| Objectives To enhance the state of nutrition,self-management ability and satisfaction of discharged patients for patients with liver cirrhosis after ESVD through continuity of care,reduce the incidence of malnutrition,anxiety and depression and gastrointestinal bleeding and improve the patientprognosis.Methods 204 patients with liver cirrhosis after ESVD in the department of gastroenterology of a tertiary hospital in Anhui Province from December 2019 to December 2021 were selected as the research object,which were randomly divided into experimental group and control group of each 102 cases,and finally included in experimental group with 94 cases and control group with 90 cases after six months of follow-up.The control group was given conventional nursing care,and the experimental group was given continuity of care intervention on basis of conventional nursing care.After the intervention,the cirrhosis self-management behavior scale,NRS-2002 nutritional risk screening scale,anxiety and depression scale and discharge satisfaction questionnaire were used to investigate at discharge and 1 month,3 months and 6 months after discharge.The serum albumin values,the number of patients with gastrointestinal bleeding within 6 months.After discharge,and the type of food eaten within 24 hours of gastrointestinal bleeding of the above four periods were recorded through the NRS-2002 nutritional risk screening scale and discharge satisfaction questionnaire.The above data were analyzed to compare the state of nutrition,risk of malnutrition,self-management ability,anxiety and depression,discharge satisfaction and gastrointestinal bleeding between the two groups.Results（1）Comparison of the general information of two groups of patients: The 184 patients included in this search covered 64 female cases and 120 male cases with the main ages between 45 and 60 years old.The rural population was higher than the urban population,yet there was no statistical significance for differences between the two in terms of occupation,marital status and underlying diseases（P>0.05）.（2）Comparison of albumin values before and after intervention: The ALB values of the two groups of patients at different periods of time were compared to find that there was no statistical difference（P > 0.05）between the experimental group at discharge（30.70 ± 5.15）and 1 month after discharge（31.98 ± 5.23）when compared to the control group（31.99 ± 3.61）and（31.03 ± 3.61）.The experimental group 3 months after discharge（33.54 ± 4.46）and 6 months after discharge（35.10 ± 4.45）were higher than those of the control group（29.15 ± 3.95）and（26.77 ± 3.80）,indicating the statistically difference（P<0.001）.（3）Comparison of NRS-2002 scores before and after intervention: The risk of malnutrition in the two groups were compared at 6 months after discharge.The experimental group had 30.9% risk of malnutrition and 69.1% risk of no malnutrition,while the control group had 41.1% risk of malnutrition and 58.9% risk of no malnutrition,indicating that the difference between the two groups was not statistically significant（P>0.05）.（4）Comparison of complications of gastrointestinal bleeding before and afterint ervention: The risk of gastrointestinal bleeding in the two groups were compare d at 6 months after discharge.There were only 4 patients（4.3%）with bleeding and 90 patients（95.7%）without bleedingin the experimental group,as well as12 patients（41.1%）with bleeding and 78 patients（86.7%）without bleeding in the control group,indicating that the difference between the two groups was st atistically significant（P <0.05）.（5）Comparison between eating roughage and gastrointestinal bleeding: There were only 6 cases with gastrointestinal bleeding in 17 patients who did not eat roughage,accounting for 3.4% of the total number of patients.In contrast,gastrointestinal bleeding was found in all the patients who ate roughage.It indicated that the difference between the two groups was statistically significant（P <0.05）.（6）Comparison of continuity of care and eating roughage: There were 2 patients（2.1%）eating roughage and 92 patients（97.9%）without eating roughage in the experimental group 6 months after discharge.In contrast,there were 8patients（8.9%）eating roughage and 82 patients（91.1%）without eating roughage in the control group.It indicated that the difference between the two groups was statistically significant（P<0.05）.（7）Comparison of self-management behavior scores before and after interventio n: The self-management behavior scores were low and at an intermediate level in both groups at discharge,and the control group（56.011±5.824）compared to the experimental group（56.074±7.618）at discharge indicated no statistical dif ference.The self-management behavior scores of the experimental group at 1 m onth after discharge（61.06±8.00）,3 months（66.23±8.56）and 6 months（73.24±9.36）were significantly higher than those of the control group（50.89±6.97）,（48.17±6.19）and（45.27±6.63）,indicating the statistical difference（P<0.05）.More over,the self-management scores gradually increased over time.（8）Comparison of SAS scores before and after intervention: Both groups had mild anxiety at discharge while there was no statistical difference between the control group（52.49±10.21）and the experimental group（52.13±6.17）（P>0.05）.The experimental group had significantly lower SAS scores at 1 month after discharge（49.98 ± 9.18）,3 months after discharge（47.69 ± 6.38）and 6 months after discharge（44.77 ± 7.53）than the control group（53.60±5.00）,（55.02±3.20）and（57.03±1.71）,indicating the statistical difference（P <0.05）.As time progressed,the SAS scores of patients in the experimental group gradually decreased and the degree of anxiety gradually decreased,while the SAS scores of patients in the control group gradually increased and the degree of anxiety gradually deepened.（9）Comparison of SDS scores before and after intervention: Both groups were mildly depressed at discharge while there was no statistical difference between the control group（53.37±5.86）and the experimental group（53.11±10.20）（P>0.05）.The experimental group was significantly lower at 1 month after discharge（51.64±7.87）,3months after discharge（48.78±7.53）and 6 months after discharge（45.90±6.71）than the control group（55.45±5.48）,（56.41±4.35）and（58.57±2.86）,indicating the statistical difference（P<0.05）.As time progressed,the SDS scores of patients in the experimental group gradually decreased and the degree of depression gradually decreased,while the SDS scores of patients in the control group gradually increased and the degree of depression gradually deepened.（10）Relationships between gastrointestinal bleeding and anxiety as well as depr ession and self-management behavior: There was no statistical difference（P>0.05）in the SAS scores of patients with bleeding（53.81±6.45）compared to the s cores of patients without bleeding（50.48±8.36）at 6 months after discharge.Th ere was statistical difference（P<0.05）in the SDS scores of patients with bleedi ng（56.63±4.41）compared to the scores of patients without bleeding（51.67±8.35）.There was statistical difference（P<0.05）in self-management scores of patie nts without bleeding（51.88±18.56）compared to score of patients without bleedi ng（60.29±15.83）.It indicated that the occurrence of gastrointestinal bleeding fo r patients with cirrhosis after ESVD is significantly associated with depression and self-managemen tbehavior.（11）Comparison of nursing satisfaction scores before and after intervention: The nursing satisfaction scores of two groups of patients were compared at 6 months after discharge.There was statistical difference（P<0.05）in that the experimental group（98.85±1.21）scored significantly higher than the control group（96.04±1.92）.Conclusions The continuity of care can improve the state of nutrition,enhance self-management behavior ability and discharge satisfaction of patients with cirrhosis after ESVD.The continuity of care can reduce the incidence of anxiety,depres sion and gastrointestinal bleeding,and promote the reasonable diet for patients. |
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