正念减压疗法对尿毒症血液透析患者肾功能及生命质量的影响

The effect of mindfulness-based stress reduction on renal function and quality of life in uremic hemodialysis patients

目的构建适合尿毒症血液透析患者的正念减压疗法干预方案,分析该方案对尿毒症血液透析患者肾功能、生命质量的影响。方法本研究为随机对照试验,采用便利抽样法选择2018年3月至2019年3月连云港市第一人民医院行血液透析治疗的尿毒症患者92例,按照随机数字表法分为对照组与正念减压疗法组,每组46例,对照组采用常规护理,正念减压疗法组采用面对面指导结合微信平台监管的正念减压疗法,2组均干预8周。采用中文版欧洲五维量表(EQ-5D-3L)评估2组患者干预前后生命质量,并比较2组患者干预前后血肌酐(Scr)、估算肾小球滤过率(eGFR)、血尿素氮(BUN)、胱抑素C(CysC)水平。结果 2组患者干预前Scr、eGFR、BUN、CysC水平比较差异均无统计学意义(均P>0.05);正念减压疗法组干预8周后Scr、eGFR、BUN、CysC水平分别为(201.81 ± 14.77)μmol/L、(35.30 ± 2.02)ml/min、(11.47 ± 2.66)mmol/L、(2.41 ± 0.28)mg/L,同期对照组分别为(218.37 ± 14.90)μmol/L、(33.99 ± 1.95)ml/min、(12.50 ± 0.76)mmol/L、(2.76 ± 0.30)mg/L,2组比较差异均有统计学意义(t值为2.53~5.79,均P<0.05)。2组患者干预前EQ-5D-3L评分比较差异无统计学意义(P>0.05);正念减压疗法组干预8周后EQ-5D-3L中的痛苦(不适)、焦虑(沮丧)、视觉模拟量表(VAS)评分分别为(1.17 ± 0.34)、(1.02 ± 0.35)、(88.57 ± 20.28)分,同期对照组分别为(1.46 ± 0.63)、(1.30 ± 0.32)、(62.69 ± 18.79)分,2组比较差异均有统计学意义(t=2.75、4.00、6.35,均P<0.05)。Scr与EQ-5D-3L中的自我照顾、痛苦(不适)、焦虑(沮丧)、行动能力、日常活动能力、VAS均呈负相关(r值为-0.481~-0.214,均P<0.05);eGFR与自我照顾、痛苦(不适)、焦虑(沮丧)、行动能力、日常活动能力、VAS均呈正相关(r值为0.199~0.492,均P<0.05)。而BUN、CysC均与EQ-5D-3L评分无显著相关(P>0.05)。结论正念减压疗法可以有效改善尿毒症血液透析患者的肾功能,提高其生命质量,值得临床推广应用。

Objective To construct a mindfulness-based stress reduction(MBSR)intervention program suitable for uremic hemodialysis patients,and analyze the impact of the program on renal function and quality of life in uremic hemodialysis patients.Methods This was a randomized controlled trial.The convenience sampling method was used to select 92 uremic patients who underwent hemodialysis in the First People's Hospital of Lianyungang City from March 2018 to March 2019.They were divided into routine group(46 cases,routine care)and MBSR group(46 cases,MBSR of face-to-face guidance combined with WeChat platform supervision)by random number table method.Both groups were intervened for 8 weeks.The Chinese version of the European Five-Dimensional Scale(EQ-5D-3L)was used to evaluate the quality of life of the patients,and the quality of life of the two groups before and after the intervention was compared;and the blood creatinine(Scr)and estimated glomerular filtration rate(eGFR),urea nitrogen(BUN),cystatin C(CysC)levels of the two groups before and after the intervention were analyzed.Results Before the intervention,there was no significant difference in the levels of Scr,eGFR,BUN,and CysC between the two groups(P>0.05);after 8 weeks of intervention,the levels of Scr,eGFR,BUN,and CysC were(201.81±14.77)μmol/L,(35.30±2.02)ml/min and(11.47±2.66)mmol/L,(2.41±0.28)mg/L in the MBSR group,(218.37±14.90)μmol/L,(33.99±1.95)ml/min,(12.50±0.76)mmol/L,(2.76±0.30)mg/L in the routine group,the differences were statistically significant between the two groups(t values were 2.53-5.79,all P<0.05).Before the intervention,there was no significant difference in EQ-5D-3L scores between the two groups(P>0.05);after 8 weeks of intervention,the pain(discomfort),anxiety(depression),Vasual Analogue Scale(VAS)scores were(1.17±0.34),(1.02±0.35),(88.57±20.28)points in the MBSR group,and(1.46±0.63),(1.30±0.32),(62.69±18.79)points in the routine group,the differences were statistically significant between the two groups(t=2.75,4.00,6.35,all P<0.05).Scr level was negatively correlated with self-care,pain(discomfort),anxiety(depression),mobility,daily activity ability,and VAS(r values were-0.481--0.214,all P<0.05);eGFR level was positively correlated with self-care,pain(discomfort),anxiety(depression),mobility,daily activity ability,and VAS(r values were 0.199-0.492,all P<0.05).But BUN and CysC levels were not correlated with EQ-5D-3L score(all P>0.05).Conclusions MBSR can effectively improve the renal function and quality of life of uremic hemodialysis patients,and it is worthy of clinical application.