潍坊市终末期肾病透析患者临床依从性与生活质量的调查研究

Investigation and Study of Weifang City and the Quality of Life of End-stage Renal Disease Patients Clinical Compliance

目的对腹膜透析(PD)和血液透析(HD)患者进行长期随访和应用终末期肾脏疾病生存质量量表(KDQOLSFTM1.3)评定生活质量的纵向观察,了解终末期肾病透析患者临床依从性与治疗结局和生活质量的关系,探讨影响血透和腹透患者生存质量的基本因素。方法采用便利抽样法收集潍坊市二级及以上医院符合要求的终末期肾病透析患者335例(HD198例,PD137例),对335例PD患者和HD患者进行随访观察,并在随访开始及结束时应用KDQOL-SFTM进行生活质量评分。采集透析患者退出率、病死率、透析感染率、再住院率等治疗结局指标,比较高低依从性组间差异,采用Cox多因素回归模型分析有关危险因素与治疗结局的关系。结果影响透析患者SF-36及KDTA得分的最终入选因素为糖尿病患病和医疗保障、ALB、年龄。137例CAPD患者退出透析61例,退出率44.52%.因死亡退出透析23例(37.70%);高低依从性组间比较,临床依从性不仅是透析退出的主要原因,也是影响透析治疗结局的重要因素,差异均有统计学意义(P<0.05)。SF-36评分8个维度得分差异均有统计学意义(P<0.05)。透析患者治疗结局危险因素的Cox回归分析结果显示依从性是影响治疗结局、导致死亡的重要危险因素。HD和PD这两种方式在体力、精神方面差异无显著性,治疗依从性好的患者可显著提高生活质量。结论 PD和HD患者死亡的主要原因是心血管疾病、透析患者随透析时间的延长、生活质量显著下降。临床依从性是影响透析治疗结局的重要因素,作为可干预因素,临床依从性应列为透析疗效监控指标和提高疗效的干预靶目标。

Objective To access the life quality of peritoneal dialysis （ PD） and hemodialysis （ HD） patients with long-term fol-low-up by end-stage renal disease（ESRD） quality of life scale（KDQOL-SFTM1.3）,understanding the relationship among ESRD dialysis pa-tients,clinical compliance and quality of life .To explore the basic factors influencingthe life quality of patients with peritoneal dialysis and blood the penetration .Methods Three hundred and thirty-five cases of the ESRD patients with dialysis selected by convenience sampling method in Weifang level-II and above hospitals（198 cases of hemodialysis,peritoneal dialysis,137 cases） were followed-up and observed.The life quality of 335 cases of PD patients and HD patients before and after the follow-up were scored by KDQOL-SFTM.The quit rate,mortality rate,dialysis infection rate and rehospitalization rate of dialysis patients were acquired ,differences of compliance between groups were ana-lyzed and Cox regression model was used to analyze the relationship between risk factors and treatment outcome .Results The factors that af-fected the scores of SF-36 and KDTA were diabetes mellitus ,medical security ,ALB and age .Sixty-one cases of 137 cases of CAPD patients , withdrawed,the exit rate was 44.52%.Among them,withdrawed for death was 23 cases,accounting for 37.70%.Comparing the level of com-pliance between groups ,clinical compliance was not only the main reason for withdrawing dialysis ,but also an important factor to affect the outcome ofdialysis treatment,the difference was statistically significant （P〈0.05）.The differences of 8 scores of SF-36 score were statistically significant（P〈0.05）.Cox regression analysis of patients on dialysis treatment outcome showed that compliance was an important risk factor that affecting treatment outcome and leading to death .Hemodialysis and peritoneal dialysis in patients with good compliance ,whose thephysi-ca,and mental ,differences were not significant ,significantly improved the quality of life .Conclusion The main reason of death in patients with PD and HD are cardiovascular disease ,a significant decline in the life quality of dialysis patientswith long-time dialysis.Clinical compli-ance is an important factor affecting the dialysis treatment outcome .As the intervention factors ,clinical compliance should be classified as di-alysis efficacy monitoring index and the intervention target of improving the efficacy .