残余肾功能对维持性血液透析患者症状困扰影响的纵向研究

Longitudinal Study of Symptom Burden in Maintenance Hemodialysis Patients

目的:调查2018年与2021年维持性血液透析患者症状的困扰程度,了解症状困扰变化的特点,并分析残余肾功能对其变化的影响。方法:采用方便抽样法,选取2018年6—9月复旦大学附属华山医院收治的110例维持性血液透析患者,根据化验期间透析前1天的24 h尿量将患者分为有残余肾功能组(RRF组,24 h尿量≥200 mL,n=35)和无残余肾功能组(无RRF组,24 h尿量<200 mL,n=75)。分别于2018年12月和2021年12月应用透析症状指数量表评估患者的症状困扰。结果:患者2021年与2018年症状困扰自身前后对照比较后发现,便秘、食欲减退、头晕、疲乏、骨关节痛、入睡困难、悲伤困扰程度的差异有统计学意义(P<0.05)。此外,分别比较2018年和2021年RRF组与无RRF组的便秘、食欲减退、头晕、疲乏、骨关节痛、入睡困难及悲伤后发现,两组在2018年入睡困难、2018年和2021年骨关节痛的差异有统计学意义(P<0.05)。结论:维持性血液透析患者3年前后的便秘、食欲减退、头晕、疲乏、骨关节痛、入睡困难、悲伤的困扰程度变化存在显著性差异。残余肾功能可降低患者入睡困难的严重程度,并缓解骨关节痛的困扰程度,应重视和保护患者的残余肾功能。

OBJECTIVE To investigate the changes of symptom burden in maintenance hemodialysis patients between 2018 and 2021,and to analyze the effect of residual renal function on them.METHODS A total of 110 patients with maintenance hemodialysis admitted to Huashan hospital affiliated to Fudan university from June to September 2018 were selected by convenient sampling method.According to the 24h urine volume 1 day before dialysis during the test,the patients were divided into two groups:the RRF group[patients had residual renal function(24 h urine volume≥200 mL)]and the non-RRF group[patients had non-residual renal function(24 h urine volume<200 mL)].The patients were assessed with the Dialysis Symptom Index scale in December 2018 and December 2021,respectively.RESULTS Compared with the patients before and after symptoms in 2021 and 2018,there were statistically significant differences in the distress degree of constipation,loss of appetite,dizziness,fatigue,bone and joint pain,difficulty falling asleep and sadness(P<0.05).In addition,comparing the constipation,loss of appetite,dizziness,fatigue,bone and joint pain,difficulty falling asleep and sadness in 2018 and 2021 between the RRF group and the non-RRF group,it was found that difficulty falling asleep in 2018 and bone and joint pain in 2018 and 2021 were statistically significant differences in the distress degree between the two groups(P<0.05).CONCLUSION There were significant differences in the distress degree of the following symptom burden:constipation,loss of appetite,dizziness,fatigue,bone and joint pain,difficulty falling asleep and sadness in maintenance hemodialysis patients before and after three years.Residual renal function can reduce the severity of difficulty falling asleep and relieve bone and joint pain.The residual renal function should be emphasized and protected.