強化健康教育對慢性腎功能衰竭高磷血癥患者的影響

廖善霞　楊斌

[摘要] 目的 探討強化健康教育對慢性腎衰竭高磷血癥患者的影響。方法 選擇89例慢性腎功能衰竭患者，隨機分為干預組45例和對照組44例，在持續給予腸道磷結合劑治療的同時分別實施強化健康教育和常規健康教育。結果 干預3個月兩組血磷水平和鈣磷乘積均較干預前顯著降低，兩組干預前后血磷水平和鈣磷乘積差異有統計學意義（P<0.05）。干預后3、6個月干預組甲狀旁腺激素均顯著低于干預前（P<0.05）。干預組疾病基礎知識、治療知識、生活行為知識、飲食知識維度和總分均顯著高于對照組（P<0.05）。干預組治療、生活行為、飲食依從性維度及總分均顯著高于對照組（P<0.05）。 結論 實施床邊宣教、健康指導手冊、多媒體教學和個性化指導等綜合的強化健康教育有助于提高慢性腎功能衰竭高磷血癥患者疾病知識的認知和依從性，促進降低血磷、調節鈣磷代謝效果的提高和穩定持續。

[關鍵詞] 慢性腎功能衰竭；高磷血癥；健康教育；鈣磷代謝

[中圖分類號] R473.5 [文獻標識碼] B [文章編號] 1673-9701（2014）11-0104-04

[Abstract] Objective To explore the effect of strengthening health education on chronic renal failure patients with hyperphosphatemia. Methods Eighty-nine patients with chronic renal failure were randomly divided into the intervention group in 45 cases and the control group in 44 cases， the strengthened health education and routine health education were respectively implemented at the same time of the continuous intestinal phosphate binder therapy. Results The serum phosphorus level and calcium phosphorus product of patients in the two groups at 3 months after the intervention were significantly lower than those before the intervention， there were statistically significant differences in the serum phosphorus level and calcium phosphorus product of patients in the two groups between before and after the intervention（P<0.05）. The parathyroid hormone level of the intervention group at 3， 6 months after the intervention were significantly lower than those before the intervention（P<0.05）. The based knowledge， knowledge of disease treatment， life behavior knowledge， dietary knowledge dimensions and total score of the intervention group were significantly higher than those of the control group（P<0.05）. The treatment， life behavior， dietary compliance dimensions and total score of the intervention group were significantly higher than those of the control group（P<0.05）. Conclusion The implement of comprehensive strengthened health education including the bedside education， health guide books， multimedia teaching and individual instruction is helpful to improve the cognition of disease knowledge and compliance in chronic renal failure patients with hyperphosphatemia， and promote the effect of the reduction of serum phosphorus and regulation of calcium phosphorus metabolism to improve and steady.

[Key words] Chronic renal failure； Hyperphosphatemia； Health education； Calcium phosphorus metabolism

高磷血癥是慢性腎功能衰竭常見并發癥，易引起鈣磷代謝紊亂、甲狀腺功能亢進，是增加患者死亡風險的危險因素，但相較于鉀、鈉離子代謝紊亂，高磷血癥的危害是一個慢性過程，將增加患者血管、瓣膜鈣化發生，造成腎性骨營養不良等并發癥[1]。治療過程漫長，由于食物也是主要的磷攝入源，因此控制血磷需要進行嚴格的生活方式和飲食干預，降低磷攝入同時需要保證其他營養物質的攝入，但患者依從性較差是治療和控制效果不佳的主要原因之一[2]。本科室采用強化健康教育對患者進行管理，旨在探討慢性腎功能衰竭高磷血癥患者的健康教育方式及其對患者生化指標、疾病知識及依從性的影響。endprint

1資料與方法

1.1一般資料

采用方便抽樣法選擇2011年9月～2013年1月我院收治的慢性腎功能衰竭患者，納入標準：符合慢性腎功能衰竭診斷標準[3]；年齡≥18歲的成年人；血磷≥1.78 mmol/L；接受血液透析治療；接受規范血液透析、腸道磷結合劑治療；……