Abstract:

Objective　To investigate the effect of multidisciplinary collaborative care on self-care ability and quality of life in elderly patients with diabetic nephropathy and sarcopenia undergoing maintenance hemodialysis. Methods　Seventy elderly patients with diabetic nephropathy and sarcopenia undergoing maintenance hemodialysis at Zhoukou Central Hospital from May 2021 to October 2023 were selected for the randomized controlled trial, and were divided into a control group and an observation group by the random number table method, with 35 cases in each group. There were 16 men and 19 women in the control group; they were (65.64±5.76) years old; their disease course was (5.47±1.38) months; their dialysis time was (8.18±1.74) months. There were 17 men and 18 women in the observation group; they were (66.87±5.42) years old; their disease course was (5.64±1.23) months; their dialysis time was (8.96±1.74) months. The control group took routine nursing care, while the observation group multidisciplinary collaborative care. Both groups were intervened for 3 months. The blood glucose and renal function indicators, muscle and exercise ability, quality of life, self-care ability, and scores of Irritability, Depression, and Anxiety Scale (IDA) were compared between the two groups before and after the intervention by t test. Results　After the intervention, the levels of fasting blood glucose, glycosylated hemoglobin, and serum creatinine and urine albumin-to-creatinine ratio in the observation group were better than those in the control group [(8.05±0.62) mmol/L vs. (8.96±0.47) mmol/L, (7.25±0.42)% vs. (8.12±0.64)%, (54.89±13.37) μmol/L vs. (75.06±14.49) μmol/L, and (58.46±3.52) ml/min vs. (55.63±2.64) ml/min], with statistical differences (t=6.920, 6.724, 6.052, and 3.805; all P<0.05). After the intervention, the daily walking speed and hand grip strength in the observation group were better than those in the control group [(1.26±0.33) m/s vs. (1.02±0.27) m/s and (25.34±3.24) kg vs. (22.38±2.76) kg], with statistical differences (t=3.330 and 4.114; both P<0.05). After the intervention, the scores of World Health Organization Quality of Life-Brief and Exercise of Self-Care Agency Scale in the observation group were higher than those in the control group (56.46±6.38 vs. 48.63±5.91 and 135.36±13.54 vs. 126.35±13.45), with statistical differences (t=5.326 and 2.793; both P<0.05). After the intervention, the scores of outward stimulation, inward stimulation, anxiety, and depression and total score of negative emotions in the observation group were lower than those in the control group (4.32±1.44 vs. 5.16±1.33, 4.25±1.52 vs. 5.45±1.46, 7.21±1.56 vs. 8.36±1.37, 6.61±1.35 vs. 8.15±1.32, and 21.56±3.27 vs. 25.62±2.96), with statistical differences (t=2.535, 3.368, 3.277, 4.825, and 5.446; all P<0.05). Conclusion　Multidisciplinary collaborative care for elderly patients with diabetic nephropathy and sarcopenia undergoing maintenance hemodialysis can improve their renal function, blood glucose, quality of life, and clinical self-care ability, promote their physical recovery, and reduce their negative emotions.

Key words:

Diabetic nephropathy,  , Multidisciplinary collaboration,  , Maintenance hemodialysis, Sarcopenia, Self-care ability

摘要：

目的　探讨多学科协作下路径护理对老年糖尿病肾病维持性血液透析肌少症患者自护能力和生活质量的影响。方法　选取2021年5月至2023年10月于周口市中心医院就诊的70例老年糖尿病肾病维持性血液透析肌少症患者进行随机对照试验。采用随机数字表法将其分为对照组和观察组，各35例。对照组男16例，女19例，年龄（65.64±5.76）岁，病程（5.47±1.38）个月，透析时间（8.18±1.74）个月。观察组男17例，女18例，年龄（66.87±5.42）岁，病程（5.64±1.23）个月，透析时间（8.96±1.74）个月。对照组实施常规护理，观察组实施多学科协作下路径护理。两组均干预3个月。比较两组患者干预前后血糖和肾功能指标、肌肉和运动能力、生活质量和自护能力以及激惹、抑郁和焦虑量表（IDA）评分。采用t检验进行统计分析。结果　干预后，观察组空腹血糖、糖化血红蛋白_、血肌酐水平和尿蛋白/肌酐比值分别为（8.05±0.62）mmol/L、（7.25±0.42）%、（54.89±13.37）μmol/L、（58.46±3.52）ml/min，对照组分别为（8.96±0.47）mmol/L、（8.12±0.64）%、（75.06±14.49）μmol/L、（55.63±2.64）ml/min，差异均有统计学意义（t=6.920、6.724、6.052、3.805，均P<0.05）。干预后，观察组日常步行速度、优势手握力分别为（1.26±0.33）m/s、（25.34±3.24）kg，对照组分别为（1.02±0.27）m/s、（22.38±2.76）kg，差异均有统计学意义（t=3.330、4.114，均P<0.05）。干预后，观察组世界卫生组织生存质量测定简表、自我护理能力测定简表评分均高于对照组［（56.46±6.38）分比（48.63±5.91）分、（135.36±13.54）分比（126.35±13.45）分］，差异均有统计学意义（t=5.326、2.793，均P<0.05）。干预后，观察组负性情绪4个维度（外向刺激、内向刺激、焦虑、抑郁）得分及总分均低于对照组［（4.32±1.44）分比（5.16±1.33）分、（4.25±1.52）分比（5.45±1.46）分、（7.21±1.56）分比（8.36±1.37）分、（6.61±1.35）分比（8.15±1.32）分、（21.56±3.27）分比（25.62±2.96）分］，差异均有统计学意义（t=2.535、3.368、3.277、4.825、5.446，均P<0.05）。结论　多学科协作下路径护理有助于改善老年糖尿病肾病维持性血液透析肌少症患者血糖和肾功能，促进体能恢复，提高患者生活质量和临床自护能力，减少负性情绪。

关键词:

糖尿病肾病, 多学科协作, 维持性血液透析, 肌少症, 自护能力