腹膜透析患者精神症状和健康状况的相关性分析及护理干预

目的:探讨腹膜透析患者的精神症状即焦虑、抑郁症状与健康状况的关系及相应的护理干预措施。方法:选取75例透析>3个月的稳定腹膜透析患者,调查其主观生存质量、睡眠质量、乏力程度;记录Karnofsky评分(代表患者的客观生存质量/健康状况);分别使用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评估患者的抑郁、焦虑症状,并分为抑郁组与非抑郁组、焦虑组与非焦虑组,同时比较各项指标在组间差异。结果:本组抑郁症状的发生率为37.3%,焦虑症状的发生率为49.3%。抑郁、焦虑评分与乏力程度、睡眠质量、主观生存质量、客观生存质量负相关,精神症状越重健康状况越差(P<0.05,P<0.01)。各项指标在抑郁组、焦虑组均低于无相应精神状况组的患者(P<0.05,P<0.01)。结论:本研究表明腹膜透析患者的精神症状较常见,并且与健康状况相关。     

持续性不卧床腹膜透析患者焦虑和抑郁状态及其相关因素探究

目的 探究持续性不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者抑郁焦虑的发病状况,了解影响维持性腹膜透析患者焦虑和抑郁产生的相关因素,探讨腹膜透析患者焦虑和抑郁与Engle系数,依从性,合并症,营养状态等的关系,旨在提高PD患者的生存质量. 方法 采用横断面调查,调查75例CAPD治疗患者的一般情况及原发病因;采用Engle系数评估患者的家庭经济状况;应用Hamilton焦虑、抑郁等级量表评估CAPD患者焦虑、抑郁发生状况;采用MDRD方程计算肌酐清除率,以评估患者的残余肾功能;以主观综合性营养评估(subjective global assessment,SGA)同时结合血生化指标评估患者营养状况;用Charlson指数评估患者合并症情况;采用ECOG和Karnofsky活动指数评分评估患者的活动能力. 结果 75例CAPD患者中,抑郁焦虑症状总体发生率为37.33％.抑郁焦虑症状的发生与疾病状况及经济状况有关(P＜0.05).腹膜透析合并焦虑抑郁患者活动能力差、依从性差、合并症多;SGA评估及生化指标显示其营养不良发生率高.精神症状与血红蛋白、白蛋白、血肌酐、尿素氮、Kt/V存在明显负相关(P＜0.01),与营养状态存在明显正相关(P＜0.01);精神症状对营养状态有显著影响(OR=3.610,P=0.025).结论 抑郁焦虑在腹膜透析患者中的发病率较高,合并抑郁焦虑症状的腹膜透析患者治疗依从性差、合并症多、营养不良的发生率高,抑郁焦虑症状的发生与患者家庭经济状况有相关性,重视腹膜透析患者的抑郁焦虑可以提高腹膜透析的质量.     

临终腹膜透析患者姑息治疗的回顾性分析

目的:通过对5例临终腹膜透析患者治疗的回顾性研究,初步探讨临终腹膜透析患者的姑息治疗方法。方法:选择2003年1月—2004年6月之间经姑息治疗死亡的5例腹膜透析随诊患者。用Charlson指数评估并发症、SGA评分评估营养状态、Karnofsky活动指数评估活动情况、Hamilton抑郁量表及Hamilton焦虑量表评估抑郁和焦虑状况,回顾他们临终前的治疗和临床表现,并评估患者死亡后家属的满意程度。结果:5例患者的症状为13.00±3.32。Charlson指数为11.50±1.92。SGA评分2人为C,3人为B。Karnofsky活动指数为30.00±10.00。Hamilton抑郁分为16.80±10.24及Hamilton焦虑分为12.40±6.03。结论:并发症多、营养不良、活动指数低、严重的心理问题可以预测临床患者的预后。给予停止透析或间歇小剂量透析、对症治疗、心理干预可以最大程度减轻患者的痛苦,提高家属的满意度。     

腹膜透析患者的症状负担相关因素调查与分析

目的该研究的目的是通过透析症状评估量表(Dialysis Symptom Index,DSI)对腹膜透析(peritoneal dialysis,PD)患者的躯体症状和情感症状负担作出评估以及探讨症状负担与PD患者的抑郁与生存质量的关系,探讨DSI对PD患者的有效性。方法收集2013年10月~2014年10月的中山大学附属第一医院腹膜透析中心随访患者的症状负担、抑郁、生存质量、人口统计学及实验室资料。使用DSI评估患者的症状负担,Beck抑郁量表(BDI)评估患者的抑郁情况,健康相关的生命质量量表(SF-36量表)评估患者的生存质量。结果本研究纳入持续不卧床腹膜透析(CAPD)患者403例,其中54.3%为男性患者,年龄中位数是60.5岁,平均透析月是23.3±15.2月。通过DSI评估,该研究中CAPD患者报告症状的平均数是10(7~13),在CAPD患者中发生率较高的症状分别是:皮肤干燥(71.5%),易醒(70.5%),疲倦(69.5%),皮肤瘙痒(65.3%),入睡困难(63.2%),下肢水肿(61.6%),口干(61.6%);困扰患者程度高的症状是入睡困难,易醒,皮肤瘙痒,疲倦,皮肤干燥,骨关节痛,口干,下肢水肿。相关性分析结果显示DSI总分与躯体功能(PCS)及精神功能(MCS)成负相关关系(r=-0.416及-0.479,P0.01),与BDI成正相关关系(r=0.558,P0.01)。使用多元线性回归分析CAPD患者生存质量的独立危险因素结果显示透析症状量表得分(DSI得分)是影响患者生存质量的独立危险因素(β=0.251,P=0.002),即患者的症状负担是其生存质量的影响因素。结论 CAPD患者的症状负担与患者的抑郁状态密切相关,将影响患者的生存质量。DSI能可靠有效地对PD患者的症状作出评估,作为PD患者随访评估工具,便于医护人员掌握并对腹膜透析患者的症状有效管理。     

腹膜透析患者胃肠道症状与心理状况的研究

目的探讨腹膜透析患者胃肠道症状与心理状况异常的发生情况及相关性。方法我院腹膜透析患者89例,采用胃肠道症状分级评分量表中文版、汉密尔顿焦虑量表和汉密尔顿抑郁量表评估患者胃肠道症状发生情况及心理状况。记录年龄、性别、透析时间、体质量指数、血压、血红蛋白、校正钙、磷、全段甲状旁腺激素(i PTH)、白蛋白、血肌酐、尿素氮、Kt/V等指标。结果腹膜透析患者胃肠道症状分级评分>1分的发生率为83.1%。心理状况调查显示中度抑郁患者2例,可能抑郁患者23例,焦虑患者13例,可能焦虑患者19例,焦虑/抑郁的总发生率为50.6%。焦虑/抑郁组患者的胃肠道评分明显高于非焦虑/抑郁组患者(P<0.05)。相关分析提示胃肠道症状分级评分与焦虑、抑郁及BMI呈明显正相关,与Kt/V呈负相关(P<0.05)。结论腹膜透析患者存在突出的胃肠道症状,也有较高的焦虑/抑郁发生率。焦虑/抑郁心理状况与患者的胃肠道症状之间存在明显相关性。     

医护患一体化护理对腹膜透析患者自我管理能力、并发症及生活质量的影响

目的:探讨医护患一体化护理对腹膜透析患者自我管理能力、并发症及生活质量的影响。方法:2017年6月至2019年6月选取惠州市第一人民医院腹膜透析患者94例,根据患者入院时间分为观察组(2017年6月至2018年5月)和对照组(2018年6月至2019年6月),各47例。对照组实施常规性健康指导,观察组实施医护患一体化护理管理,比较两组干预前后自我管理能力、并发症发生率及生活质量情况。结果:干预后观察组患者腹膜透析操作技术、饮食管理、服药管理、病情监测、水钠摄入及自我管理评分均高于对照组,低血压、腹膜炎、透析感染、心肌缺血、心律失常等并发症发生率低于对照组,躯体症状、肾病影响、肾病负担、认知功能、工作状态、社交质量、睡眠质量、性功能、社会支持、患者满意度及总生活质量评分较对照组明显提高,差异均有统计学意义(均P<0.05)。结论:医护患一体化护理能有效提高腹膜透析患者自我管理能力,降低患者并发症发生率,提高患者生活质量。     

持续非卧床腹膜透析患者睡眠质量及其相关因素分析

目的调查持续非卧床腹膜透析患者的睡眠质量状况并分析其相关因素。方法对117例持续非卧床腹膜透析患者进行问卷调查。结果 117例患者的匹兹堡睡眠指数总分为(7.45±4.58),52例(44.44%)患者睡眠质量较好,65例(55.56%)患者睡眠质量较差,其中33例(28.20%)睡眠质量极差。不同性别患者在入睡时间方面的差异具有统计学意义(P0.05);血白蛋白水平和睡眠效率及睡眠障碍因子得分呈负相关;综合营养评分不同的患者在入睡时间、催眠药物方面的差异具有统计学意义(P0.05)。日总体力活动能量消耗与睡眠障碍、匹兹堡睡眠指数总分之间呈负相关(P0.05)。结论持续非卧床腹膜透析患者睡眠质量较差,与睡眠质量相关的因素可能有性别、营养状况、体力活动。     

136例腹膜透析患者抑郁状况及影响因素分析

目的 了解腹膜透析患者的抑郁状况,并探讨其影响因素.方法 采用描述性研究设计,应用自编的一般资料调查表、抑郁自评量表、健康状况调查问卷、医学应对方式问卷对136例腹膜透析患者进行调查.结果 136例腹膜透析患者的抑郁发生率为31.6%,腹膜透析抑郁组患者的生活质量低于非抑郁组(P<0.01);非抑郁组的面对、应对方式总分高于抑郁组(P<0.01),非抑郁组在回避、屈服方面得分低于抑郁组(P<0.01);抑郁与生活质量各维度及面对应对方式呈负相关(P<0.01),与回避、屈服应对方式呈正相关(P<0.01).多元逐步回归分析显示,家庭人均月收入、躯体角色功能、情绪角色功能、面对、屈服是腹膜透析患者抑郁的主要影响因素(P<0.01或P<0.05).结论 136例腹膜透析患者抑郁发生率为31.6%,家庭经济收入、患者躯体角色功能及情绪角色功能和面对、屈服应对方式是抑郁的主要影响因素,提示护理人员应有针对性地对腹膜透析患者开展心理干预,以改善患者的心理状况.     

腹膜透析患者焦虑抑郁状况及其与生活质量的相关性分析

目的探讨腹膜透析患者焦虑、抑郁状况及其与生活质量的相关性。方法对238例腹膜透析患者应用Hamilton焦虑、抑郁量表、生命质量量表(medicaloutcomesstudy36-itemshortformhealthsurvey,MOSSF-36)进行现状调查,了解患者焦虑、抑郁状况及其与生存质量的相关性。结果患者焦虑发生率为48.31%,无焦虑患者生活质量躯体不适(bodilypain,BP)、总体健康感觉(generalhealthphysical,GHP)、社交能力(socialfunction,SF),情感健康(emotionalwell-being,EW)评分均高于焦虑患者(均P0.05);患者抑郁症发生率为55.46%,无抑郁患者生活质量GHP、SF和EW评分均高于抑郁患者(均P0.05);患者焦虑、抑郁情绪与生活质量总分及各维度呈负相关(均P0.01)。结论腹膜透析患者焦虑、抑郁症发生率较高,而且患者焦虑、抑郁情绪越严重者,其生存质量越低。     

综合护理干预在改善维持性腹膜透析患者营养状况及生活质量中的应用

目的:探讨综合护理干预措施在改善维持性腹膜透析患者营养状态和生活质量中的应用效果。方法:选择2015年6月~2016年5月来我院就诊的维持性腹膜透析患者80例作为研究对象,采用对比研究的方式分别于护理前和综合护理6个月后评定患者的血清白蛋白、血红蛋白和血转铁蛋白的含量、主观综合性营养评估(SGA)以及生存质量评分情况。结果:与护理前相比护理后患者的血清白蛋白、血红蛋白和血转铁蛋白含量均有所提高,SGA评分发生降低(P0.05)。干预后患者生存质量主观感受、健康状况主观感受、生理领域、心理领域、社会关系领域评分较干预前高(P0.05),环境领域与干预前比较差异无统计学意义(P0.05)。结论:综合护理干预措施可改善维持性腹膜透析患者的营养状态,提高患者生活质量。     

维持性血液透析患者睡眠质量、抑郁和生活质量相关关系的研究

目的探讨维持性血液透析患者睡眠质量、抑郁与生活质量之间的关系。方法收集符合标准维持性血液透析患者71例,采用匹兹堡睡眠质量指数（PSQI）评估睡眠质量,以简明健康状况调查表（SF-36量表）和BECK抑郁自评问卷（BDI）分别评估生活质量和抑郁情况。记录年龄、性别、婚姻、干体重、血红蛋白、铁蛋白、转铁蛋白饱和度、钙、磷、全段甲状旁腺激素、白蛋白、C-反应蛋白、透析前及透析后血肌酐、尿素氮。结果睡眠质量较差（PSQI评分〉5）的血液透析患者占76.1%;睡眠质量较好组患者的生活质量总分、生理及心理健康总分均高于睡眠质量较差组（P〈0.01）,睡眠质量较差组的抑郁评分高于睡眠质量较好组（P〈0.05）;中-重度抑郁患者（BDI评分≥8分）占63.4%,该组患者生活质量总分、生理及心理健康总分均低于非中-重度抑郁组（P〈0.01）,且睡眠质量差（P〈0.01）;SF-36生活质量总分、生理健康总分及心理健康总分和睡眠质量及抑郁相关（P〈0.01）,睡眠质量和抑郁是生活质量独立的危险因素。结论维持性血液透析患者睡眠质量较差、抑郁较为常见,睡眠和抑郁之间相互影响,并且降低了患者的生活质量。     

A Pilot Study Exploring the Effects of a 12-Week T'ai Chi Intervention on Somatic Symptoms of Depression in Patients with Heart Failure

Abstract Background: Patients with chronic heart failure (HF) and with elevated depression symptoms are at greater risk of morbidity and mortality. Somatic symptoms of depression are particularly prevalent in HF and are related to worse disease prognosis. T'ai chi practice is related to increased emotional well-being in various clinical populations; however, relatively little is known about t'ai chi's effects on somatic versus cognitive symptom dimensions of depression in HF. Purpose: The objective of the study was to measure whether a t'ai chi intervention effectively reduces somatic and/or cognitive symptoms of depression in patients with HF. Methods: Patients with HF were assigned to either t'ai chi training (n=16) or a usual-care group (n=12). At baseline and after the 12-week intervention period, participants were evaluated for changes in depressive symptoms using Beck Depression Inventory (BDI) total scores (BDI-t) and subcategorized scores of BDI-somatic (BDI-s) and BDI-cognitive (BDI-c), and for symptoms of fatigue using the Multidimensional Fatigue Symptom Inventory-Short Form. Results: Patients with HF in the t'ai chi group compared to the usual-care group had reduced BDI-s (p≤0.017), but not BDI-c (p=0.50) scores from pre- to postintervention. Although t'ai chi did not significantly reduce fatigue, changes in physical fatigue (p≤0.05) were independently associated with changes in BDI-t scores. Conclusions: T'ai chi practice reduced somatic symptoms of depression, which have been linked to worse prognosis in HF. Reductions in fatigue appear to explain some but not all of the reductions in somatic symptoms of depression.     

Comparison of the Charlson Comorbidity Index and the Davies score as a predictor of outcomes in PD patients.

BACKGROUND: Comorbidity is a strong predictor and confounds many studies of outcomes. Previous studies have shown that the Charlson Comorbidity Index (CCI) and the Davies score predict mortality in peritoneal dialysis (PD) patients. However, there are few data on the comparison of comorbidity scores. OBJECTIVE: To compare the CCI (combines comorbidity and age) and Davies score (comorbidity score without age) to see if one score was superior to the other in predicting outcomes. DESIGN: Prospective database study. SETTING: Seven dialysis centers in Western Pennsylvania. PARTICIPANTS: 415 incident PD patients, starting PD from 1/1/90 to 2/1/00. MEASUREMENTS: The CCI and Davies score calculated at the start of PD; serum albumin levels and demographics at the start of PD; total hospitalizations and mortality, collected prospectively. RESULTS: The correlation between CCI and Davies was 0.80, p < 0.0001. The CCI was inversely correlated with serum albumin (-0.31, p < 0.0001). Davies was significantly correlated with age (0.32, p < 0.0001) and inversely correlated with albumin (-0.27, p < 0.0001). The CCI alone was a stronger predictor than Davies alone (score by best subsets regression 49.6 vs 42.0, p = 0.0058). The CCI and Davies with age appeared to be equivalent models of survival (49.61 vs 49.64). The best predictive models were CCI and initial albumin, or Davies, age, and initial albumin. Both CCI and Davies were predictors of hospitalization rates, but the model with the Davies score was better (Akaike information criterion 799.2 vs 850.2). The best predictive model was Davies, albumin, age, and race. CONCLUSIONS: Both comorbidity scores were significant predictors of outcomes, with CCI the stronger predictor for mortality, but the Davies was a stronger predictor of hospitalizations. One or both should be done at the start of dialysis to predict outcome.     

正念减压干预对妊娠晚期妇女睡眠质量、生活质量和抑郁心理的影响研究

目的 研究正念减压法对妊娠晚期妇女睡眠质量、生活质量和抑郁的改善状况。方法 采用方便抽样法,以匹兹堡睡眠质量指数量表、世界卫生组织生活质量简表及爱丁堡抑郁量表为评价指标,对130例孕晚期妇女随即分为对照组和干预组,干预组采用正念减压法进行治疗。结果 对照组的妊娠晚期妇女睡眠质量均分为6.68±2.95分,生活质量均分为58.24±6.72分,EPDS平均得分为7.75±4.73；干预组妊娠晚期妇女睡眠质量均分为9.16±1.12分,生活质量均分为103.25±9.25分,EPDS平均得分为5.80±3.92分。三组数据之间均有显著差异(P＜0.05)。结论 正念减压法对妊娠晚期妇女睡眠质量、生活质量和抑郁状况均有较大的改善,产科临床应建立完整的妊娠晚期睡眠质量、生活质量和抑郁状况管理体系,对出现异常的妊娠晚期妇女及时进行正念减压干预,以改善睡眠,降低抑郁发生率,提高其生活质量。     

Self-reported subjective sleep quality and fatigue in patients with peritoneal dialysis treatment at home

The aim of this study was to describe habitual sleep, daytime symptoms, sleep-disturbing factors, current sleep during 1 week and fatigue in patients with peritoneal dialysis treatment at home and also discover predictions for sleep quality outcome. The knowledge should increase possibilities for supportive nursing health care. Fifty-five patients answered two mailed questionnaires and filled in a sleep diary. Of these, 60% had moderate, persistent sleep problems combined with daytime symptoms. Nocturnal awakenings with difficulties falling asleep again and a sleep duration predicted as 57% of sleep quality. Nocturnal pruritus and 'difficulties finding a comfortable sleeping position' were significant sleep-disturbing factors. Sleep quality predictors means progress in knowledge about the complexity of the situation for peritoneal dialysis patients. Poor sleep, daytime symptoms, sleep-disturbing factors and chronic fatigue need to be enlightened, especially for the nephrology nurses who are in a unique position to give supportive nursing health care.     

Quality of sleep and psychosocial factors for patients undergoing peritoneal dialysis.

OBJECTIVES: Sleep disorders are common in end-stage renal disease patients. This study examined the relationship between self-reported quality of sleep (QoS) and certain psychosocial domains for patients on peritoneal dialysis (PD). METHODS: The study subjects included 190 PD patients from 7 urban dialysis clinics in Northern Taiwan, from whom we obtained biochemical parameters and demographic data. QoS, quality of life (QoL), religious/spiritual activity, and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI) questionnaire, Medical Outcomes Study Short Form (SF-36) for QoL, the Royal Free Questionnaire, and the Beck Depression Inventory, respectively. RESULTS: The average PSQI score was 9.1 +/- 4.1 and, in total, 85.8% of all patients were poor sleepers (global PSQI > or =5). There was no difference in age, gender, and mode or duration of PD between good and poor sleepers. Biochemical data did not differ between the two groups. Widowed patients experienced significantly poorer QoS than patients with other marital status (PSQI scores: 12.3 +/- 4.9 vs 8.88 +/- 4.0, p = 0.006). The percentage of patients that held a bachelor's degree or above was significantly higher in good sleepers (55.6% vs 29.4%, p = 0.008). The PSQI value correlated negatively with the QoL scale in both physical (r = -0.295, p < 0.001) and mental domains (r = -0.410, p < 0.001), and correlated positively with the depression scale (r = 0.351, p < 0.001). There appeared to be no association between QoS and spiritual/religious activity (r = -0.097, p = 0.223). CONCLUSIONS: Psychosocial factors including depression, patients' perceptions regarding QoL, marital status, and educational background correlated significantly to the subjective QoS for PD patients. When dealing with sleep disorders in PD patients, physicians should pay considerable attention to their psychosocial backgrounds.     

安神热庵包足浴结合耳穴压豆对诱导透析患者睡眠质量的影响

目的观察安神热庵包足浴结合耳穴压豆对诱导透析期血液透析患者睡眠质量的改善效果。方法选取2018年2月至2019年4月本院收治的诱导透析期血液透析患者60例为研究对象,按照随机数字表法将其等分为对照组与研究组,对照组采取常规护理方法,研究组在常规护理方法的基础上,采取安神热庵包足浴结合耳穴压豆干预。比较两组患者焦虑、抑郁、睡眠质量和护理满意度评分。结果干预前,两组焦虑、抑郁、睡眠质量评分比较差异无统计学意义(P>0.05),干预后两组患者焦虑、抑郁、睡眠质量评分均较干预前降低(P<0.05),研究组焦虑、抑郁、睡眠质量评分均低于对照组(P<0.05);出院时研究组护理满意度评分高于对照组(P<0.05)。结论对诱导透析期血液透析患者,采取安神热庵包足浴结合耳穴压豆干预,可明显减轻焦虑和抑郁,改善睡眠质量,提高护理满意度。