肾移植前后实施维持性血液透析患者抑郁状态的特征

Depression characteristics of maintenance hemodialysis patients before and after kidney transplantation

学术背景:血液透析是终末期肾功能衰竭患者进行肾移植前后的重要治疗和支持措施,可使之生存期延长。抑郁是维持性血液透析患者最常见的一种心理障碍,心理干预是临床上常用的治疗措施。目的:综合分析维持性血液透析患者抑郁状态的发病机制、相关因素、临床影响以及心理干预方法。检索策略:由心理学及心身疾病研究人员应用计算机检索PubMed数据库(http://www.ncbi.nlm.nih.gov/sites/entrez)1980-01/2007-10有关维持性血液透析患者抑郁状态的文献,检索词为"Maintained hemodialysis,End-stage renal disease,Depression,Intervention,Treatment"等,限定语言种类为English。同时检索中国科技期刊全文数据库(http://www.edu.cnki.net)1990-01/2007-10有关维持性血液透析患者抑郁状态的文献,检索词为"维持性血液透析,终末期肾脏疾病,心理干预",限定语言种类为中文。初步检索的文献量为外文1519篇,中文21篇。对资料进行初审,纳入标准:维持性血液透析患者抑郁状态的流行病学调查结果、临床表现、发病机制、相关因素、临床影响以及心理干预方法。排除标准:重复性研究。文献评价:根据以上标准筛选,共收集到文献46篇,其中英文35篇,中文11篇;2篇为综述,其余均为临床与实验研究。资料综合:抑郁是维持性血液透析患者最常见的一种心理障碍。临床特征包括抑郁心境、兴趣减退、易激惹、极易疲劳、躯体方面的主诉增多、自我评价下降、注意力集中困难及社交退缩等。维持性血液透析患者体内毒素过量累积,损害了大脑功能,破坏了去甲肾上腺素和5-羟色胺能神经元及其通路,导致抑郁出现。维持性血液透析患者抑郁的相关因素包括人口统计学因素、社会因素、临床相关因素及行为及人格特点等。抑郁对患者的透析充分性、生理功能、治疗依从性及生活质量等方面都有负面影响。常用的心理干预方法包括个体心理干预方法及集体心理治疗。结论:抑郁对维持性血液透析患者的生理功能、治疗依从性和生活质量等方面都有明显影响,心理干预能减轻患者的抑郁水平,增强其对疾病的适应能力和治疗依从性,提高生活质量。但维持性血液透析患者抑郁状态的心理干预研究,在取样、实验设计和实验方法等方面还存着一些不足之处。

BACKGROUND： Hemodialysis is an important therapy and support measure for the end-stage renal disease patients, for their survival period can be prolonged obviously. Depression is one kind of the most common mental disorders among the maintenance hemodialysis （MHD） patients, which is often treated with psychological interventions in clinical practice. OBJECTIVE： To analyze the mechanism, related factors, clinical influences and psychological interventions of the depression in MHD patients. RETRIEVAL STRATEGY： A computer-based search was done by the researcher of psychology and psychosomatic disease, to identify the articles about the depression of MHD patients on PubMed database （http：//www.ncbi.nlm.nih.gov/sites/entrez） from January 1980 to October 2007, and the terms included maintained hemodialysis, end-stage renal disease, depression, intervention and treatment. The language was limited to English. The China Journals Full-text Database （http：//www.edu.cnki.net） was also retrieved for the relevant Chinese articles from January 1990 to October 2007 with the terms of ＂maintained hemodialysis, end-stage renal disease, psychological intervention＂. The language was limited to Chinese. All together 1 519 articles in foreign languages and 21 in Chinese were collected for the preliminary check. Inclusion criteria： articles related to the epidemiological research, clinical manifestation, mechanism, related factors, clinical influences and psychological interventions of the depression in MHD patients. Exclusion criteria： Repetitive studies. LITERATURE EVALUATION： Totally 35 English articles and 11 Chinese articles were collected. Among the 46 articles, two are summaries and the others are clinical or experimental studies. DATA SYNTHESIS： Depression is one kind of the most common mental disorders among the MHD patients. The clinical manifestations include depressed mood, decreased interest, irritability, fatigue, increased somatic complaints, descended self-evaluation, poor concentration and social withdrawal, etc. Excessive accumulation of the toxin in the MHD patients will damage the brain function, and destruct the arterenol and serotoninergic neurons, as well as their pathways, which all may result in the depression. The related factors of the depression in MHD patients consist of demographic factor, social factor, clinical related factor, behavior and personality trait, etc. Depression has a negative impact on the dialysis adequacy, physiological function, treatment compliance and quality of life in the MHD patients. The common physiological intervention is individual physiological intervention and group psychotherapy. CONCLUSION： Depression has profound influences on the physiological function, treatment compliance and quality of life of the MHD patients. Psychological intervention seems effective in relieving MHD patients＇ mental state, increasing their compliance to treatment, and elevating their quality of life. There are still shortages on the sampling, experimental design and method in the studies of psychological intervention.