维持性血液透析患者心理、认知功能状态及其影响因素研究

Analysis of psychological and cognitive functions in maintenance hemodialysis patients

目的调查维持性血液透析(maintenance hemodialysis,MHD)患者心理状态(焦虑、抑郁状态)及认知功能障碍发病情况及其影响因素,为MHD患者制定康复干预策略及临床心理干预提供依据。方法采用认知情绪调节策略问卷(cognitive emotion regulation questionnaire,CERQ)、流调用抑郁自评量表(center for epidemiologic studies depression,CES-D)以及医院焦虑自评量表(hospital anxiety and depression,HAD)对复旦大学附属中山医院血液净化中心MHD患者进行问卷调查,同时收集患者实验室检查结果等资料,分析影响患者心理健康的相关因素。结果共有309例MHD患者完成调查:CERQ得分为96.25(86.21,108.32)分;CES-D调查显示无抑郁状态者181例(58.58%),可能有抑郁状态者122例(39.48%),需要心理科医师干预者6例(1.94%);HAD评分显示焦虑状态患病率为96.77%,其中轻度、中度和重度焦虑状态患病率分别为35.60%、50.49%和10.68%。多元回归方程显示患者抑郁状态发生率与血管通路类型相关(β=0.153,P=0.015),与血清白蛋白呈负相关(β=-0.141,P=0.003);焦虑状态发生率和透析频次呈正相关(β=0.145,P=0.022),与血清白蛋白呈负相关(β=-0.146,P=0.002)。分析3个量表间相关关系显示抑郁及焦虑状态评分均与认知功能评分呈正相关(r分别为0.314、0.143,P分别为0.001、0.012)。结论MHD患者存在不同程度的心理及认知功能障碍,后者在一定程度上加剧患者的焦虑及抑郁状态发生率。患者心理障碍与营养状态密切相关,应重视营养对透析患者心理问题的影响。

Objective To investigate the incidence and risk factors of psychological(anxiety and depression)and cognitive dysfunctions in patients undergoing maintenance hemodialysis(MHD).Methods Cognitive Emotion Regulation Questionnaire(CERQ),Center for Epidemiologic Studies Depression(CES-D)Scale,and Hospital Anxiety and Depression(HAD)Scale were used in this study.Results A total of 309 MHD patients completed the investigation.The median score of CERQ was 96.25(86.21,108.32).The CESD survey showed no depressive state in 181 cases(58.58%),possible depression state in 121 cases(39.48%),and 6 cases(1.94%)requiring psychological intervention.The prevalence of anxiety was 96.77% by using HAD scale.The rates of mild,moderate and severe anxiety were 35.60%,50.49% and 10.68%,respectively.Multivariate linear regression analysis suggested that CES-D score was positively correlated with the use of catheter for hemodialysis(β=0.153,P=0.015)and negatively correlated with serum albumin level(β=-0.141,P=0.003).HAD score was positively correlated with dialysis frequency(β=0.145,P=0.022)and negatively correlated with albumin level(β=-0.146,P=0.002).Both CES-D score and HAD score were positively correlated with CERQ score(r=0.314 and 0.143;P=0.001 and 0.012).Conclusions MHD patients presented higher incidences of psychological and cognitive dysfunctions.Cognitive dysfunction increased the incidences of anxiety status and depression.Nutritional status was closely related to the psychological state in MHD patients.