个体化护理干预对Harvoni治疗尿毒症伴丙型肝炎病毒感染患者疗效及生活质量的影响-现代医学

个体化护理干预对Harvoni治疗尿毒症伴丙型肝炎病毒感染患者疗效及生活质量的影响

单位：南京医科大学第一附属医院肾内科, 江苏南京 210029

分类号：R473.51

出版年·卷·期（页码）：2017·36·第十一期（1660-1664）

摘要：

目的：观察透析间期口服Harvoni治疗维持性血液透析伴丙型肝炎病毒（HCV）感染患者的不良反应，在透析过程中实施个体化护理干预对此类患者丙肝治愈率和生活质量的影响。方法：对12例维持性血液透析伴HCV感染患者在透析间期口服Harvoni治疗，无肝硬化患者服用12周，确诊肝硬化患者服药24周，密切观察和记录患者治疗期间的不良反应，并在透析过程中采取个体化护理措施，分别于口服Harvoni治疗半个月和停药时检测病毒定量指标。治疗前和停药后1周内分别填写SF-36量表以评估患者生活质量。结果：12例患者全部完成标准疗程，治疗期间主要不良反应包括疲乏、头痛、恶心、腹泻、焦虑等，给予个体化护理干预后各项不良反应明显改善。早期应答率100%；治疗结束时患者血清ALT正常，血清HCV-RNA阴性（<1 000 IU·ml^-1），持续应答率100%。SF-36量表统计结果显示，维持性血液透析伴HCV感染患者8个维度的评分均低于中国常模（P<0.05），在服药治疗结束后1周内患者躯体疼痛、总体健康、生命活力、社会功能和精神健康5个维度评分明显高于服药治疗前，差异均有统计学意义（P<0.05）。结论：针对透析伴HCV感染患者口服Harvoni治疗期间的不良反应，在透析过程中进行个体化护理干预，有助于达到丙肝临床治愈，减少不良反应的持续时间，促进患者躯体功能和精神健康的改善，提高生活质量。

Objective:To observe the adverse reactions of oral administration of Harvoni and the effect of individualized nursing care intervention on the cure rate and quality of life to hemodialysis patients with hepatitis C virus(HCV) infection. Methods:12 maintenance hemodialysis patients with HCV infection received oral Harvoni treatment, which lasted 12 weeks in patients without live cirrhosis, 24 weeks in patients with liver cirrhosis. During treatment, close observation and recording of patients, and individualized nursing measures were taken during the dialysis. The quantitative indexes of virus were detected respectively after the treatment of Harvoni orally for 2 weeks. The SF-36 scale was used to assess the quality of life of patients before and after treatment. The main side effects were fatigue, headache, nausea, diarrhea, and anxiety. The adverse reactions were improved after the intervention of individual nursing care. Results:All patients completed the standard course of treatment. The early response rate was 100%. At the end of treatment, serum ALT was normal, serum HCV-RNA was negative (<1 000 IU·ml^-1) and the sustained response rate was 100%. The results of SF-36 showed that the scores of physical pain, general health, vitality, social function and mental health of the patients were significantly higher than those before the medication(P<0.05), and the difference was statistically significant. Conclusion:Individualized nursing care intervention for dialysis patients with HCV infection during oral administration of Harvoni can achieve clinical cure of hepatitis C, reduce the duration of adverse reactions, and promote physical function and mental health, as well as improve the quality of life.

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