维持性血液透析患者对透析中康复运动接受程度的多中心现况调查

A multi-center investigation on the acceptance and adherence to rehabilitation exercise during hemodialysis in maintenance hemodialysis patients

目的了解维持性血液透析患者(maintenance hemodialysis,MHD)对透析中康复运动的接受程度,为在MHD患者中广泛开展康复运动、进行运动管理及教育提供参考和依据。方法对参加北京市血液透析联合体"运动康复对维持性血液透析患者生活质量影响"的多中心随机对照研究的中心和患者进行问卷调查。问卷内容包括:(1)各中心患者构成情况;(2)满足入组条件患者一般资料、睡眠评分、家庭支持、骨折病史、跌倒评分以及近1个月透析中并发症及穿刺问题的总次数等;(3)满足入组条件不接受透析中康复运动的具体原因。结果 (1)6家透析中心参与本研究,共有维持性血液透析患者586名,符合随机对照研究入组标准的265名患者中,接受康复运动者220例(83%);不接受者45例(17%)。(2)接受和不接受康复运动患者比较,年龄、是否在职、婚姻状况、文化程度、透析龄、是否合并糖尿病、血管通路类型、有无骨折史、睡眠评分、家庭支持评分、跌倒评分等均无显著性差异,近1个月透析中并发症及穿刺问题总次数存在显著性差异(接受组:5.21±5.89,不接受组:7.67±7.87,Z=-2.290,P=0.022)。(3)不接受透析中康复运动的患者中,有主观原因频次:63次,占总频次的75%;有客观原因频次:21次,占总频次的25%。结论 MHD患者对透析中康复运动的接受程度高,不接受患者虽然以主观原因为主,但穿刺问题及高并发症发生率可能导致了患者对康复运动的主观不接受。根据总体评估:维持性血液透析患者中进行康复运动有很好的患者基础。

Objective To investigate the acceptance and adherence to rehabilitation exercise during he-modialysis for the better management and education of rehabilitation exercise in maintenance hemodialysis （MHD） patients. Methods This was a prospective study in the organization of Beijing Hemodialysis Union based on a multi-center randomized controlled trial （RCT） for the effect of rehabilitation exercise on quality of life （EREQL） in MHD patients. A questionnaire investigation, including the composition of patients in each Chin J Blood Purif,December,2017,Vol.16,No.12 center, the general information of patients who meet the inclusion criteria, and the specific reasons from pa-tients who meet the inclusion criteria but do not accept rehabilitation exercise, was carried out in the centers that participated in the RCT. Results Six dialysis centers participated in this study with a total of 586 MHD patients, among them 265 patients met the inclusion criteria and 220 of the 265 patients （83.0%） accepted the rehabilitation exercise during hemodialysis and 45 cases （17.0%） refused to do this. There were no significant differences in patient age, work status, marital status, educational level, duration of dialysis, with or without diabetes, type of vascular access, history of fracture, sleep score, family support, and falling down rate be-tween the patients who accepted the rehabilitation exercise and those who did not. However, the total number of complication and puncture failure during dialysis in the recent month were significant different between ac-cepting group and rejecting group （5.21＆#177;5.89 vs. 7.67＆#177;7.87, Z=-2.290, P=0.022）. In the patients who rejected the rehabilitation exercise during hemodialysis, subjective reasons accounted for 63 times （75.0%）, and objec-tive reasons 21 times （25.0%）. Conclusions In China, a large proportion of MHD patients accepted the reha-bilitation exercise during hemodialysis. The higher prevalence of puncture failure and complication may lead patients to reject the rehabilitation exercise in a subjective way. Most patients had better adherence after ac-cepting the rehabilitation exercise. Therefore, the basis for carrying out rehabilitation exercise during hemodi-alysis in MHD patients is fairly good in China.