老年血液透析与腹膜透析患者生存质量的比较及相关因素探讨

目的比较老年血液透析和腹膜透析患者的生活质量的差异,探讨其相关影响因素及适合老年慢性肾衰竭患者的透析方式。方法选择2007年12月～2008年12月在上海交通大学附属第一人民医院肾内科血液净化中心规律血液透析患者52例,腹膜透析中心腹膜透析患者46例。所有患者均检测生化指标,计算其残余肾功能,并行健康生活质量SF-36问卷调查。结果①两组患者MAP、血肌酐、血白蛋白、血红蛋白、Ca、P、PTH、等临床参数和SF-36量表中的8个维度比较,差异无统计学意义（P〉0.05）;②分层分析提示：透析龄小于等于2年的患者中,腹膜透析组的躯体疼痛、情感职能要优于血液透析组;透析龄大于2年的患者中,腹膜透析组在躯体疼痛方面要优于血液透析组,血液透析组的生命活力要明显优于腹膜透析组,差异有统计学意义（P〈0.05）;③相关性分析表明：两组患者的躯体综合得分和精神综合得分与血红蛋白水平、Kt/V、RRF呈正相关,有统计学意义（P〈0.05）。结论透析患者的生活质量与血红蛋白、Kt/V、RRF相关,在透析前两年腹膜透析患者具有相对较好的生活质量。

Comparison of life quality and analysis of its related factors in elder patients on peritoneal dialysis and those on hemodialysis

Objective Patients＇ life quality is an important indicator reflecting the effectiveness of the medical care they received. Patients with end-stage renal disease are often elder and complicated with various other diseases. The objectives of this study were to evaluate life quality and its related factors in elder patients on peritoneal dialysis and those on hemodialysis. Methods We recruited 52 patients on maintenance hemodialysis （HD） and 46 patients on maintenance peritoneal dialysis （PD） treated in this hospital during the period between 2007-2008. These patients were 60 years of age or older, and survived for more than 3 months after dialysis. The 36-item Short Form Health Survey Questionnaire （SF-36） was used for the life quality assessment. Clinical parameters were examined. Means and deviations for the 8 scales were calculated, and correlation analysis was performed to determine the effect of these variables on life quality in these patients. Results There were no differences in physical component summary score （PCS） and mental component summary score （MCS） between patients on HD and those on PD （P〉0.05）. In the first 2 years of dialysis, body pain was less and emotional function was better in patients on PD than those on HD. After the dialysis for more than 2 years, the vital ability was better in patients on HD than those on PD, but body pain was less in patients on PD than those on HD. Dialysis adequacy, residual renal function, and hemoglobin level positively correlated with life quality （P〈 0.05）. Conclusion There were no differences in life quality between patients on HD and those on PD. Life quality in patients on HD or PD positively correlated with dialysis adequacy, residual renal function and hemoglobin level.