress Reduction on objective indexes of patients:Before intervention,there was no significant difference in interdialysis weight gain(%),systolic pressure,diastolic pressure and ALB before dialysis between the two groups(P>0.05).After intervention:There was no significant difference in diastolic blood pressure between the intervention group and the Control Group(P>0.05),but the interdialysis weight gain(%),systolic blood pressure before dialysis in the intervention group were lower than those in the control group,and the ALB were higher than those in the control group,the difference was statistically significant(P<0.05).The difference value of interdialysis weight gain(%)in the intervention group was lower than that in the control group,while the difference value of ALB was higher than that in the control group,and the difference was statistically significant(P<0.05).⑤The indirect effect of baseline anxiety level as a mediator variable in MB SR to improve sleep quality in MHD patients was-0.0059,95%CI(-0.2809,0.1874),the inference is not established;The indirect effect of baseline depression level as a mediator variable in MBSR to improve sleep quality in MHD patients was-0.0008,95%CI(-0.1608,0.1332),the inference is also not established.But through the inspection found that by MBSR intervention can significantly improve ΔPSQI score,direct to test the effect of 2.1916.ConclusionThe intervention program of Mindfulness-based Stress Reduction is highly operable and easy for patients to accept and operate.It can reduce the level of depression and anxiety in patients with maintenance hemodialysis,improve their sleep quality,improve their quality of life,reduce their volume load and improve their nutritional status.