心理干预对腹膜透析患者焦虑、抑郁情绪和生活质量的影响

The effect of psychological intervention on anxiety, depression and quality of life in peritoneal dialysis patients

目的探讨心理干预对腹膜透析患者焦虑、抑郁情绪和生活质量的影响。方法采用健康状况问卷（SF-36）评估164例腹膜透析患者的生活质量；分别用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）评估患者的抑郁、焦虑症状，根据评分并将其分为抑郁、焦虑组与非抑郁、焦虑组，比较2组间生活质量及腹膜透析质量的差异。将抑郁、焦虑组患者以就诊先后顺序分为心理干预组和非心理干预组，比较2组间生活质量及腹膜透析质量的差异。结果腹膜透析患者抑郁、焦虑情绪的发生率分别为21．95％和41．46％。抑郁、焦虑症状评分与生活质量8项指标中7项呈负相关；尤其在躯体疼痛、情感问题所导致的角色限制和情感健康中差异有显著性（r分别为-0．310，-0．367，-0．409；均P〈0．01），抑郁、焦虑组sF．36总分[（46．23±16．25）分，（73．69±19．17）分，P=0．000]、主观综合营养评估[（19．84±4．41）分，（57．34±6．14）分，P〈0．01]、尿素清除指数[（2．00±0．43）分，（3．764-0．35）分，P〈0．01]明显低于非抑郁、焦虑组。心理干预治疗后心理干预组sF-36总分、主观综合营养评估、尿素清除指数明显高于非心理干预组。结论腹膜透析患者抑郁、焦虑症状发生率较高，且与患者生活质量密切相关。

Objective To investigate the association of anxiety or depression and quality of life in peritoneal dialysis （PD） patients and use the corresponding psychological intervention to improve their quality of life （QoL）. Methods 164 peritoneal dialysis patients＇ QoL were evaluated by the short form 36 health survey ques- tionnaire （SF-36）. Depression and anxiety were estimated by Hamilton Depression Rating Scale （HAMD） and Hamihon Anxiety Rating Scale （ HAMA ） respectively. All the patients were divided into anxiety or depression group and non-anxiety or depression group. QoL and quality of PD were compared between two groups. Patients of anxiety or depression group were divided randomly into psychological intervention group and non-anxiety or depres- sion group. Patients of anxiety or depression group were treated with psychological intervention in addition to rou- tine treatment. Patients of non- anxiety or depression group were treated only with routine treatment. QoL and quality of FD were recompared between two groups. Results Incidence of depression and anxiety was 21.95% and 41.46% respectively of patients with PD. Depression and anxiety scores were negatively correlated with 7 out of 8 scales SF-36 questionnaire. Two groups had significantly difference especially emotional well-being and role limita- tions caused by bodily pain and emotional problems（ r = - 0. 310, - 0. 367, - 0. 409 especially, P 〈 0.01 ）. The anxiety or depression group＇ total score of SF-36 [ （46.23 ± 16.25 ） vs （73.69 ± 19.17 ）, P 〈 0.01 ], subjective global assessment [ （19.84 ± 4.41 ）vs（ 57.34 ± 6.14）, P〈 0.01 ] and urea clearance divided by volume of distri- bution [ （2.00± 0.43 ） vs （ 3.76 ± 0.35 ）, P = 0. 000 ] were lower than non- anxiety or depression group. After treatment , anxiety or depression group＇ total score of SF-36 [ （ 70.96 ± 20.86 ） vs （46.60 ± 18.85 ）, P 〈 0.011, subjective synthesis nutrition evaluate and urea urea clearance divided by volume of distribution are higher than those of non- anxiety or depression group. Conclusion Incidence of anxiety or depression are high in PD patients, which have close association with quality of Life.