慢性透析患者的焦虑和抑郁状态及其相关因素分析

Anxiety and depression in uremic patients undergoing hemodialysis and peritoneal dialysis

目的探讨慢性肾衰竭接受血液透析和腹膜透析患者的情绪障碍,即焦虑症状和抑郁症状的发生情况及其影响因素,从而为提高尿毒症治疗效果、合理选择透析方法提供依据。方法选择昆明医学院第二附属医院肾内科对107例透析患者和42例患其他疾病的患者,使用Hamilton焦虑表和Hamilton抑郁表分透析方法、透析持续的时间、透析前对肾衰竭的知晓度等,来评估患者的情绪状况。同时了解患者透析费用的来源。结果本组107例慢性肾衰竭接受透析的患者,Hamilton焦虑评分(15.1±8.6),Hamilton抑郁评分(12.3±6.8),高于患其他疾病的患者(9.47±5.26),(8.81±5.82),差异有显著性(P<0.05)。肾衰竭原因的不知晓的患者Hamilton焦虑评分(18.34±5.30)和Hamilton抑郁评分(13.42±7.9),明显高于肾衰竭原因的知晓的患者(14.12±6.33,10.55±7.01),且差异具有显著性(P<0.05)。透析0～30d,腹膜透析患者的Hamilton焦虑评分和抑郁评分,明显高于血液透析患者,且差异具有显著性(P<0.05)。但透析30天以上血液透析都其Hamilton焦虑和抑郁评分,高于腹膜透析患者,差异具有显著性(P<0.05)。自费患者Hamilton焦虑评分和抑郁评分明显高于公费患者,差异也有显著性(P<0.01)。男性Hamilton焦虑评分(14.63±5.47)高于女性(8.73±4.33),而女性Hamilton抑郁评分(13.55±7.00)高于男性(7.31±5.43),差异有统计学意义(P<0.05)。结论透析患者焦虑和抑郁症状的发生率较高,与患者的透析方法、透析时间、经济、性别、透析前对肾衰竭的知晓度等存在显著相关性。

Objective To study the anxiety and depression conditions in uremic patients undergoing hemodialysis or peritoneal dialysis, and to evaluate the relationship between these emotional disorders and the method of treatment, for the improvement of dialysis method and the prognosis in these patients. Methods Mood status was evaluated using the Hamilton Anxiety Scale and Hamilton Depression Scale for 107 uremic patients undergoing hemodialysis or peritoneal dialysis as well as 42 patients with diseases other than uremia. The method and duration of dialysis was recorded, the acquaintance with uremic by the patient before dialysis was analyzed, and the source for the payment of medical expense was also obtained. Results The anxiety scale and depression scale were significantly higher in the 107 dialysis patients （15.1 ± 8.6 and 12.3 ± 6.8, respectively） than in the 42 patients with diseases other than uremia （9.47 ± 5.26 and 8.81 ± 5.82, respectively; P〈 0.05, as compared with the scales between the two groups of patients）. In the first 30 days of dialysis, the anxiety scale and depression scale were significantly higher in patients with peritoneal dialysis than in patients with hemodialysis （P〈 0.05, as compared with the scales between the two groups of patients）. However, after dialysis for more than 30 days, the two scales were higher in hemodialysis patients than in peritoneal dialysis patients （P 〈 0.05, as compared with the scales between the two groups of patients）. The two scales were higher in patients without medical insurance than patients having medical insurance （P〈 0.01）. Male patients had higher anxiety scale （14.63 ± 5.47） than female patients （8.73 ± 4.33）, but females patients had higher depression scale （13.55 ± 7.00） than male patients （7.31 ± 5.43; P 〈 0.05, as compared with the scales between male and female patients）. Conclusion The incidences of anxiety and depression were higher among uremic patients undergoing hemodialysis and peritoneal dialysis. These mood disorders were related to dialysis method, duration of dialysis, the situation of medical insurance, sex and the acquaintance with the diseases causing uremia before dialysis.