Intervention Study On Self Management For Patients With Maintenance Hemodialysis

ObjectiveTo provide a basic references for exploring suitable intervention model in patients with maintenance hemodialysis(MHD),the situation and its influent factors of self management ability in patients with MHD were analyzed,and the intervention effects of self management behavior on patients with MHD were evaluated.MethodsDuring January,2014 and December,2015,a tatol of 98 patients with MHD,who were treated in the hemodialysis center of the second People's Hospital of Yueyang City,were recruited as the participants.The patients were randomly and evenly divided into the control group(n=49)and the intervention group(n=49).The patients in the control group were given routine nursing.Based on routine nursing,the patients in the intervention group were given self management behavior intervention including diet and fluid intake behavior,physical activity behavior,psychological and social aspects of behavior,behavior therapy and diversified health education.Before the intervention,the current situation of self-management ability in patients with MHD was investigated and its influencing factors were analyzed.Before and after the intervention,“Self management behavior questionnaire” and “health related quality of life questionnaire survey questionnaire(SF-36)” were used to evaluate the patients' self management behavior,and levels of their quality of life were compared.Blood pressure,body mass index,blood lipid,renal function,nutritional and inflammatory factors were also detected,respectively.Software package for statistical analysis 18.0(SPSS18.0)was used to analyze the data.The statistical methods ivolved the paired t test,X2 test,and multivariate Logistic regression analysis.Expressed in P 0.05 or less difference was statistically significant.Results1.Among 98 patients with MHD,the scores of diet and fluid intake behavior,physical activity,psychological and social behavior,therapy behavior,and their total scores were respectively(47.75±9.37)),(48.33±8.22)),(46.98±10.41)),(48.68±9.37)),(47.94±10.46).2.By Logistic regression analysis,the patients' age with MHD(OR=8.527),education level(OR=5.056),family income(OR=12.564),exercise and labor(OR=4.895),hobbies(OR=4.267),the number of dialysis(OR=8.184),and sleep(OR=4.782)were independently influencing factors for their self management behavior ability(P < 0.05).3.There were not statistically different for the scores of diet and fluid intake behavior,physical activity,psychological and social behavior,therapy behavior,or the total scores of self-management ability between before and after intervention in the control group(P>0.05).However,every score in the intervention group after intervention was significantly higher than that before intervention or in the control group(P<0.05).4.After the intervention,the valuve of MAP before dialysis or BMI in the intervention group was respectively significantly lower than that before intervention or in control group(P<0.05).Meanwhile,the valuve of TC,TG,LDL-C,Cr and BUN of blood volume,sera hs-CRP,IL-6 or TNF in the intervention group was also respectively significantly lower than that before intervention(P<0.05);but the level of HDL-C,blood Hb or AIB was respectively significantly higher than that before intervention(P<0.05),and the ratio of Kt/V was obviously higher than that before intervention(P<0.05).5.After the intervention,the scores of PF,RP,BP,SF,MH,RE,VT,GH,and the total scores of SF-36 scale in the intervention group were respectively significantly higher than that before intervention or in the control group(P<0.05).6.After the intervention,the total scores of self-management behavior or quality of life,and the scores of their every dimention in the WeChat group were higher than that in the non-WeChat group,their differences were statistically significant(P<0.05).Conclusions1.Self-management ability in the patients with MHD is at a low level.Their age,educational level,family income,exercise and labor,hobbies,dialysis frequency and sleep are independently influent factors for the patients' self-management behavior ability.2.Self-management behavior intervention could effectively enhance the self-management behavior and quality of life in patients with MHD.