肾移植前后行维持性血液透析患者的心理健康状况测评

Mental health evaluation of patients with maintained hemodialysis before and after kidney transplantation

背景:移植肾功能丧失也是导致终末期肾病的常见原因之一,维持性血液透析患者的生存期有明显的改善。目的:测量和评估肾移植前后实施维持性血液透析患者的心理健康状况。方法:选取维持性血液透析患者106例,同时选取慢性肾功能不全患者100例未接受任何透析治疗为对照。应用抑郁自评量表(SDS)、焦虑自评量表(SAS)、症状自评量表(SCL-90)和艾森克人格问卷(EPQ成人)为测量工具,采用自评方式,对比两组评分,且将两组得分与常模比较。结果与结论:两组患者在SCL-90量表各因子上的得分均显著高于常模;维持性血液透析患者在人际关系敏感性、抑郁、焦虑、睡眠、饮食等方面明显高于对照组(P<0.05);在躯体化方面,对照组的因子分比维持性血液透析患者的因子分高(P<0.01);两组患者SDS和SAS量表得分(标准分)显著高于常模,维持性血液透析患者SDS和SAS量表得分明显高于对照组(P<0.01);在人格量表中E和N量表的分值维持性血液透析患者偏高(P<0.01)。提示终末期肾病患者在开始规律透析治疗后仍存在着躯体和精神方面的问题,尤其在人际关系敏感性、抑郁、焦虑、睡眠等方面较透析前加重,而且透析患者情绪不太稳定,因此在充分透析基础上,应该增加对维持性血液透析患者心理及精神方面的治疗。

BACKGROUND： Renal allograft failure is one of the most familiar reasons of end-stage renal disease. The survival time in maintained hemodialysis patients improves remarkably. OBJECTIVE： To measure and evaluate the mental health condition of patients with maintenance hemodialysis before and after kidney transplantation. METHODS：A total of 106 hemodialysis patients and 100 chronic renal insufficiency patients who did not take any dialysis （as control） were involved. Self-rating Depression Scale （SDS）, Self-rating Anxiety Scale （SAS）, Symptom Checklist 90 （SCL-90） and Eysenck Personality Questionnaire （EPQ） were used as survey tools to evaluate the patients’ mental health condition. The scores of the two groups were compared with each other and with that of the norm. RESULTS AND CONCLUSION： The mean SCL-90 scores of the two groups were significantly higher than that of the norm, and hemodialysis patients had higher scores than control people in the aspects of interpersonal sensitivity, depression, anxiety, sleep and diet （P 〈 0.05）. Chronic renal insufficiency patients who did not take any dialysis had higher factor scores in somatization than hemodialysis patients （P 〈 0.01）. The mean scores of SAS and SDS in the two groups were significantly higher than that in the norm, and the scores in the hemodialysis group were significantly higher than that in the control group （P 〈 0.01）. The scores of E and N in the personality scale of hemodialysis group were higher than that of the control group （P 〈 0.01）. These findings indicate that end-stage renal disease patients still have severe physical and mental problems after regular hemodialysis treatment. Especially, the condition in the aspects of interpersonal sensitivity, depression, anxiety and sleep worsens after hemodialysis. Hemodialysis patients are emotionally unstable. So the treatment on the mental condition in maintained hemodialysis patients should be strengthened on the basis of sufficient hemodialysis.