深圳地区多中心维持性血液透析患者症状发生现况与应对方法分析

Symptoms and the strategy for symptom management in maintenance hemodialysis patients in Shenzhen area

目的调查深圳地区3家三级甲等医院维持性血液透析患者的症状发生现况,并针对现况提出症状管理对策.方法采用便利抽样方法选取深圳地区3家三级甲等医院2017年4~10月在门诊进行维持性血液透析的368名慢性肾脏疾病患者为研究对象,采用一般资料调查表及透析症状评估量表对其进行调查,全面分析维持性血液透析患者的症状经历。结果维持性血液透析患者总的症状发生率为81.88%,各项症状的发生率为16.44%~79.19%。在30项症状中,不同症状的发生例数、发生频率、症状严重程度、症状对患者造成的烦恼或困扰间存在明显的差异(χ~2=631.383,P<0.001;t=42.651,P<0.001;χ~2=1070.703,P<0.001;t=101.040,P<0.001)。将不同特征患者症状发生情况进行分层对比分析,结果显示不同性别、年龄、透析龄、透析频率、透析方式、有无基础疾病的MHD患者疲乏症状的发生有显著差异(χ~2=13.288,P=0.003;χ~2=10.305,P=0.006;χ~2=80.144,P<0.001;χ~2=48.033,P<0.001;χ~2=114.949,P<0.001;χ~2=55.068,P<0.001);不同性别、年龄、透析龄、透析频率、透析方式、有无基础疾病的患者皮肤干燥症状的发生率也存在显著差异(χ~2=4.797,P=0.029;χ~2=46.846,P<0.001;χ~2=52.661,P<0.001;χ~2=14.282,P=0.001;χ~2=74.599,P<0.001;χ~2=6.031,P=0.014);不同透析频率、透析方式的患者瘙痒症状的发生具有较大差异(χ~2=6.200,P=0.045;χ~2=55.886,P<0.001);不同年龄、透析龄的患者焦虑症状的发生具有较大差异(χ~2=13.785,P=0.001;χ~2=27.939,P<0.001);不同年龄及有无基础疾病的患者入睡困难症状的发生率也具有差异(χ~2=9.598,P=0.008;χ~2=4.585,P=0.032)。结论维持性血液透析患者症状发生率较高,且其症状发生率、严重程度及其对患者造成的困扰程度存在较大差别,各症状间具有共存性和相关性,因此,组建多学科症状管理团队、加强对症状的评估、将药物干预与非药物干预相结合、全面提升患者的自我管理能力是维持性血液透析患者症状管理的关键。

Objective To investigate the symptoms in maintenance hemodialysis（MHD） patients in three tertiary hospitals in Shenzhen, and to put forward the strategies for symptom management based on the presentations of the MHD patients. Methods A total of 368 patients with chronic kidney disease undergoing MHD at outpatient clinics from April 2017 to October 2017 were recruited using a convenient sampling method.General information questionnaire and symptom assessment scale for dialysis were used for a comprehensive investigation of the symptoms in MHD patients. Results The total symptom rate was 81.88% and the rate of various symptoms was 16.44~79.19% in MHD patients. Among the 30 symptoms, different symptoms were different in case number（χ~2=631.383, P〈0.001）, frequency（t=42.651, P〈0.001）, severity（χ~2=1070.703,P〈0.001）, and annoyances and troubles caused by the symptom（t=101.040, P〈0.001）. Stratified analyses of the MHD patients with different symptoms showed that gender（χ~2=13.288, P=0.003）, age（χ~2=10.305, P=0.006）, dialysis age（χ~2=80.144, P〈0.001）, dialysis frequency（χ~2=48.033, P〈0.001）, dialysis mode（χ~2=114.949, P〈0.001） and primary kidney disease（χ~2=55.068, P〈0.001） were significantly different in these MHD patients. The incidence of dry skin was significantly different, relating to gender（χ~2=4.797, P=0.029）,age（χ~2=46.846, P〈0.001）, dialysis age（χ~2=52.661, P〈0.001）, dialysis frequency（χ~2=14.282, P=0.001）, dialysis mode（χ~2=74.599, P〈0.001）, and primary disease（χ~2=6.031, P=0.014） of the MHD patients. The incidence of pruritus was significantly different, relating to dialysis frequency（χ~2=6.200, P=0.045） and dialysis mode（χ~2=55.886, P〈0.001） of the MHD patients. The incidence of anxiety was significantly different, relating to age（χ~2=13.785, P=0.001） and dialysis age（χ~2=27.939, P〈0.001） of the MHD patients. The incidence of sleep difficulty was also significantly different, relating to age（χ~2=9.598, P=0.008） and primary disease（χ~2=4.585, P=0.032） of the MHD patients. Conclusions The prevalence of symptoms is high in MHD patients.These symptoms are significant different in prevalence rate, severity, and influences on the patients, and are co-existent and correlated. Therefore, the essential approaches to manage symptoms in MHD patients should include symptom assessment, symptom management by multidisciplinary team, drugs and other interventions,and self-management ability.