基于健康信念模式的血液透析患者液体管理影响因素的关系模型研究

doi:10.3761/j.issn.0254-1769.2023.24.008

摘要/Abstract

摘要：

目的在健康信念模式指导下，探讨血液透析患者液体管理依从性及透析间期体重控制的影响因素及其影响路径。方法采用便利抽样，选取广东省4所医院433例血液透析患者为研究对象，采用一般资料调查表、液体限制健康信念量表和液体管理依从性量表进行调查，并计算透析间期相对体重增长量（relative-interdialytic weight gain，R-IDWG）。结果患者液体管理依从性得分为（3.08±0.97）分，为中等水平；35.57%的患者R-IDWG超标。健康信念方面，患者感知液体限制的益处（β=0.161）和自我效能（β=0.685）可直接促进液体管理依从性；感知液体限制不佳的威胁可通过感知液体限制的益处和自我效能间接促进液体管理依从性（β=0.235）；感知液体限制的障碍通过自我效能间接负向影响液体管理依从性（β=-0.246）。患者液体管理依从性越高，则R-IDWG控制越好（β=-0.361）。协调因素方面，年龄、文化程度、透析龄和糖尿病是液体管理依从性（|β|：0.050~0.162）和R-IDWG控制（|β|：0.049~0.309）的影响因素。各路径系数（β）达到统计学显著水平（P<0.05）。结论医护人员应全面评估患者的健康信念，对文化程度较低和患糖尿病的患者加强监测，识别液体管理的薄弱环节，以促进R-IDWG达标。

关键词: 终末期肾脏病, 血液透析, 液体管理, 依从性, 健康信念模式, 护理

Abstract:

Objective To investigate the influencing factors and pathways of fluid management adherence and interdialytic weight control in hemodialysis patients based on the health belief model. Methods Using convenience sampling，433 patients receiving hemodialysis were included from 4 hospitals in Guangdong province. The demographic and clinical data questionnaire，Health Belief Scale of Fluid Restriction，and Fluid Intake Adherence Scale were used. The relative-interdialytic weight gain（R-IDWG） was calculated. Results The mean score of patients’ fluid management adherence was 3.08±0.97，indicating a moderate level，with 35.57% of patients exceeding the required R-IDWG standard. Regarding health beliefs，perceived benefits（β=0.161） and self-efficacy（β=0.685） of fluid restriction directly affected fluid adherence；perceived threats of poor fluid restriction indirectly affected fluid management adherence through perceptions of benefits and self-efficacy（β=0.235）；perceived barriers were indirectly and negatively associated with fluid management adherence through self-efficacy（β=-0.246）. Higher fluid management adherence was associated with better control of R-IDWG（β=-0.361）. Regarding the coordinating factors，age，educational level，hemodialysis vintage and diabetes were influential factors of fluid management adherence（|β|：0.050-0.162） and R-IDWG control（|β|：0.049-0.309）. The coefficients（β） of each path were statistically significant（P<0.05）. Conclusion Healthcare providers should comprehensively assess patients’ health beliefs，focus on patients with lower educational levels and diabetes，and identify weakness in their fluid management to achieve the required R-IDWG standard.

Key words: End-Stage Renal Disease, Hemodialysis, Fluid Management, Adherence, Health Belief Model, Nursing Care

陈辰, 郑晶, 刘旭, 刘佳丽, 尤黎明. 基于健康信念模式的血液透析患者液体管理影响因素的关系模型研究[J]. 中华护理杂志, 2023, 58(24): 2996-3003.

CHEN Chen, ZHENG Jing, LIU Xu, LIU Jiali, YOU Liming. Relational model of factors influencing fluid management in hemodialysis patients based on the health belief model[J]. Chinese Journal of Nursing, 2023, 58(24): 2996-3003.

图/表 5

表1 研究对象的一般资料（n=433）

Table 1 General data of hemodialysis patients（n=433）

表2 健康信念、液体管理依从性及R-IDWG在血液透析患者一般资料中的差异（n=433）

Table 2 Differences of health beliefs， fluid management adherence and R-IDWG in general data（n=433）

表3 健康信念、液体管理依从性及R-IDWG的相关性分析（r值，n=433）

Table 3 Correlation analysis of health beliefs， fluid management adherence and R-IDWG1）（r value，n=433）

图1 液体管理依从性及R-IDWG影响因素的结构方程模型注：仅选取有统计学意义的社会人口学特征并仅标注P<0.05的标准化路径系数（β）。R-IDWG为透析间期相对体重增长量1）P<0.05；2）P<0.01。

Figure 1 Structural equation model for factors influencing fluid management adherence and R-IDWG

表4 液体管理依从性及R-IDWG影响因素的路径分析（n=433）

Table 4 Path analysis of influencing factors of fluid management adherence and R-IDWG（n=433）

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