基于潜类别增长模型分析中青年维持性血液透析患者失志综合征纵向变化轨迹

Clinical Nursing Latent class growth model-based study of demoralization syndrome among maintenance hemodialysis patients in young and middle-aged adults

目的探讨中青年维持性血液透析(MHD)患者失志变化轨迹,并分析影响轨迹类别的因素,为制订个体化干预方案提供理论依据。方法本研究为横断面研究。便利抽样选取2020年4月至2021年4月绍兴市上虞人民医院接受MHD治疗的中青年患者,对其进行4次追踪调查,调查工具包括一般资料调查表、中文版失志量表(DS-MV)和亲密关系经历量表简版(ECR-S)。使用潜类别增长模型识别潜在的失志轨迹类别,采用Logistic回归方程分析失志轨迹类别的预测因素。结果本研究最终纳入105例患者,共识别出3种失志轨迹类别,根据其特征分别命名为稳定高水平组、缓慢降低组、持续降低组,分别为24、39、42例。单因素分析显示,年龄、职业状态、家庭人均月收入、合并症数量、依恋焦虑得分与失志轨迹类别有关(F=15.92,χ^(2)值为9.16~15.95,均P<0.05);多因素Logistic回归分析显示,年龄、职业状态、家庭人均月收入、合并症数量、依恋焦虑得分是中青年MHD患者失志轨迹类别的重要预测指标。结论中青年MHD患者呈现3种异质化失志变化轨迹,临床护理应根据患者失志轨迹类别制订个体化干预策略。

Objective To investigate distinct trahectories of demoralization of maintenance hemodialysis patients in young and middle-aged adults,and analyze the factors that affect the trajectory category,so as to provides reference for formulating individualized intervention strategies.Methods This study was a cross-sectional survey.From April 2020 to April 2021,young and middle-aged maintenance hemodialysis patients fromShangyu People′s Hospital were collected by convenience sampling method and conducted 4-time follow-up investigation.The survey tools included general information questionnaire,Demoralization Scale Mandarin Version(DS-MV)and Experiences in Close Relationship Scale-Short Form(ECR-S).Latent class growth model was used to identify trajectory patterns of demoralization,Logistic regression was used to identify predictors of demoralization trajectories.Results Totally,105 patients were enrolled in the present study.Three distinct trajectories were identified and named as"table high level group"24 cases,"slow reduction group"39 cases and"continuous reduction group"42 cases.Univariate analysis showed that age,occupational status,average income per person in family,number of comorbidities,attachment anxiety scores were related to the category of demoralization trajectories(F=15.92,χ^(2)values were 9.16-15.95,all P<0.05).Multivariate Logistic regression analysis showed that age,occupational status,average income per person in family,number of comorbidities,and attachment anxiety scores were important predictors of patterns of demoralization trajectories in young and middle-aged maintenance hemodialysis patients.Conclusions This study identified three distinct demoralization trajectories in young and middle-aged maintenance hemodialysis patients,clinical nursing should formulate individualized intervention strategies according to the types of patients′delirium trajectories.