维持性血液透析患者生活质量及相关因素分析

Quality of life of patients undergoing maintenance hemodialysis and its influencing factors

目的探讨维持性血液透析患者的康复状况的影响康复及其相关因素。方法对维持性血液透析治疗超过3个月以上的125例患者进行调查，在患者来透析中心进行透析时收集患者的年龄、性别、是否合并糖尿病、透析前工作状态等个人情况，记录患者当前的血红蛋白、白蛋白、尿素清除指数（Kt／V）等反映临床治疗情况的指标；并发症情况采用Charlson并发症指数进行量化；患者的活动能力用Kamofsky活动指数进行量化；心理情况根据Hamilton抑郁量表对患者进行评定；生活质量评分采用生活质量量表SF-36评分标准进行逐项评分。变量之间的相关性采用单因素相关分析。结果125例患者中1级（生活不能自理）患者7例（5．6％），2级患者（生活仅能自理）43例（34．4％），3级患者47例（37．6％），4级患者13例（10．4％）。康复状况与患者的年龄存在明显的关系，年轻的患者康复状况较年老患者好（X^2=5．864，P〈0．05）；1级患者大部分为老年人、糖尿病患者，其活动指数、合并症评分和抑郁评分、生活质量评分均较差，与2-4级康复患者相比差异有统计学意义（t=5．263、7．866、6．215、5．474，P〈0．05）。患者的康复状况与年龄、是否糖尿病、透析前是否工作、血白蛋白水平、活动指数、Charlson并发症指数、Hamilton抑郁积分相关（r=-0．618、-0．512、0．593、0．369、0．801、-0．696、-0．516）。结论维持性血液透析患者的康复情况受到生理、心理及其他诸多因素的影响，应加强对患者的人文关怀及情感支持。

Objective To investigate the quality of life （QOL） of hemodialysis patients and its influencing factors. Methods One hundred and twenty-five patients who underwent maintenance hemodialysis treatment for more than 3 months were selected, and their age, gender, combined disease and dialysis status were recorded. Hemoglobin, albumin and urea clearance index （Kt/V） were tested. Chadson complications index, Karnofsky activity index, Hamilton Depression Scale and MOS 36-item short health survey questionnaire were used to assess complication, activity, and psychological situation of the patients. Results Of the 125 patients, there were 7 （ 5.6% ） grade 1 patients （ could not take care of themselves） ,43 （34. 4% ） grade 2 patients （could only take care of themselves）,47 （37.6%） grade 3 patients,and 13 （10. 4% ） grade 4 patients. A significant relationship between rehabilitation status and age was found. Young patients were better than older patients （ X^2 = 5. 864, P 〈 0.05 ）. The majority of grade 1 patients were older and had been diagnosed with diabetes, and their Karnofsky activity index, Charlson complications index and Hamilton Depression Scale index were lower than Grade 2-4 patients （t values were 5. 263,7. 866,6. 215 and 5.474, respectively; all P 〈 0. 05 ）. The QOL of the patients were related with age, diabetes, dialysis, serum albumin level, activity index, index of Charlson complications and Hamilton depression （r = -0. 618, -0. 512,0. 593,0. 369,0. 801, -0. 696 and -0. 516 ,respectively）. Conclusions The QOL of maintenance hemodialysis patients may be related with physical, psychological, and many other factors. It should be needed to strengthen health care and emotional support to the patients.