肺移植患者骨代谢异常干预方案的构建及应用研究

doi:10.3761/j.issn.0254-1769.2026.10.009

摘要/Abstract

摘要：

目的基于健康行为过程取向理论构建肺移植患者骨代谢异常干预方案并进行初步验证，旨在提升患者骨骼健康状态，为临床护理实践提供参考。方法以健康行为过程取向理论为指导，在文献回顾基础上，通过专家会议修订，构建肺移植患者骨代谢异常干预方案。采用便利抽样法，选取浙江省某三级甲等综合医院等待肺移植术的患者作为研究对象，其中，2024年7—11月的患者为试验组（n=41），2023年10月至2024年2月的患者为对照组（n=38）。试验组在常规护理的基础上实施骨代谢异常干预方案，对照组给予常规护理。干预周期涵盖移植等待期及术后6个月随访期。比较术前、术后3个月、术后6个月两组肺功能指标、6 min步行距离和骨密度的变化情况，以及两组不良事件发生率的差异。结果试验组脱落5例，最终纳入36例，对照组脱落4例，最终纳入34例。术后3、6个月，试验组的肺功能指标、6 min步行距离均优于对照组（P<0.05）；术后6个月试验组的左侧髋关节骨密度高于对照组（P<0.05）。干预过程中，两组均未出现不良事件。结论实施基于健康行为过程取向理论的肺移植患者骨代谢异常干预方案对提升患者肺功能、运动能力效果显著，对改善骨骼健康方面也具有一定优势。

关键词: 肺移植, 骨代谢, 健康行为过程取向理论, 护理

Abstract:

Objective To develop and preliminarily evaluate an intervention program for bone metabolism abnormalities in lung transplant recipients based on the Health Action Process Approach（HAPA），with the aim of improving patients’ bone health and providing a reference for clinical nursing practice.Methods Guided by the HAPA theory and informed by literature review and expert panel discussions，an intervention program was constructed for lung transplant recipients with bone metabolism disorders. Convenience sampling was adopted to select patients awaiting lung transplantation at a tertiary general hospital in Zhejiang Province. Patients recruited between July and November 2024 were assigned to an intervention group（41 cases），while those recruited between October 2023 and February 2024 served as a control group（38 cases）. The intervention group received the bone metabolism disorder intervention program in addition to standard rehabilitation care，whereas the control group received standard rehabilitation care only. The intervention period lasted from preoperative assessment through 6 months postoperatively. Changes in pulmonary function parameters，6-minute walk distance，and bone mineral density were compared between the 2 groups before intervention，and at 3 and 6 months postoperatively. The incidence of adverse events was also compared.Results In the intervention group，5 patients dropped out，resulting in 36 patients included in the final analysis，while 4 patients dropped out in the control group，leaving 34 patients for analysis. At 3 and 6 months postoperatively，the intervention group demonstrated significantly better pulmonary function parameters and 6-minute walk distances compared to the control group（P<0.05）. At 6 months postoperatively，the bone mineral density of the left hip in the intervention group was significantly higher than that in the control group（P<0.05）. No adverse events occurred in either group during the intervention period.Conclusion The HAPA-based intervention program for bone metabolism disorders in lung transplant recipients significantly improves pulmonary function and exercise capacity，and confers certain advantages in enhancing bone health.

Key words: Lung Transplantation, Bone Metabolism, Health Action Process Approach, Nursing Care

王衍蝶, 曾妃, 梁江淑渊, 顾培培, 谢梦珊, 郝芳芳. 肺移植患者骨代谢异常干预方案的构建及应用研究[J]. 中华护理杂志, 2026, 61(10): 1362-1370.

WANG Yandie, ZENG Fei, LIANG Jiangshuyuan, GU Peipei, XIE Mengshan, HAO Fangfang. Construction and application of an intervention program for bone metabolism abnormalities in lung transplant recipients[J]. Chinese Journal of Nursing, 2026, 61(10): 1362-1370.

图/表 6

表1 肺移植患者骨代谢异常干预方案

Table 1 An intervention program for bone metabolism disorders in lung transplant recipients

表2 两组一般资料的比较

Table 2 Comparison of general data between the 2 groups

表3 两组患者骨密度的比较[g/cm2，M（P25，P75）]

Table 3 Comparison of bone mineral density between the 2 groups [g/cm2，M（P25，P75）]

表4 两组患者骨骼状态的比较[例（百分比，%）]

Table 4 Comparison of bone status between the 2 groups[cases（percentage，%）]

表5 两组肺功能指标的比较[%，M（P25，P75）]

Table 5 Comparison of pulmonary function between the 2 groups[%，M（P25，P75）]

表6 两组6 min步行距离的比较[m，M（P25，P75）]

Table 6 Comparison of 6-minute walk distance between the 2 groups[m，M（P25，P75）]

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