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中国血液净化2020年3月第19卷第3期Chin J Blood Purif,March,2020,Vol.19,No.3·护理研究·契约式管理对腹膜透析患者的容量管理效果刘丽1吴燕妮1张蕊1【摘要】目的用契约式管理方式对容量超负荷的腹膜透析患者进行容量管理，并进行效果分析。
方法选取哈尔滨医科大学附属第二医院腹膜透析中心经人体成分分析仪筛选容量超负荷并满足入组标准患者随机分为实验组与对照组，对照组实施常规健康教育，实验组在此基础上实施契约式管理并签订健康管理协议。
观察时间为6个月，比较2组容量管理行为、容量状况和透析相关指标以及实验室检查结果等的差异。
结果观察6个月后，相对于对照组，实验组患者体质量降低(t=-3.201，P=0.002)；对血压的监测次数增加(Z=-2.265，P=0.024)，液体摄入量减少(Z=-2.285，P=0.022)；实验组容量超负荷指标改善(t=-3.623，P=0.001)。
结论契约式管理对腹膜透析患者的容量管理有明显约束作用，能改善其容量管理行为，改善患者容量状况。
【关键词】腹膜透析；契约式管理；容量管理；容量状况；健康管理模式中图分类号：R473文献标识码：A doi:10.3969/j.issn.1671-4091.2020.03.015Contractual management model improved fluid status in peritoneal dialysis patients LIU Li1,WU Yan-ni1,ZHANG Rui11Department of Nephrology,the Second Affiliated Hospital of Harbin Medical University,Harbin150086,ChinaCorresponding author:LIU Li,Email:****************【Abstract】Objective To evaluate the effectiveness of contractual management on fluid status in perito-neal dialysis(PD)patients.Methods Patients with over hydration screened by human body compositionmonitor and met the inclusion criteria from the Peritoneal Dialysis Center of the Second Affiliated Hospital ofHarbin Medical University were randomly assigned into two groups.Patients in control group received rou-tine health care and those in experimental group adopted contract management on the basis of routine healtheducation and signed a health care agreement.The volume management behavior,volume status,dialysis relat-ed indicators and laboratory examination results were compared before intervention and after intervention for6months.Results In experiment group after the intervention for6months,body weight decreased as com-pared with that in control group(t=-3.201,P=0.002),the times of blood pressure measurement per week in-creased(Z=-2.265,P=0.024),liquid intake decreased(Z=-2.285,P=0.022),and over hydration parameters im-proved(t=-3.623,P=0.001).Conclusion Contractual management is a management mode that obviously re-stricts the volume management of PD patients.This management can improve the volume management behav-ior and volume status in PD patients.【Key words】Peritoneal dialysis;Contractual management;V olume management;V olume status;Healthmanagement model腹膜透析(peritoneal dialysis,PD)是终末期肾病(end-stage renal disease,ESRD)患者尤其是亚裔终末期肾病患者一种成功的肾脏替代治疗方法[1]。
应用品管圈提高腹膜透析患者容量管理依从性的临床实践陈静;王娟;徐鹏飞【期刊名称】《中国医药科学》【年(卷),期】2018(008)023【摘要】目的探讨品管圈管理工具在提高腹膜透析患者的容量管理依从性中的应用.方法成立品管圈小组,确立\"提高腹膜透析患者的容量管理依从性\"为活动主题,进行现况调查、目标设定、原因分析、对策拟定,应用PDCA循环原则实施各项对策.结果我科通过开展品管圈活动,制订规范化容量管理的方法和流程,使腹膜透析患者容量超负荷的发生率由原来的25％降至8％,护士的各项隐性能力也显著提高.结论应用品管圈活动对腹膜透析患者进行容量管理的控制,规范了腹透患者容量管理的流程,降低了腹透患者容量超负荷的发生率,提高了患者的依从性,此种方法和流程值得在临床科室推广.该活动同时增加了护士的主动管理能力,便于更好的促进临床实际问题的解决.【总页数】4页(P138-141)【作者】陈静;王娟;徐鹏飞【作者单位】南京大学医学院附属鼓楼医院肾内科,江苏南京 210000;南京大学医学院附属鼓楼医院肾内科,江苏南京 210000;南京大学医学院附属鼓楼医院肾内科,江苏南京 210000【正文语种】中文【中图分类】R473.5【相关文献】1.品管圈在提高透析患者治疗依从性中的应用 [J], 程辉;黄秋鹏;庞晴;何霁;2.品管圈活动在提高透析患者控水依从性中的应用 [J], 顾文娟;张红娟;赵黎3.品管圈在提高透析患者治疗依从性中的应用 [J], 程辉;黄秋鹏;庞晴;何霁4.自动化腹膜透析在维持性腹膜透析患者容量管理中的应用 [J], 罗佩婷; 张禹; 李忻阳; 陈洋洋; 赵巧; 苗里宁; 崔文鹏5.5E康复模式联合个案管理对腹膜透析患者容量管理依从性及预后的影响 [J], 田兴;苗金红;姚岚;梁小丽;郑媛;刘晓;袁媛因版权原因，仅展示原文概要，查看原文内容请购买。
护理实践与研究201 7年第14卷第14期17•腹膜透析患者自我管理行为与营养状况及容量负荷的相关性研究李祥云摘要目的:探讨腹膜透析患者自我管理行为与营养状况及容量负荷的关系。
方法:2014年1月〜2016年12月选取腹膜透析时间大于3个 月的患者150例为研究对象，根据患者容量负荷情况将患者分为无水肿组〇 = 75)，轻度水肿组〇 = 40)，中度水肿组〇=20)及重度水肿组〇 二15)，应用自我管理行为评定量表评定各组自我管理行为，并测定各组患者营养状况。
结果:腹膜透析无水肿组患者血清蛋白、血红蛋白水平高于其余各组(P<〇.〇5)，而24 h腹膜液蛋白丢失量少于其余各组（P<0.05)，且随着腹膜透析患者容量负荷量增加（P<0.05)，患者血清蛋 白、血红蛋白水平明显减少(P<〇.05)，而24 h腹膜液蛋白丢失量明显增加（P<0.05)。
腹膜透析无水肿组在饮食及液体摄入、治疗行为、身体 活动、心理社会行为及自我管理行为总分方面均高于轻度、中度及重度水肿组(P<〇.〇5)，且随着腹膜透析患者容量负荷量增加患者自我管理行 为总评分及各维度评分明显下降(P<〇.〇5)。
经Pearson单因素分析可知，腹膜透析患者自我管理行为与患者容量负荷量及24 h腹膜液蛋白丢 失量呈负相关(P<〇.〇5)，而与血清蛋白、血红蛋白水平呈正相关(P<〇.05)。
结论:容量负荷量增多的腹膜透析患者营养状况恶化，而患者自 我管理行为与营养状况及腹膜透析负荷量有密切的关系，通过提高患者自我管理行为将有助于改善患者容量负荷量及营养状况。
关键词腹膜透析；自我管理行为；营养状况;容量负荷 doi :10.3969/j. issn. 1672 -9676.2017.14.006Research on correlation between self - management behaviors of peritoneal dialysis patients and nutrition condition and capacity loadLI Xiang - yun(The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221000)Abstract Objective ： To discuss the relation between the self - management behaviors of peritoneal dialysis patients and their nutrition condition and capacity load. Methods ：Selected 150 patients with peritoneal dialysis duration more than 3 months from January 2014 to December 2016 as the research object, and the patients were divided into no edema group ( n =15) ,slight edema group ( n, = 40) , moderate edema group ( n, = 20) and severe edema group (n = 15)，and self - management behavior rating scale was used to evaluate the self - management behaviors of each group and determine the nutrition condition of patients in each group. Results ：The serum protein, hemoglobin levels of peritoneal dialysis patients in the no edema group were higher than those of patients in other groups(P <0.05) , while their loss of peritoneal fluid protein within 24h was less than that of patients in other groups(P <0. 05) , and with the increase of capacity load of peritoneal dialysis patients(P <0.05 ) ,the patients5serum protein and hemoglobin levels decreased significantly(P <0.05), while the peritoneal fluid protein within 24h increased(P <0.05). The peritoneal dialysis patients in the no edema group hand total scores of diet and fluid digestion ,treatment behavior, physical activity, psychological and social behaviors and self - management behavior than those of patients in the slight, moderate and severe edema groups(P <0. 05) , and with the increase of capacity load of peritoneal dialysis patients, the total scores and score of each dimension of self - management behavior of patients decreased significantly (P < 0. 05 ). Through Pearson single - factor analysis, the self - management behavior of peritoneal dialysis patients was of negative correlation with the patients5capacity load amount and loss of peritoneal fluid protein within 24h (P < 0.05), while it was of positive correlation with the serum protein and hemoglobin levels(P <0. 05). Conclusion：The peritoneal dialysis patients with increase of load capacity had their nutrition condition aggravated, while the patients5self - management behavior had a close relation with nutrition condition and peritoneal dialysis load capacity, and by improving the patients5self - management behavior, it would be helpful to improve the patients5capacity load and nutrition condition.Key words Peritoneal dialysis ；Self - management behavior； Nutritional status；Capacity load腹膜透析是目前治疗终末期肾病有效的方法，腹膜透析 过程中容量负荷增加是较常见的现象,容量负荷增加不仅会 加重患者营养不良，同时也是导致腹膜透析患者退出及死亡 的重要因素[1]。
