腹膜透析患者生存质量的影响因素分析

目的:分析影响腹膜透析患者生存质量的因素,旨在探讨提高患者生存质量的途径。方法:90例透析>3个月的稳定腹膜透析患者纳入本研究。调查患者的主观生存质量、睡眠质量、躯体症状评分;记录Karnofsky评分;使用Hamilton抑郁量表评估患者的抑郁症状;采用Charlson并发症指数评估患者的并发症状况;检查患者的透析充分性指标尿素清除指数(Kt/Vurea)以及相应的生化指标,分析影响患者生存质量的可能因素。结果:年龄、躯体症状、睡眠质量与主观生存质量正相关,躯体症状越轻、睡眠质量越好生存质量越高,而抑郁程度越重主观生存质量越差,者负相关。客观生存质量与透析龄、Charlson并发症指数、抑郁评分负相关,而与躯体症状正相关,也就是躯体症状越轻,患者的健康状态越好,多元线性回归分析结果表明,年龄、抑郁评分、躯体症状及睡眠质量是主观生存质量的显著预测因子,而抑郁评分、Charlson并发症指数、躯体症状是客观生存质量的显著预测因子。结论:抑郁和躯体症状是影响腹膜透析患者生存质量的因素,将康复干预与医疗干预摆在同等重要位置才是提高生存质量的途径。

Quality of life in peritoneal dialysis patients

Objective:To analyze the factors influencing quality of life in order to explore the possible ways to improve quality of life in peritoneal dialysis patients.Method:90 patients who had received peritoneal dialysis for at least 3 months were enrolled in this study.Subjective quality of life, quality of sleep, and somatic symptoms were colleeted.Karnofsky scores reflecting objective quality of life or health status were evaluated. Depression was estimated using Hamilton Depression Rating Scale that includes 17 items.Comorbidity was also measured by Charlson Cormobidity Index(CCI). We also evaluated dialysis adequacy as assessed by Kt/Vurea, and corresponding biochemical parameters.Result:Subjeetive quality of life was positively correlated with age, somatic symptoms, and quality of sleep, and negatively correlated with depression scores. There was a negative correlation between objective quality of life and duration of dialysis, CCI and depression scores.Multiple linear regressions were also performed separately for subjeetive and objective quality of life. The results indicated that age, depression, somatic symptoms, and quality of sleep were significant predictors of subjective quality of life. In contrast, the significant predictors of objective quality of life were depression, CCI and somatic symptoms.Conclusion: It is demonstrated that depression and somatic symptoms are the factors threatening quality of life in dialysis patients. In order to improve quality of life, rehabilitation intervention and medical intervention should be viewed as equally important.