梁惠珊

【摘 要】目的：分析探讨慢性肾脏病患者院后随访护理中应用六师联动模式的应用效果。方法：此次研究所纳入的研究对象（n=80），是我院2019年7月至2020年7月收治的慢性肾脏病患者。根据院后随访护理干预不同进行分组，分为对照组（n=40，常规出院指导）和实验组（n=40，六师联动模式）。对比观察两组护理效果。结果：两组患者治疗依从性比较，对照组总治疗依从性为82.50%，实验组治疗总依从性为95.00%，实验组治疗总依从性较高（P<0.05）；与出院时患者的肾功能指标相比较，出院后6个月复查时患者的肾功能有显著改善，但实验组优于对照组（P<0.05）。结论：应用六师联动模式出院随访护理，慢性肾脏病患者的治疗依从性和肾功能能够得到显著改善，利于提高患者的生存质量，值得推广。

【关键词】慢性肾脏病；出院随访护理；六师联动模式；应用效果

The use of the six-division linkage mode in the follow-up care of patients with chronic kidney disease to improve treatment compliance and renal function

Liang Huishan Department of Nephrology， Second Floor， Inpatient Department， Yuedong Hospital， Third Affiliated Hospital of Sun Yat-sen University，

Guangdong Meizhou 514700，China

【Abstract】Objective： To analyze and explore the application effect of the six-division linkage model in post-hospital follow-up care of patients with chronic kidney disease. Methods： The subjects （n=80） included in this study were patients with chronic kidney disease admitted to our hospital from July 2019 to July 2020. According to different post-hospital follow-up nursing interventions， they were divided into control group （n=40， routine discharge guidance） and experimental group （n=40， six-division linkage mode）.The nursing effect between the two groups were compared and observed.Results： Comparing the treatment compliance of the two groups of patients， the total treatment compliance of the control group was 82.50%， the total treatment compliance of the experimental group was 95.00%， and the total treatment compliance of the experimental group was higher（P<0.05）； Compared with the renal function indexes of the patients at the time of discharge， the patient’s renal function was significantly improved at the follow-up 6 months after discharge， but the experimental group was better than the control group（P<0.05）. Conclusion： Applying the six-division linkage model for discharge follow-up care， the treatment compliance and renal function of patients with chronic kidney disease can be significantly improved， which is beneficial to improve the quality of life of patients and is worthy of promotion.

【Key？Words】Chronic kidney disease； Discharge follow-up care； Six divisions linkage mode； Application effect

因現阶段生活方式的改变以及饮食、运动结构失衡等因素的影响，慢性疾病发生率不断上升的同时，其所带来的并发症发生率也在不断提高，其中以慢性肾脏病较为常见。患者会有口腔异常、饮食不佳等表现症状，会在一定程度上影响机体对营养的需求，进而会危及患者的生命安全[1-2]。临床对于该疾病的治疗主要以延缓慢性肾功能不全和进展为主，如何保障药物治疗效果，延缓进入终末期阶段是临床医护人员面临的难题[3-4]。以往的常规院后随访护理干预不具有系统性、连续性的特点，患者易受环境改变导致治疗依从性下降，临床疗效不佳，肾功能未能得到有效改善[5]。……