陕西省维持性血液透析患者透析现状及症状困扰的调查研究

Investigation of dialysis status and symptoms in 1,012 maintenance hemodialysis patients in Shaanxi Province

目的了解陕西省维持性血液透析(maintenance dialysis,MHD)患者的透析现状及症状困扰程度并分析相关影响因素。方法在2020年10~12月通过采取查阅病历和问卷调查相结合的方法,对陕西省MHD患者进行调查,调查内容包括一般人口学资料、合并疾病及透析相关资料,采用症状量表(dialysis symptom index,DSI)评定症状困扰程度。结果陕西省1012例MHD患者中,以男性为主占65.6%,40岁以上患者占64.7%;透析患者原发病因前3位分别为高血压肾损害(28.7%)、慢性肾小球肾炎(19.9%)和糖尿病肾病(18.7%);血管通路主要为自体动静脉内瘘(89.3%),透析龄<5年占45.3%,透析次数5次/2w占42.2%;血钙、血磷、甲状旁腺激素(parathyroid hormone,PTH),三者的达标率分别为50.1%、45.8%和29.9%。MHD患者症状困扰发生率为35.1%~81.1%,症状困扰总得分为(57.10±20.09)分;不同的居住地(H=25.041,P<0.001)、文化程度(H=9.414,P=0.024)、月收入水平(H=7.816,P=0.021)、血钙(H=31.138,P<0.001)、磷(H=33.784,P<0.001)、PTH(H=45.365,P<0.001)的患者症状困扰差异有统计学意义(P<0.05)。结论陕西省MHD患者以中老年人群为主,血液透析患者前3位原发病因依次为高血压肾损害、慢性肾小球肾炎、糖尿病肾病,自体动静脉内瘘使用比例较高,血磷、甲状旁腺激素控制不理想。MHD患者普遍经历多种症状困扰,症状的发生受诸多因素的影响。

Objective To understand the current status and its influencing factors of dialysis and symptom distress in maintenance hemodialysis(MHD)patients in Shaanxi Province.Methods During October to December,2020,a total of 1,012 MHD patients treated in Shaanxi Province were investigated using a combination of medical records and questionnaires,including demographic data,complications,and dialysis-related information.The degree of symptom distress was assessed by the Dialysis Symptom Index(DSI).Results Among the 1,012 MHD patients in Shaanxi Province,65.6%were males,and 64.7%were over 40 years old.The top 3 primary causes of the MHD patients were hypertension(290 cases,28.7%),chronic glomerulonephritis(201 cases,19.9%),and diabetic nephropathy(189 cases,18.7%).The main blood access method was autologous arteriovenous internal fistula(89.3%).Dialysis age<5 years was in 45.3%patients,and 5 times/2 weeks of dialysis was performed in 42.2%patients.The compliance rates of serum calcium,phosphorus and parathyroid hormone(PTH)were 50.1%,45.8%and 29.9%respectively.The incidence of symptom distress ranged from 35.1%to 81.1%in the 1,012 MHD patients,with a total symptom distress score of(57.10±20.09).There was a statistically difference in symptom distress among patients with different residence place(H=25.041,P<0.001),educational level(H=9.414,P=0.024),income(H=7.816,P=0.021),and levels of serum calcium(H=31.138,P<0.001),phosphorus(H=33.784,P<0.001)and PTH(H=45.365,P<0.001)(P<0.05).Conclusion Most MHD pa-tients in Shaanxi Province were middle and old age person.The top 3 primary causes of the MHD patients were hypertension,chronic glomerulonephritis and diabetic nephropathy.Arteriovenous internal fistula was the main blood access route.The compliance rates of serum calcium,phosphorus and PTH were lower.A variety of symptoms distressed most MHD patients,and the presence of symptoms was influenced by many factors.