| Objective:Maintenance Hemodialysis(MHD)treatment is one of the main Renal replacement methods for End Stage Renal Disease(ESRD)patients.These patients often have hypertension,complicated blood pressure mechanism,difficulty in blood pressure control,and the optimal target value of blood pressure has not been determined.In the blood purification standard operating procedure(2021 edition),ambulatory blood pressure monitoring(ABPM)is not included as a routine measure for periodic evaluation of complications and complications in MHD patients.In addition,the long-term illness of MHD patients requires the patients to have good self-management ability,and the complexity of their condition leads to unsatisfactory self-management status,especially poor blood pressure management.Regular ambulatory blood pressure monitoring and effective self-management instruction are essential to assess and improve blood pressure control in MHD patients.Purpose:To understand the characteristics of ambulatory blood pressure and the status of self-management of MHD patients in Qingdao City Hospital center 24 hours after dialysis,to explore the influence of self-management instruction of blood pressure based on knowledge-attitude-behavior health education model on blood pressure control and self-management behavior in Qingdao City Hospital MHD patients.Methods:1.49 patients with hypertension who met the inclusion and exclusion criteria of this study and underwent MHD therapy in the hemodialysis room of 2021 from November to February 2022 were selected as the experimental group,the baseline data of 46 non-dialysis patients without renal dysfunction in the same period were collected by3questionnaire survey in the essential hypertension,including Age,sex,height,weight,smoking history,drinking history,diabetes history,current oral antihypertensive drugs,as well as the experimental group Dialysis Etiology,dialysis treatment time,dialysis program and other related information;The experimental group and the Control Group completed a 24-hour ambulatory blood pressure monitoring with the same standard,and collected the ambulatory blood pressure parameters of the two groups,the mean systolic blood pressure(24h SBP),mean diastolic blood pressure(24h DBP),mean daytime systolic blood pressure(d SBP),mean daytime diastolic blood pressure(d DBP),mean nocturnal systolic blood pressure(n SBP),mean nocturnal diastolic blood pressure(n DBP),nocturnal systolic blood pressure drop rate,nocturnal diastolic blood pressure drop rate,non-dipper blood pressure,inverse dipper blood pressure,hypotension.The mean±standard deviation(±)of basic clinical measurement data was used in the experimental group and the Control Group,and the difference between the two groups was compared by t test of independent samples,and the difference between the two groups was expressed by percentage(%),and the difference between the two groups was compared byχ~2test.2.The Experimental Group received one-month self-management instruction of blood pressure based on the model of knowledge-attitude-behavior health education,the self-management behaviors of the experimental group before and after self-management instruction were scored with the self-management behavior scale for MHD patients,and family blood pressure data were collected before and after self-management instruction were scored with the self-management behavior scale for MHD patients,and family blood pressure data were collected before and after self-management instruction,paired t test was used to compare the differences of family mean systolic pressure,family mean diastolic pressure and patients’self-management behavior before and after self-management guidance.P<0.05 was significant difference.Results:1.General demographic data of the experimental group:There were 49 cases of maintenance hemodialysis hypertension in the experimental group,including 41 males and 8 females.They ranged in age from 39 to 86,with an average age of 64.8 to 8.8years.The duration of dialysis ranged from 3 months to 11 years,the median dialysis age was 2.4 years,and the average dialysis duration was 3.6 years.The main causes of dialysis were diabetic renal injury in 23 cases(47%),hypertensive renal injury in 134cases(27%),polycystic kidney in 2 cases(4%),and primary glomerulonephritis in 3cases(6%),the other 8 cases were of unknown cause(16%).There were only 5patients who were treated with one antihypertensive drug orally,31 patients who were treated with two antihypertensive drugs,13 patients who were treated with three or more antihypertensive drugs,with an average of 2.3 antihypertensive drugs.2.Between the two groups in terms of sex,age,BMI,history of smoking,history of drinking,history of diabetes and oral administration of more than 3 kinds of antihypertensive drugs,there was no significant difference(P>0.05).There were significant differences in the mean nocturnal systolic blood pressure and mean nocturnal diastolic blood pressure(P<0.05).24h mean systolic pressure(24h SBP),24h mean diastolic pressure(24h DBP),daytime mean systolic pressure(d SBP),daytime mean diastolic pressure(d DBP),nighttime mean systolic pressure(n SBP)and nighttime mean diastolic pressure(n DBP),hypotension and antidipper blood pressure were compared between the two groups(P>0.05),there was no statistical difference between the groups.3.The change of blood pressure and the score of self-management behavior in the experimental group before and after self-management instruction:There was significant difference in family mean systolic blood pressure(P<0.05),but P>0.05 in mean diastolic pressure.Before and after self-management guidance,there were significant differences in control weight score,reasonable diet score,correct medication score,physical activity score,state monitoring score,blood pressure monitoring score and Emotion Management Score(P<0.05).Conclusion:1.The decrease rate of nocturnal blood pressure in patients with MHD hypertension is lower than that in patients with normal hypertension.Ambulatory blood pressure monitoring is beneficial to the occurrence of severe hypertension and hypotension in the interphase of hemodialysis.2.The self-management instruction of blood pressure is helpful to blood pressure controling and self-management behavior improving in MHD patients. |
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