社会心理因素对终末期肾病行腹膜透析患者康复结局的影响

Effect of social and psychological factors on rehabilitation of end stage renal disease patients under peritoneal dialysis

目的:分析社会心理因素对终末期肾病行腹膜透析患者康复结局的影响。方法:选择2005-08/2007-03北京大学第一医院肾内科腹膜透析中心确诊的终末期肾病接受腹膜透析治疗患者171例,男66例,女105例,年龄(60±13)岁,平均透析时间22.8个月。采用问卷调查与访谈相结合方法对患者的康复结局进行评定:主要利用Karnofsky活力指数评估活动状况;采用社会功能缺陷筛选表评估社会参与状况。评估患者的心理社会因素主要采用Hamilton抑郁、焦虑等级量表、医学应对方式问卷和社会支持评定量表。结果:共发放问卷200份,回收有效问卷171份,占85.5%。本组患者活动正常者134例,占78.4%;存在参与受限者129例,占75.4%;焦虑症状的发生率为24.5%(42例),抑郁症状的发生率为8.2%(15例)。本组患者对疾病在采取"屈服"应对方式方面的得分显著高于其他慢性病患者,而"面对"和"回避"两种应对方式的采用与其他患者无统计学差异。将反映康复结局的活动、参与指标作为因变量,社会心理因素中的抑郁焦虑水平、应对方式、社会支持等作为自变量,用多元逐步标准回归篩除法,找出影响康复结局的相关因素,最后进入回归模型的因素为患者的抑郁程度、对疾病采取面对或屈服应对方式、对社会支持的利用程度。结论:社会因素中患者对社会支持的利用程度、心理因素中患者的抑郁状况及对疾病所采取的应对方式等因素对终末期肾病患者的康复结局有重要影响。

OBJECTIVE：To analyze the effects of social and psychological factors on rehabilitation status of end stage renal disease （ESRD） patients under peritoneal dialysis.METHODS：From August in 2005 to March in 2007,171 patients experienced peritoneal dialysis were diagnosed at the Center of Peritoneal Dialysis,Department of Nephrology,First Hospital,Peking University,including 66 males and 105 females,aged （60±13） years,with an average dialysis time of 22.8 months.They were studied with questionnaires and interview.Rehabilitation status was investigated from two aspects of activity and participation by Karnofsky activity index,Social Dysfunction Screening Scale.Hamilton depression and anxiety scales,Medical Coping Modes Questionnaire and Social Supporting Rating Scale were used to investigate social and psychological factors.RESULTS：A total of 200 questionnaires were handed out and 171 （85.5%） of them were drawn in.134 patient had normal activity status,78.4% of them had Dysfunction and 129 patients （75.4%） had normal social function status.Forty-two （24.5%） of patients had the symptom of anxiety,15 （8.2%） had depression.The score of ＂Acceptance-Resignation＂ was significantly higher in this group than patients with other chronic diseases.There were no significant differences in scores of ＂Confrontation＂ and ＂Avoidance＂.Activity of rehabilitation outcome and participation index served as dependent variable,whereas depression and anxiety,coping mode and social supporting as independent variable.Using multiple stepwise regression analysis,factors that affected patient rehabilitation were found,including depression,utilization of social support and the facing coping mode.CONCLUSION：Depression,utilization of social support and the facing coping mode have important effects on patient rehabilitation.