老年透析病人便秘现状及影响因素分析

Analysis of current status and influencing factors of constipation in elderly patients undergoing dialysis

目的了解老年血液透析病人和腹膜透析病人便秘发生率,探讨其影响因素。方法选取2021年1~6月于东南大学附属中大医院血液净化中心接受血液透析和腹膜透析治疗的老年病人300例进行问卷调查,收集病人一般资料、便秘评估量表(CAS)评分、便秘病人生存质量评分及实验室指标。根据CAS评分将病人分为便秘组和非便秘组,采用Logistic回归分析病人发生便秘的风险因素。结果共发放调查问卷300份,有效回收291份(97.0%)。结果显示,血液透析病人便秘发生率为66.92%,腹膜透析病人便秘发生率为89.29%。便秘组和非便秘组生存质量总分以及躯体不适、社会心理不适、担忧焦虑和满意度得分差异均有统计学意义(P<0.05)。血液透析病人便秘组与非便秘组病人年龄、透析龄差异有统计学意义(P<0.05);腹膜透析病人便秘组与非便秘组病人年龄、血磷水平差异有统计学意义(P<0.05)。Logistic回归分析显示,透析方式(OR=2.28,95%CI 1.49~3.50,P<0.001)、年龄(OR=1.71,95%CI 1.21~2.43,P=0.003)、透析龄(OR=0.38,95%CI0.15~0.98,P=0.046)、糖尿病(OR=3.23,95%CI 1.88~5.57,P<0.001)是病人发生便秘的独立危险因素。结论老年透析病人发生便秘受透析方式、年龄、透析龄的影响。

Objective To investigate the incidinence of constipation in the elderly patients undergoing hemodialysis(HD)or peritoneal dialysis(PD),and to explore its influencing factors.Methods From January to June 2021,300 elderly patients who received HD or PD treatment in the Blood Purification Center of Zhongda Hospital of Southeast University were selected for questionnaire survey.The general information,Constipation Assessment Scale(CAS)scores,Patient-Assessment of Constipation Quality of Life(PAC-QOL)and the levels of laboratory indicators of the patients were collected.According to CAS score,the patients were divided into constipation group and non-constipation group,and binary Logistic regression was performed to analyze the risk factors of constipation.Results A total of 300 questionnaires were distributed,and 291(97.0%)were effectively recovered.The incidence rate of constipation was 66.92%in HD patients,and 89.29%in PD patients.There were statistically significant differences in the total quality of life scores and the scores of physical discomfort,psychosocial discomfort,anxiety and satisfaction between the constipation group and the non-constipation group(P<0.05).There were significant differences in age and dialysis age between the constipation group and the non-constipation group in HD patients(P<0.05);And the age and blood phosphorus of PD patients showed significant difference between the constipation group and the non-constipation group(P<0.05).Logistic regression analysis showed that dialysis method(OR=2.28,95%CI 1.49-3.50,P<0.001),age(OR=1.71,95%CI1.21-2.43,P=0.003),dialysis age(OR=0.38,95%CI 0.15-0.98,P=0.046),diabetes(OR=3.23,95%CI1.88-5.57,P<0.001)were independent risk factors for constipation.Conclusions Dialysis method,age,dialysis age,and diabetes show effects on the incidence of constipation in the elderly patients.