Case Management Model In The Study Of Clinical Application Of Prevention And Treatment Of Hemodialysis Complications

Objective: Case management model for hemodialysis(HD)patients’ blood pressure value,weight growth and biochemical indexes between dialysis [serum creatinine(Cr),blood albumin(Alb),hemoglobin(Hb)],quality of survival,management effectiveness,medication adherence of self,family support,the influence of the incidence of complications,analysis and evaluation of this model to promote the HD nurse practice,provide a basis for clinical reference in HD patients health management.Methods: Cases choice between December 2014 and June 2015,guangxi university of Chinese medicine rui kang hospital affiliated blood purification room line HD treatment of end-stage renal disease(ESRD)patients in 66 cases,using the random number table method each 33 cases were randomly divided into observation group and control group,two groups are the regular hemodialysis treatment and nursing management,group on the basis of the implementation of case management care intervention 6 months,six steps to implement case management points,including assessment,planning,implementation,coordination,supervision and evaluation.Collect and statistical analysis of demographic sociology data;Intervention before and after intervention in 1 month,3 months,6 months period between dialysis for blood pressure value,weight growth,biochemical index evaluation,at the same time with kidney disease related quality of life table “KDQOL-SFTM scale”,“self management effectiveness questionnaire”,“Morsiky from questionnaire”,“the family APGAR function evaluation of quality of life”,self management effectiveness,medication adherence,and family support;In 3 months,6 months after intervention in statistical analysis of dialysis complications occurred.Results:1.Baseline comparison before interventionTwo groups of patients with gender,age,marital status,educational level,occupation,hospitalization expense payment,dialysis duration,time and biochemical indexes such as comparative differences are not significant(P > 0.05).2.Comparasion of intra-group after the interventionGroup comparison: observation group of systolic pressure,diastolic blood pressure,pulse pressure difference,between dialysis period weight growth,Cr,propagated,Hb,observation group and control group patients’ survival quality subscales SF-36 total split,KDTA total split and part dimension scores,eating behavior self-management effectiveness,body activity self management effectiveness,medication adherence,family support and the incidence of complications of group internal cause has statistical significance(P < 0.05);Control of systolic pressure,diastolic blood pressure,pulse pressure difference,Hb,observation group and control group patients survival quality subscales SF-36 total split,KDTA total split and some dimension scores,eating behavior self-management effectiveness,body activity self management effectiveness,medication adherence,and family support was statistically significant(P < 0.05).3.Comparasion of inter-group after the intervention3.1 After 3 months intervention,the observation group of systolic pressure,diastolic pressure,dialysis interphase weight growth,Cr,propagated,Hb,SF-36 total split,dynamic,overall health,mental health,KDTA total split,kidney disease burden,social influence,symptoms of kidney disease,kidney disease,the sleep quality,social support,patient satisfaction,medication adherence,family support and self management efficiency always divide and each dimension compared with control group,with statistical significance(P < 0.05).3.2 After 6 months intervention,the observation group systolic pressure,diastolic blood pressure,pulse pressure difference,between dialysis period weight growth,Cr,propagated,Hb,SF-36 total split,dynamic,overall health,mental health,KDTA total split,kidney disease burden,social influence,symptoms of kidney disease,kidney disease,the sleep quality,social support,health assessment,patient satisfaction,medication adherence,family support and self management efficiency always divide and each dimension compared with control group,with statistical significance(P < 0.05).3.3Complication:after 3,6 months intervention,the observation group complications overall decline than the control group,difference between the two groups was statistically significant(P < 0.05);Within the group,group comparison before and after the treatment was statistically significant(P < 0.05),complications general rise in the control group.Conclusions:1.Case management can help the effective control of blood pressure and HD patients dialysis interphase weight gain.2.Case management can help the HD patients maintain ideal Cr,Alb,Hb values.3.Case management can improve the quality of life of HD patients,increase the efficiency of the self-management HD patients,medication adherence and family support.4.Case management can reduce the HD patients with high blood pressure,low blood pressure,arrhythmia hypoglycemia and so on.