心理问题对长期腹膜透析患者生活质量的影响

The Effect of Psychological Problem on Quality of Life in Peritoneal Dialysis Patients

目的探讨持续不卧床腹膜透析(CAPD)病人的焦虑及抑郁状况对生活质量的影响,以及导致病人产生焦虑及抑郁的可能因素。方法79例CAPD病人,采用KDQOL-SFTM1.2中的短表SF-36评估病人的生活质量;采用汉密尔顿焦虑抑郁量表评估病人的心理状态;采用主观综合性营养评估(SGA)、握力试验及其他生化指标评估病人营养状况;记录病人的性别、年龄、工作状况、文化程度、医疗负担等资料;根据C-G方程评估残余肾功能。结果①79例CAPD病人中焦虑者43人(54.4%);抑郁12人(15.2%)。②79例CAPD病人生活质量的8个维度均显著低于中国一般人群水平(P<0.05)。③与非抑郁组比较,抑郁组患者在体力作用、总体健康、情感作用、社会功能方面明显低下(P<0.05);与非焦虑组比较,焦虑组在体力状况、总体健康、情感状况、社会功能方面也明显低下(P<0.05)。④抑郁组患者营养不良发生率明显高于非抑郁组(P<0.01);焦虑组患者营养不良发生率明显高于非焦虑组(P<0.05)。⑤女性的焦虑、抑郁状况较男性严重(P<0.05);与在职组患者相比,非在职组患者的SF-36指数明显下降、焦虑指数和抑郁指数明显升高(P<0.05);无医疗保障组患者的SF-36指数明显低于有医疗保障组,而焦虑指数、抑郁指数明显高于有医疗保障组(P<0.05)。结论CAPD病人中焦虑、抑郁普遍存在,可能与患者的性别、工作状况、医疗负担、营养状况等因素有关,应及早发现并干预病人的心理问题,可提高生活质量。

Objective To investigate the condition of psychological problems among the patients under peritoneal dialysis and the effect of depression and anxiety on the quality of life during CAPD. Methods 79 peritoneal dialysis patients were divided into 3 groups （depression group and normal group/anxiety group and normal group） by Hamilton depression/anxiety scale （HAMD）. Quality of life in patients was evaluated by using SF-36 questionair. Patients＇ nutritional status were evaluated by SGA, hand grip test and serum albumin levels. Resuits （1）43（54,4% ） patients suffered from depression and 12（15.2% ） from anxiety. （2）The quality of life a- mong patients was significantly lower than that of general people in all 8 scales （ P 〈 0.05）. （3） The patients in depression group had lower level of role-physical, general health, role-emotional and social functional （ P 〈 0.05）. The patients in anxiety group had lower level of physical functioning, general health, emotional well-being and social function（ P 〈 0.05）. （4）The nutritional status in non-depression group and non-anxiety group were better than in depression group（ P 〈 0.05）and anxiety group（ P 〈0.05）. （5）It seems that depression and anxiety status were worse in female than in male（ P 〈 0.05）, non-working group than working group（ P 〈0.05）,medical burden group than non-medical burden group（ P 〈 0.05）. SF-36 was higher in working group and non-medical burden group as contrast to non-working group（ P 〈 0.05） and medical burden group（ P 〈 0.05 ）. Conclusion Psychological problem is very common in peritoneal dialysis patients and has very deep influence on their quality of life. The factors that impacted on depression/anxiety scores were sedated as sex, work status, medical burden and nutritional status.