CAPD生活质量管理对腹膜透析患者预后的影响

Effects of patients control on quality of life in peritoneal dialysis patients

目的探讨腹膜透析患者管理对持续性非卧床腹膜透析（CAPD）患者生活质量的影响。方法将2000年6月～2007年6月于该院行CAPD治疗的97例现存患者纳入研究。其中管理组49例，非管理组48例。管理组在本腹膜透析中心接受长期的患者管理，包括管理前的评估、长期门诊和家庭随访；非管理组则进行常规的电话随访和指导。以KDQOL-SFTM量表评估患者生活质量。使用汉密尔顿抑郁量表（HAWD）评估患者的抑郁症状，以主观全面营养评估法（subjective global assessment，SGA）、血清白蛋白（ALB）、血红蛋白（Hb）指标评估营养状况，以腹膜尿素清除指数（Kt／Vurea）评估腹膜清除效能，患者24h尿量评估残存肾功能。干预后1年进行回顾性对照分析，评价腹透管理对CAPD患者生活质量及相关因素的影响，同时观察腹透管理对不同透析时间的CAPD患者生活质量改善的差异。结果管理组腹透患者管理后透析相关生活质量评分均高于管理前及非管理组（P〈0．05），Hamilton抑郁评分低于管理前及非管理组（P〈0．01），SGA、AIb及Kt／V均较管理前及非管理组提高（P〈0．05）。管理组及非管理组患者残存肾功能均呈下降趋势，组间差异无显著性（P〉0．05）。管理组以不同透析时间划分的三个亚组患者在管理后KDTA及SF-36评分均高于非管理组对应亚组，且以腹透时间≤1年组提高最为明显。结论腹膜透析患者管理能从多个方面提高CAPD患者的生活质量，且对提高早期腹膜透析患者生活质量意义重大。

[ Objective ] To study the effects of patients management on quality of life in continuous ambulatory peritoneal dialysis patients. [ Methods ] 97 patients who had received PD during the last 7 years were enrolled in this study. 49 cases were in the management group and received long-term nursing and education, including precontrol evaluation, family and department education, lasting encouragement and psychological counsel. The other 48 cases were in the non-management group as control and received only normal nursing. Assessed patients＇ quality of life with KDQOL-SFTM questionnaires. Depression was evaluated using HAMD. SGA, Hb, Alb were used to assess nutritional status. Kt/Vurea and residue renal function were also detected. All the data were recollected and analyzed after one year. The patients were grouped according to time of peritoneal dialysis （≤ 1 year; 1-3 years; ≥3 years）. Then quality of life of these groups were observed. [ Results ] After the patients management, the patients＇ KDTA and SF-36 scores in management group were significantly higher than before the implementation of management, and also higher than that of non-management group （P 〈0.01）. Lower Hamilton scores and higher SGA, Alb, Kt/V indexes were observed after patients management （P 〈0.05）. The residue renal function in two groups were decreased and there was no significant difference（P 〉0.05）. KDTA and SF-36 were significantly raised after patients management in different subgroup. Remarkably changes were observed in the first subgroup （≤1 year）. [ Conclusion ] Patients management can improve quality of life in peritoneal dialysis patients, especially for those at the early stage.