维持性血液透析患者抑郁及其影响因素分析

Analysis of depression and factors influencing it in patients with maintenance hemodialysis

目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者的抑郁情况及相关影响因素。方法收集2019年10月至2020年9月在右江民族医学院附属河池医院肾内科规律透析治疗患者的人口学资料、临床资料及测定握力,采用抑郁自评量表评估MHD患者抑郁情况,统计学分析抑郁与相关影响因素的关系。结果136例MHD患者入选本研究,年龄(58.32±15.00)岁,透析龄(37.70±27.55)个月,男性95例(69.85%)。84例(61.76%)有不同程度抑郁(轻、中、重分别为26.47%、23.53%、11.76%)。单因素分析显示,年龄、性别、教育程度、握力、睡眠时间、血管通路、透析方式、合并症、Scr、ALB在不同程度抑郁组间比较差异具有统计学意义(P<0.05)。相关性分析显示,年龄、合并症与抑郁评分呈正相关(P<0.05),性别(男)、婚姻、教育程度、握力、睡眠时间、运动时间、透析时间、透析方式、ALB、BUN、Scr、K+与抑郁评分呈负相关(P<0.05)。多元线性回归分析显示,教育程度、睡眠时间、透析方式、握力、合并症、BUN是MHD患者抑郁的影响因素。结论MHD患者抑郁发生率较高,教育程度、睡眠时间、透析方式、握力、BUN是抑郁的保护因素,合并症是抑郁的危险因素。防治MHD患者合并症,血液透析联合血液灌流、血液透析滤过透析,改善患者睡眠、提高患者肌力可预防、减少抑郁发生,改善患者症状和生活质量,延长生命。

Objective To investigate the depression status and factors contributing to depression in patients with maintenance hemodialysis.Methods This study collected the demographic data,clinical data and grip strength of the patients who were subjected to regular dialysis in the Department of Nephrology,Hechi Hospital Affiliated to Youjiang Medical University for Nationalities from October 2019 to September 2020.Self-Rating Depression Scale was used to evaluate the depression of the patients with MHD,and the relation between depression and factors influencing it was statistically analyzed.Results A total of 136 patients with MHD were enrolled in this study,their ages being(58.32±15.00)years,the duration of dialysis being(37.70±27.55)months,with 95 cases of males(69.85%).84 cases(61.76%)had varying degrees of depression[light depression(26.47%),medium depression(23.53%)and heavy depression(11.76%)].Univariate analysis showed that there were significant differences in age,gender,education level,grip strength,sleeping time,vascular access,dialysis mode,comorbidities,Scr,ALB among groups with different degrees of depression(P<0.05).Correlation analysis showed that age and complications were positively correlated with depression scores(P<0.05),but gender(males),marriage,education level,grip strength,sleeping time,exercise time,dialysis duration,dialysis mode,ALB,BNU,SCr and K+were negatively associated with depression scores(P<0.05).Multiple linear regression analysis showed that education level,sleeping time,dialysis mode,grip strength,comorbidities and BUN were factors influencing the depression in patients with MHD.Conclusion Patients with MHD have a high incidence of depression.Education level,sleeping time,dialysis mode,grip strength,and BUN are protective factors for depression.Comorbidities are risk factors of depression.Measures such as prevention and treatment of MHD complications,hemodialysis combined with hemoperfusion and hemodiafiltration,improvement of patients’sleep and myodynamia,can prevent and reduce the incidence of depression,with the symptoms alleviated and the life quality and life expectancy improved in patients with MHD.