穿刺疼痛对使用动静脉内瘘的血液透析患者生活质量的影响

目的：分析穿刺疼痛对使用动静脉内瘘进行维持性血液透析患者生活质量的影响。方法：使用肾疾病 生活质量简表(KDQOL-SF1.3)、疼痛视觉模拟法、疼痛自我效能量表及患者一般情况调查表对180例使用动静脉内 瘘进行血液透析治疗的患者进行调查。结果：动静脉内瘘穿刺患者穿刺疼痛强度中位数为5分，疼痛自我效能得分 为(31.42±14.59)分；生活质量总体得分不高，KDQOL-SF1.3为(69.45±24.19)分，其中SF-36(49.82±19.17)分，ESRDtargeted( 55.46±18.37)分。逐步多元回归分析结果显示，患者生活质量主要与性别(β=0.152，P<0.05，OR=1.638，95% CI 1.241~1.954)、工作状态(β=0.307，P<0.05，OR=2.069，95% CI 1.206~?3.148)、内瘘使用时间(β=?0.815，P<0.05， OR=0.223，95% CI 0.095~0.741)、穿刺疼痛强度(β=?0.017，P<0.05，OR=1.004，95% CI 0.886~1.431)及疼痛自我效能 (β=?0.409，P<0.05，OR=0.803，95% CI 0.710~0.984)有关。生活质量分值与穿刺疼痛强度等级分值间存在负相关(r分别 为?0.472，?0.465，?0.381，P<0.01)，与疼痛自我效能值间存在正相关(r分别为0.647，0.203，0.518，P<0.05)，穿刺疼 痛强度与疼痛效能呈负相关(r=?0.745，P<0.01)。结论：穿刺疼痛是影响使用动静脉内瘘行血液透析治疗患者生活质 量的重要原因。

Effect of puncture-related pain on the quality of life in patients undergoing maintenance hemodialysis through internal arteriovenous fistula

Objective: To investigate the effect of puncture-related pain on the quality of life in patients undergoing maintenance hemodialysis through internal arteriovenous fi stula. Methods: A total of 180 hemodialysis patients with the arteriovenous fistula were surveyed by the kidney disease quality of life short form(KDQOL-SF1.3), demographic data questionnaire, visual analogue scale and pain self-efficacy questionnaire. Results: The median score of puncture-related pain was 5 and the score of pain self-efficacy was (31.42±14.59). The quality of life in the patients undergoing maintenance hemodialysis is poor. KDQOL-SF1.3 was (69.45±24.19), SF-36 was (49.82±19.17) and ESRD-targeted was (55.46±18.37). Multivariate analysis demonstrated that the quality of life was positively correlated with the patient gender (β=0.152, P<0.05, OR=1.638, 95% CI 1.241–1.954), working position (β=0.307, P<0.05, OR=2.069, 95% CI 1.206–-3.148), using time of arteriovenous fistula (β=?0.815, P<0.05, OR=0.223, 95% CI 0.095–0.741), the score of pain (β=-0.017, P<0.05, OR=1.004, 95% CI 0.886–1.431) and pain self-efficacy (β=-0.409, P<0.05, OR=0.803, 95% CI 0.710–0.984). There existed negative correlation between the quality of life score and the puncture-related pain score in these patients (r=-0.472, -0.465, -0.381, P<0.01), positive correlation between the quality of life score and the score of pain self-efficacy (r=0.647, 0.203, 0.518, P<0.05), and negative correlation between the puncture-related pain score and the score of pain self-efficacy(r=-0.745, P<0.01). Conclusion: Puncture-related pain is a crucial influential factor on the quality of life in the patients undergoing maintenance hemodialysis through internal arteriovenous fistula.