维持性血液透析患者抑郁症状调查及对策

Investigation of depression in the patients subject to maintenance hemodialysis

目的探讨维持性血液透析（MHD）患者的抑郁状况及对策。方法选择无精神病史的维持性血液透析（MHD）患者50例进行汉密尔顿抑郁量表（HAMD，17项版本）评分。将患者分为抑郁组和非抑郁组，分析与抑郁症状相关的因素，并予心理干预治疗。结果28．0％的患者有抑郁症状。两组间患者的年龄、性别、文化程度、透析时间差异无统计学意义。抑郁组内向性格、自费医疗、糖尿病肾病（DN）、透析顺应性低及C-反应蛋白（CRP）高、营养不良评分（MS）值均显著高于非抑郁组（P〈0．05，P〈0．01）；血清白蛋白（SAlb）、尿素清除指数（Kt／V）明显低于非抑郁组（P〈0．05，P〈0．01）；体重标准化蛋白代谢率（nPCR）两组差异无统计学意义（P〉0．05）。心理干预有效率85．7％。结论MHD患者产生抑郁症状的机率较高，抑郁症状与患者内向性格、自费医疗、糖尿病肾病、透析顺应性低、微炎症状态、营养不良、透析不充分性等因素有关，心理干预有一定疗效。

Objective To investigate the depressive stage of the patients with maintenance hemodialysis （MHD） and therapies. Method Fifty patients with MHD without psychotic disorder were assessed by Hamilton Depression scale （HAMD） and divided into two groups： depression group and normal group. The related factors of depression in patients with MHD were analyzed. The patients with depression were treated by psychotherapy for 3 months. Result 28. 0% patients were suffered from depression. There were no differences in age, sex, educational level, and dialysis time between two groups. There was significant difference in the mean values of CRP, MS, noncompliance, DN, introvert character and self-expenses in between the two groups （P〈0. 01 or P〈0. 05）. The levels of serum Alb and Kt/V were significantly lower in depression group than those in normal group （P〈 0. 05 or P〈0. 01）. There was no significant difference in nPCR between two groups （P〉0. 05）. 85.7% patients in depression group were improved with psychotherapy. Conclusion Depression was common in MHD patients. Depression was related with introvert character, self-expenses, noncompliance, DN, microinflamrnation, malnutrition and dialysis psychotherapy. inadequacy. Depression can be improvedwith