肾移植前后实施维持性血液透析患者生活质量的评估及其影响因素

背景:由于病情和治疗方法的特殊性,维持性血液透析患者时时面对着种种与治疗有关的压力,生理功能、心理状况和社会功能都受到严重影响,容易导致生活质量下降.目的:测量并评估肾移植前后实施维持性血液透析患者的生活质量,分析影响其生活质量的主要相关因素.设计、时间及地点:以健康人为对照的病例-对照研究,于2008-01/06广东医学院附属医院血液净化中心完成.对象:维持性血液透析患者120例作为患者组,同期选择120例在年龄、性别、居住地、婚姻状态、受教育情况和经济地位等方面与患者组相匹配的健康人作为对照组.方法:采用个人一般资料问卷调查两组对象的年龄、性别、居住地、受教育情况、职业、婚姻状态、家庭经济状况、医疗保障方式等8项个人一般资料,采用一般临床的资料问卷调查患者组的原发病、并发症、接受透析治疗的年限、血清肌酐水平、血红蛋白含量、血清钙水平、血清磷水平、血清钾水平、血清钠水平、血清尿素氮水平、尿素下降率以及透析间期体质量的增加最占干体质量的百分比等12项临床资料.主要观察指标:采用中国版SF-36量表、家庭支持量表、抑郁自评量表和焦虑自评量表对维持性血液透析患者及对照组进行生活质量评分,并进行比较;采用医学应对方式问卷对患者组进行评估,并将得分与常模进行比较;对影响生活质量的因素进行单因素线性回归分析和多元线性回归分析.结果:两组分别发放问卷120份,患者组收回112份,回收率为93.3%,对照组收回117份,回收率为95.7%.与对照组比较,患者组SF-36量表的生理功能、生理职能、躯体疼痛、一般健康状况、活力、社会功能、情感职能、精神健康的平均得分明显下降(P＜0.01),焦虑自评量表得分和抑郁自评量表得分明显上升(P＜0.01),家庭支持问卷得分明显下降(P＜0.01).医学应对方式问卷测试结果显示.患者组的面对因子得分显著低于常模(P＜0.01),回避和屈服两因子的得分显著高于常模(P＜0.01).单因素线性回归分析显示,并发症、年龄、血红蛋白含量、透析年限、经济状况、抑郁、焦虑、家庭支持、应对方式中的回避因子,以及受教育程度与心理健康总分显著相关(|r|=0.376～0.561,P＜0.051);发症、年龄、血红蛋白含量、透析年限、经济状况、抑郁、焦虑、家庭支持、应对方式中的回避因子,以及受教育程度与心理健康总分显著相关(|r|=0.376～0.561.P＜0.05).多因素线性回归分析显示,患者的片发症、抑郁、年龄、透析年限、家庭支持和经济状况是影响维持性血液透析患者生理健康总分的6个主要因素,患者的抑郁、焦虑、并发症,家庭支持和应对方式中的回避是影响维持性血液透析患者心理健康总分的5个主要因素.结论:维持性血液透析患者的牛活质量普遍较差,并与患者的肾功能、躯体症状及社会心理因素有关.

Evaluation on the quality of life in patients with maintained hemodialysis before and after kidney transplantation and the influencing factors

BACKGROUND:Because of the peculiarity of disease and treatment,the maintenance hemodialysis(MHD)patients confront manifold stress related to treatment.Their physical function,mental health and social function were all serially impaired,resulting in the decrease in quality of life(QOL).OBJECTIVE:To measure and evaluate QOL in patients with MHD before and after kidney transplantation,and analyze the main related factors.DESIGN,TIME AND SETTING:Case-controlled study compared with health people was performed at Hemodialysis Center of the Affiliated Hospital of Guangdong Medical College from January 2008 to June 2008.PARTICIPANTS:120 patients with MHD were selected as patient group,and 120 healthy people without disease matched by age,gender,residence,marital status,educational background,family economic condition,were taken as control group.METHODS:The general information questionnaire was used to investigate individual age,gender,residence,educational background,profession,marital status,family economic condition,medical insurance modes.The general clinical information questionnaire was used to investigate the patients' primary diseases,complication,duration for accepting hemodialysis,serum creatinine(Scr),haemoglobin(Hb),serum calcium(Ca~(2+)),serum phosphorus(PO43~-),serum potassium(K~+),serum natrium(Na~+),and blood urea nitrogen(BUN)before hemodialysis,rate of the declining of urea nitrogen,as well as rate of interdialytic weight gain to dry weight(IWGR%).MAIN OUTCOME MEASURES:Their QOL were measured by using the Chinese version of Short Form-36(SF-36).Their depression,anxiety,family support and coping modes were measured by using the Chinese version of self-rating depression scale (SDS),self-rating anxiety scale(SAS),Perceivd Social Support from Family Scale and Medical Coping Modes Questionnaire (MCMQ).The scores of SF-36,SDS,SAS and Social Support from Family Scale of the MHD patients were compared with those of the normal controls.The scores of MCMQ of the MHD patients were compared with the norm.Univariate linear regression analysis and multiple linear regression analysis were applied to evaluate the related factors.RESULTS:120 questionnaires were put out to each group.112 qualified questionnaires in the patient group and 117 qualified questionnaires in the control group were retracted with the recovery rate of 93.3%and 95.7%,respectively.The mean scores of physical functioning,role-physical,bodily-pain,general health,vigor,social functioning,role-emotional and mental health were significantly lower in the patient group than those in the control group(P＜0.01).The mean scores of SAS,SDS were significantly higher in the MHD group than those in the control group(P＜0.01).The mean score of Perceivd Social Support from Family Scale was significantly lower in the patients group than that in the control group(P＜0.01).The mean score of confronce was significantly lower than the norm(P＜0.01).The mean scores of avoidance and resignation were significantly higher than the norm(P＜0.01).Univariate linear regression analysis showed that complication,age,haemoglobin(Hb),duration for accepting hemodialysis,family economic condition,depression,anxiety,family support,the factor of avoidance of medical coping modes and educational background had significant correlation with the total score of mental health(|r|=0.376-0.561,P＜0.05).Multiple linear regression analysis showed that the main factors that influenced the physical health of QOL in MHD patients were complication,depression,age,duration for accepting hemodialysis,perceivd social support from family and family economic condition,and the main factors that influenced the psychological health of QOL in MHD patients were depression,anxiety,complication,Perceivd social support from family and the factor of avoidance of MCMQ.CONCLUSION:The QOL of MHD patients are remarkably decreased,it is significantly related with their kidney function,complications and social-psychological factors.