维持性血液透析述情障碍患者医学应对方式和生活质量的研究

A study on medical coping style and qualities of life in maintenance hemodialysis patients with alexithymia

目的探讨维持性血液透析述情障碍患者的医学应对方式和生活质量。方法对进行维持性血液透析（MHD）治疗的67例终末期肾病患者，依据多伦多述情障碍量表（TAS-20）评分分为2组，即总分〉60分为述情障碍组，〈50分为非述情障碍组。分别进行医学应对问卷（MCMQ）、生活质量综合评定问卷（GQLI）的测评，并进行统计学处理。结果67例MHD患者TAS-20评分为（72．31±12．28）分，TAS-20总分〉60分（述情障碍者）31例，平均得分（82．37±15．84）分；TAS-20总分〈50分（无述情障碍者）26例，平均得分（40．17±10．24）分；两者差异有显著性（t=8．90，P〈0．01）。50～60分者10例，平均得分（55．68±4．89）分。述情障碍组MHD患者MCMQ面对因子评分显著低于非述情障碍组，而回避、屈从因子评分则显著高于非述情障碍组（P〈0．01或0．05）。述情障碍组MHD患者GQLI总分及躯体健康、心理健康、社会功能因子分均显著高于非述情障碍组，显著有显著性（P〈0．01或〈0．05）；而物质生活维度评分两者差异无显著性（P〉0．05）。相关分析显示，TAS-20评分与MCMQ的面对因子评分呈显著负相关，而与MCMQ回避、屈从因子评分呈显著正相关（P〈0．01或0．05）；与GQLI总分、躯体健康、心理健康及社会功能因子分呈显著负相关（P〈0．01或0．05），而与物质生活维度评分无相关性。结论情障碍组MHD患者倾向于采用回避和屈服消极的应对方式，较少采用积极面对的应对方式；情障碍组MHD患者的生活质量要差于非述情障碍组。

Objective To discuss alexithymia in patients with maintenance hemodialysis and its impact on medical coping style and the ability of daily living. Methods The patients with end-stage renal disease treated by the maintenance hemodialysis （MHD） were divided into 2 groups, namely, alexithymia group （total score 〉 60） and non-alexithymia group （ total seore 〈 50） , according to the Toronto Alexithymia Scale （ TAS-20）. The Medical response to the questionnaire （ MCMQ） and the activities of daily living scale （ADL） were used to evaluate the patients. Results The TAS-20 score was （72. 31±12.28 ） in 67 cases of patients with M HD. Among these, 31 cases for TAS-20 total score 〉 60 points ,with an average score （82.37±15.84） and 26 cases for TAS-20 total score 〈50 points, with an average score （50. 17±10.24）. There was significant difference （t=8.90, P〈 0.01 ）. The face factor score of MCMQ was significantly lower in alexithymia groups than that in non-alexithymia group,while the avoidance and subordination factor score was significantly higher than that in non-alexithymia group（P 〈 0.01 or 0.05 ）. The ADL scores and factor scores of the alexithymia group were significantly higher than that of non-alexithymia group,and there was a significant difference （t = 3.53, P〈 0.01 ）. Correlation analysis showed that TAS-20 score and the face factor score of MCMQ was significantly negatively correlated with MCMQ evasive and subordination factor,and factor scores and ADL score was significantly positively correlated （P〈 0.01 or 0.05）. Conclusion MHD patients in the alexithymia group tend to use and yield response to avoid negative coping style and less use of active coping style. The quality of life and activities of daily living of MHD patients in alexithymia group are worse than that of the non-alexithymia group.