慢性肾脏病非透析患者自我照顾行为现状及影响因素分析

Analysis of the current status and influencing factors of self-care behavior of non-dialysis patients with chronic kidney disease

目的了解慢性肾脏病(chronic kidney disease,CKD)非透析患者自我照顾行为现状并分析其影响因素。方法 2018年11月-2019年2月对四川大学华西医院肾脏内科门诊CKD非透析患者336例采用一般资料调查表、CKD自我照顾行为量表、社会支持量表、广泛性焦虑自评量表和9条目患者健康问卷,通过微信问卷星进行横断面研究并分析自我照顾行为的影响因素。结果 CKD非透析患者自我照顾行为得分中位数为60分,中高水平自我照顾行为者占97.6%。CKD非透析患者自我照顾行为得分与社会支持总分(r=0.210,P<0.001)、客观支持得分(r=0.127,P=0.020)、主观支持得分(r=0.195,P<0.001)和社会支持利用程度得分(r=0.164,P=0.002)呈正相关,与焦虑得分(r=–0.132,P=0.015)、抑郁得分(r=–0.230,P<0.001)、体质量指数(r=–0.181,P=0.001)、收缩压(r=–0.168,P=0.010)呈负相关。二分类多因素logistic回归分析示,CKD非透析患者自我照顾行为的影响因素为性别[比值比(odds ratio,OR)=2.179,95%置信区间(confidence interval,CI)(1.134,4.187),P=0.019]、收缩压[OR=0.967,95%CI(0.947,0.987),P=0.002]、抑郁得分[OR=0.844,95%CI(0.765,0.931),P=0.001]。结论 CKD非透析患者的自我照顾行为处于中高水平,医护人员可以通过减轻患者抑郁等负性情绪、指导患者进行血压管理等措施来提高患者自我照顾行为水平,从而延缓疾病的进展。

Objective To investigate the current status and influencing factors of self-care behavior of non-dialysis patients with chronic kidney disease(CKD).Methods A total of 336 patients with CKD were investigated by a general data questionnaire,the CKD Self-care Behavior Scale,Social Support Scale,Generalized Anxiety Self-assessment Scale,and 9-item Patients Health Questionnaire through WeChat platform,and the influencing factors of self-care behavior were explored by binary logistic regression analysis.Results The median score of self-care behavior of CKD patients without dialysis was 60,and the patients with median and high level of self-care behavior accounted for 97.6%.The score of self-care behavior of CKD patients without dialysis was positively correlated with the total score of social support(r=0.210,P<0.001),objective support score(r=0.127,P=0.020),subjective support score(r=0.195,P<0.001),and social support utilization score(r=0.164,P=0.002),and negatively correlated with the anxiety score(r=–0.132,P=0.015),depression score(r=–0.230,P<0.001),body mass index(r=–0.181,P=0.001),and systolic blood pressure(r=–0.168,P<0.001).The results of binary logistic regression analysis showed that the influencing factors of non-dialysis CKD patients’self-care behavior were gender[(odds ratio,OR)=2.179,95%confidence interval,CI(1.134,4.187),P=0.019],systolic blood pressure[OR=0.967,95%CI(0.947,0.987),P=0.002],and depression score[OR=0.844,95%CI(0.765,0.931),P=0.001].Conclusions The self-care behavior of CKD patients without dialysis is at the median and high level.Healthcare workers can improve the self-care behavior of CKD patients by reducing their negative emotions such as depression,and guiding patients to carry out blood pressure management,to delay the progress of the disease.