维持性血液透析患者生活质量影响因素分析

目的 研究维持性血液透析(MHD)患者的生活质量及其影响因素. 方法 选择本院血液透析中心102例MHD患者,采用问卷调查方式,利用慢性肾脏病专用量表KDQOL-SFTM1.3评价患者肾脏病与透析相关生存质量(KDTA)和一般健康相关生存质量(SF-36),并分析其影响因素. 结果 量表各影响因素中,医护人员的鼓励、社会支持、症状、认知功能、社会关系质量和患者满意程度评分较高,而性功能、肾脏病给生活带来的负担、总体健康期望和自我健康评价评分则较低.影响因素方面,女性患者躯体功能、躯体疼痛评分(分)明显低于男性(63.52±17.96比71.65±18.66,64.33±21.23比76.58±19.20,均P<0.05).年龄>60岁患者工作状况、性功能评分(分)较≤40岁和40～60岁患者显著升高(61.98±13.63比52.27±7.54和55.23±19.97,68.33±4.04比5.45±9.34和15.81±26.92,均P<0.05);且60岁以上者患者满意程度评分较高,躯体功能评分较低.原发病中仅糖尿病患者受到医护人员鼓励最多[(93.57±11.29)分].白蛋白<3.5 g/L患者KDTA总评分、肾脏病对日常生活的影响、认知功能、躯体功能、总体健康期望及与以往比较评分(分)均明显低于白蛋白≥3.5 g/L者(53.62±8.87比61.26±9.42,44.58±12.52比57.47±17.15,65.56±20.60比78.18±15.73,54.38±19.73比68.87±17.57,31.11±10.23比41.19±66.27,44.44±27.06比68.57±26.94,均P<0.05).透析≥6年患者症状、躯体疼痛、精力状况、总体健康期望评分(分)较高(分别为86.92±6.67、85.08±57.34、 78.40±13.04、 53.33±24.22),而社会支持评分(分)以透析3～6年者最高(94.23±10.96,均P<0.05).而不同血红蛋白和尿素清除指数水平对MHD患者生活质量无明显影响. 结论 MHD患者对自己的信心不足,个人负担较重;营养状态对患者的生活质量影响较大.因此MHD患者的生活质量仍需加强,尤其营养状态方面更是今后的重点.

Analysis of the influencing factors of life quality in patients undergoing maintaining hemodialysis

Objective To determine the influencing factors and life quality of patients undergoing maintaining hemodialysis(MHD). Methods One hundred and two MHD patients in hemodialysis center were enrolled,and a questionnaire investigation using KDQOL-SFTM 1.3 was employed.This questionnaire was disease-specific for chronic kidney disease.The object was to evaluate the quality of life,in relation with the patients' kidney disease and dialysis(KDTA) and the patients' general health(SF-36),and to analyze the influencing factors. Results Among the influencing factors revealed in questionnaire investigation,the items such as encouragement from medical staff,social support,symptoms,cognitive function,quality of social relationship and satisfaction degree of patients won higher scores,while the items such as sex function,difficulties in daily activity due to kidney disease,expectation of general health and self-evaluation of health won lower scores.Among the influencing factors,the scores of physical functions and body pain were much lower in female than male patients(63.52±17.96 vs.71.65±18.66,64.33±21.23 vs.76.58±19.20,both P<0.05).Patients of age>60 won higher scores than patients of age≤40 and 4060 in respect to work condition and sex function(61.98±13.63 vs.52.27±7.54 and 55.23±19.97,68.33±4.04 vs.5.45±9.34 and 15.81±26.92,all P<0.05);patients of 60 years old or older won higher scores in respect of satisfaction degree of patients but lower scores in respect of physical functions.Among primary diseases,only patients with diabetes won much encouragement from medical staff(93.57±11.29).Patients whose serum albumin was lower than 3.5 g/L won much lower scores than those with serum albumin higher than 3.5 g/L in respect of scoring of KDTA,influence to daily life due to kidney disease,cognitive function,physical functions,expectation of general health,and scores obtained previously(53.62±8.87 vs.61.26±9.42,44.58±12.52 vs.57.47±17.15,65.56±20.60 vs.78.18±15.73,54.38±19.73 vs.68.87±17.57,31.11±10.23 vs.41.19±66.27,44.44±27.06 vs.68.57±26.94,all P<0.05).Patients who had undergone hemodialysis for longer than 6 years won higher scores in respect to symptoms,body pain,vigour and expectation of general health(86.92±6.67,85.08±57.34,78.40±13.04,53.33±24.22,respectively),while patients who had hemodialysis for as long as 3 to 6 years won highest scores in respect to social support(94.23±10.96,all P<0.05).The level of hemoglobin and urea clearance index showed no obvious influence to MHD patients' daily life. Conclusion MHD patients have poor self-confidence and they usually lose self-confidence.Nutritional status greatly influences patients' daily life.So it is important to improve the quality of daily life in MHD patients,especially in respect of nutritional support,and this aspect should form our focus of medical support.