肾移植与血液透析患者医学应对方式的比较

背景：对疾病治疗的认知评价，直接影响患者的应对活动和身心反应，医学应对是影响临床治疗的重要因素之一。目的：比较血液透析及肾移植患者医学应对方式的特点和影响因素。设计、时间及地点：问卷调查，于2005-01／2006-01在首都医科大学附属北京友谊医院泌尿科完成。对象：选择在首都医科大学附属北京友谊医院门诊接受血液透析治疗的患者及门诊随诊的肾移植患者各60例。接受血液透析治疗／肾移植手术时间≥3个月，移植肾功能正常；自愿参加调查。方法：采用问卷调查法，由调查者采用统一的解释性语言，指导患者填写下列问卷。①一般情况问卷：包括性别、年龄、文化程度、职业、婚姻状况、子女情况、家庭收入、医疗付费方式、医疗费用对家庭的影响、接受血液透析治疗／肾移植手术时间等。②医学应对问卷：包含面对、回避和屈服3个分量表，各条目按1～4级计分，其分量表得分越高，表明个体越倾向于采用这种应对方式。主要观察指标：计算血液透析及肾移植患者的医学应对问卷各分量表得分，并与常模进行比较；分析患者的一般情况与各分量表得分的相关性。结果：120例患者全部进入结果分析，无脱落。①两组患者在医疗付费方式、医疗费用对家庭的影响以及血液透析／移植时间方面，差异存在显著性意义（P〈0．05）。②血液透析患者医学应对方式问卷中面对、屈服量表得分均低于肾移植患者（P〈0．05），两组患者的回避量表得分差异无显著性意义（P〉0．05）。③血液透析患者医学应对方式中面对量表得分低于常模（P〈0．05），回避、屈服量表得分均高于常模（P〈0．05）。肾移植患者的面对量表得分与常模相似，差异无显著性意义（P〉0．05）；回避、屈服量表得分均高于常模（P〈0．05）。④血液透析患者的面对量表得分与性别相关（r=-0．277，P〈0．05）；屈服量表得分与家庭收入相关（r=-0．287，P〈0．05）。肾移植患者的面对量表得分与婚姻状态相关（r=0．282，P〈0．05）。结论：治疗方法和心理社会因素影响终末期肾病患者的医学应对方式。与血液透析患者相比，肾移植患者更多采用面对、屈服的应对方式。血液透析患者的面对得分与其性别相关，屈服得分与家庭收入相关；肾移植患者的面对得分与其婚姻状况相关。

Comparison of medical coping styles in renal transplant patients and hemodialysis patients☆

BACKGROUND: The perception evaluation of treatment can influence the patients' coping activities and psychosomatic reactions. Therefore, the medical coping mode adopted by patients is one of the most important medium factors affecting clinical treatment.OBJECTIVE: To explore the characteristics and influencing factors of medical coping styles in hemodialysis patients and renal transplant patients.DESIGN, TIME AND SETTING: Questionnaire investigation was performed from January 2005 to January 2006 in Department of Urology, Beijing Friendship Hospital, Capital Medical University (Beijing, China).PARTICIPANTS: Sixty hemodialysis outpatients and 60 renal transplant outpatients with normal graft function from Beijing Friendship Hospital of Capital Medical University, were enrolled into this study. All the patients had to fulfill the questionnaire investigation.METHODS: Questionnaire investigation was carried out in 60 hemodialysis patients and 60 renal transplant patients.Patients completed the questionnaires following instructions by investigators.The interview scale included variables such as gender, age education, occupation, marital status, children, family income, payment mode, influence of medical cost on family, time receiving hemodialysis and time after renal transplantation, etc. Medical coping mode questionnaire contains three subscales: Confrontation. Avoidance and Acceptance-Resignation. Patients scored the questions over a range of 1 to 4 points. A higher score indicated a higher coping tendency adopted by patients.MAIN OUTCOME MEASURES: All the patients were scored by each scale of Confrontation, Avoidance and Acceptance-Resignation, and were compared with the norms. Pearson's correlation analysis was used to explore the correlation between coping modes and influencing factors in hemodialysis patients and renal transplant patients.RESULTS: All 120 patients were involved in the result analysis. There were significant differences between hemodialysis patients and renal transplant patients in medical payment modes, the influence of medical cost on family, and the time on hemodialysis/time after renal transplantation (P<0.05).The average scores of Confrontation and Acceptance-Resignation in hemodialysis patients were lower than those in renal transplant patients (P<0.05). The Avoidance scores showed no significant differences in two groups of the patients (P>0.05). The average score of Confrontation in hemodialysis patients was lower than the norm (P<0.05), and the average scores of Avoidance and Acceptance-Resignation in hemodialysis patients were higher than the norms (P<0.05). The renal transplant patients exhibited similar scores of Confrontation as the norm, without significant differences (P>0.05). The average scores of Avoidance and Acceptance-Resignation in renal transplant patients were higher than the norms (P<0.05). In hemodialysis patients, the score of Confrontation was correlated with the gender of patients (r=-0.277, P<0.05); the score of Acceptance-Resignation was correlated with the family income (r=-0.287, P<0.05). In renal transplant patients, the score of Confrontation was correlated with the marital status (r=0.282, P<0.05).CONCLUSION: The medical coping style adopted by end-stage renal disease patients is influenced by the clinical treatment methods and psychosocial factors.Compared to the hemodialysis patients, renal transplant patients are prone to the Confrontation and Acceptance-Resignation. As for the hemodialysis patients, the score of Confrontation is correlated with the gender of patients, the score of Acceptance-Resignation is correlated with the family income.In renal transplant patients,the score of Confrontation is correlated with the marital status.