摘要
目的探讨腹膜透析患者皮肤瘙痒的相关因素及个体化护理的干预效果,为临床提供指导。方法选取2017年1月至2020年6月在首都医科大学附属北京安贞医院肾内科进行腹膜透析随访、并被诊断为皮肤瘙痒的患者87例,采用视觉模拟量表(VAS)判断患者皮肤瘙痒的程度,并将患者分为皮肤瘙痒轻中度组(VAS≤6分)和皮肤瘙痒重度组(VAS>6分)。通过单因素分析及Logistic多因素回归分析皮肤瘙痒程度的影响因素。观察个体化护理干预3个月对皮肤瘙痒的改善效果。结果87例患者中,皮肤瘙痒轻中度组占64.4%(56/87),皮肤瘙痒重度组占35.6%(31/87),皮肤瘙痒轻中度组的年龄、糖尿病患病率、血白蛋白、血磷、血清全段甲状旁腺激素和C反应蛋白水平分别为(61.8±11.5)岁、33.3%(19/56)、(36.3±5.3)g/L、(1.6±0.5)mmol/L、328.4(144.9,494.5)ng/L、2.8(0.6,8.3)mg/L,皮肤瘙痒重度组分别为(67.0±9.2)岁、61.1%(19/31)、(33.9±4.8)g/L、(1.9±0.3)mmol/L、397.0(300.0,758.6)ng/L、7.2(2.6,17.2)mg/L,2组比较差异有统计学意义(t值为-2.17、2.14、-2.32,Z值为-2.28、-2.90,χ^(2)值为6.07,均P<0.05)。Logistic多因素回归分析显示低白蛋白、高血磷和高C反应蛋白是腹膜透析患者重度皮肤瘙痒的独立影响因素(P<0.05)。经个体化护理3个月后,18.4%(16/87)的患者完全缓解,19.5%(17/87)的患者显效,55.2%(48/87)的患者有效,6.9%(6/87)的患者无效,总有效率93.1%(81/87)。结论腹膜透析患者皮肤瘙痒中超过1/3为重度,其中低白蛋白、高血磷和高C反应蛋白是重度皮肤瘙痒的独立影响因素,个体化护理可有效改善腹膜透析患者的皮肤瘙痒。
Objective To explore risk factors of skin pruritus in peritoneal dialysis patients and the effect of individualized care intervention,to provide guidance for clinical practice.Methods The total of 87 patients with peritoneal dialysis who were followed-up with pruritus in the Beijing Anzhen Hospital from January 2017 to June 2020 were selected.The Visual Analogue Scale(VAS)was used to evaluate the degree of pruritus,and the patients were divided into two groups:mild-to-moderate skin pruritus group(VAS≤6 points)and severe skin pruritus group(VAS>6 points).The risk factors of severe skin pruritus were analyzed by single factor and multivariate Logistic regression.The improvement of skin pruritus after 3 months of individualized nursing intervention was observed.Results Among the 87 patients,the mild-to-moderate skin pruritus group and the severe skin pruritus group accounted for 64.4%(56/87)and 35.6%(31/87),respectively.Single factor analysis showed that the age,prevalence of diabetes,serum albumin,serum phosphorus,intact parathyroid hormone and C-reactive protein levels were(61.8±11.5)years old,33.3%(19/56),(36.3±5.3)g/L,(1.6±0.5)mmol/L,328.4(144.9,494.5)ng/L,2.8(0.6,8.3)ng/L in the mild-to-moderate skin pruritus group,and(67.0±9.2)years old,61.1%(19/31),(33.9±4.8)g/L,(1.9±0.3)mmol/L,397.0(300.0,758.6)ng/L,7.2(2.6,17.2)mg/L in the severe skin pruritus group,the differences were significant between the two groups(t values were-2.17,2.14,-2.32,Z values were-2.28,-2.90,χ^(2) value was 6.07,P<0.05).Logistic multivariate regression analysis showed that low albumin,high blood phosphorus and high C-reactive protein were independent risk factors for severe skin pruritus in peritoneal dialysis patients(P<0.05).After 3 months of individualized care,18.4%(16/87)patients had complete remission,19.5%(17/87)patients significantly relieved,55.2%(48/87)relieved,6.9%(6/87)were ineffective,and the total response rate was 93.1%(81/87).Conclusions More than one-third of peritoneal dialysis patients with pruritus are severe.Lower serum albumin,higher serum phosphorus and higher C-reactive protein are independent risk factors for severe pruritus in peritoneal dialysis patients.Individualized care can effectively improve pruritus in peritoneal dialysis patients.
作者
王玉
薛定宜
叶宝珠
刘蓉
李党香
Wang Yu;Xue Dingyi;Ye Baozhu;Liu Rong;Li Dangxiang(Department of Nephrology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Nursing,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)
出处
《中国实用护理杂志》
2021年第13期979-984,共6页
Chinese Journal of Practical Nursing
关键词
腹膜透析
皮肤瘙痒
个体化护理
Peritoneal dialysis
Skin pruritus
Individualized care
