SONG-HD量表评估血液透析患者疲劳程度的应用价值及影响疲劳的相关因素分析

Application value of SONG-HD scale in evaluating fatigue level of patients undergoing hemodialysis and analysis of factors influencing fatigue

目的探讨使用肾脏病血液透析标准化结局(standardized outcomes in nephrology-hemodialysis,SONG-HD)量表评估维持性血液透析(MHD)患者疲劳程度的应用价值及影响疲劳的相关因素。方法选取2021年4月在厦门大学附属第一医院肾内科血液透析室规律MHD患者201例,通过使用SONG-HD疲劳测量工具评估疲劳程度。参与者均以面对面访谈问卷进行疲劳评估,分析各种临床和实验室指标,采用单因素及多因素logistic回归分析维持性血液透析患者发生疲劳的影响因素。结果201例MHD患者中,疲劳发生率为73.1%(147/201)。疲劳组超敏C反应蛋白(hs-CRP)、甲状旁腺素(PTH)水平分别为0.91(0.30,3.63)mg/L、216.00(141.00,347.00)ng/L,均显著高于非疲劳组的0.40(0.30,2.01)mg/L、153.00(96.73,308.50)ng/L(Z=2.12、2.17,均P<0.05),而疲劳组透析前二氧化碳结合力、血白蛋白水平分别为(21.03±2.65)mmol/L、(36.76±3.20)g/L,均低于非疲劳组的(22.68±3.01)mmol/L、(38.61±2.85)g/L(t=3.77、3.73,均P<0.05)。单因素logistic回归分析显示,hs-CRP、透析前二氧化碳结合力、血白蛋白及PTH与血液透析患者出现疲乏相关(Wald值分别为4.32、12.39、12.23、4.66,均P<0.05),同时,在调整混杂因素的多变量模型中,血液透析患者疲劳的独立危险因素为较低的透析前二氧化碳结合力及血白蛋白(Wald值分别为12.41、11.67,均P<0.05)。结论维持性血液透析患者疲劳发生率较高。SONG-HD量表评估MHD患者疲劳程度使用方便。在调整混杂因素后,维持性血液透析患者出现疲劳和较低的透析前二氧化碳结合力及血白蛋白之间存在关联。

Objective To investigate the application value of standardized outcomes in nephrology hemodialysis(SONG-HD)scale in evaluating the fatigue level of patients undergoing maintenance hemodialysis(MHD)patients and the factors that affect fatigue.Methods A total of 201 patients undergoing regular MHD who received treatment in the Department of Nephrology,The First Affiliated Hospital of Xiamen University in April 2021 were included in April,2021.The SONG-HD scale was used to evaluate patient's fatigue level.Fatigue was assessed using face-to-face interview questionnaire.Clinical and laboratory indicators were analyzed.Univariate logistic regression analysis and multivariate logistic regression analysis were performed to analyze the factors that affect fatigue of patients undergoing MHD.Results Among the 201 MHD patients,73.1%(147/201)had fatigue.The high-sensitivity C-reactive protein and parathyroid hormone levels in patients with fatigue were 0.91(0.30,3.63)mg/L and 216.00(141.00,347.00)ng/L,respectively,which were significantly higher than 0.40(0.30,2.01)mg/L and 153.00(96.73,308.50)ng/L in patients who had no fatigue(Z=2.12,2.17,both P<0.05).The pre-dialysis carbon dioxide binding capacity and blood albumin levels in patients who had fatigue were(21.03±2.65)mmol/L and(36.76±3.20)g/L,respectively,which were significantly lower than(22.68±3.01)mmol/L and(38.61±2.85)g/L in patients who had no fatigue(t=3.77,3.73,both P<0.05).Univariate logistic regression analysis showed that high-sensitivity C-reactive protein,pre-dialysis carbon dioxide binding capacity,serum albumin level,and parathyroid hormone level were related to the occurrence of fatigue in patients undergoing MHD(Wald=4.32,12.39,12.23,4.66,all P<0.05).Additionally,in a multivariate model adjusted for confounding factors,the independent risk factors for fatigue in patients undergoing MHD were relatively low pre-dialysis carbon dioxide binding capacity and serum albumin level(Wald=12.41,11.67,both P<0.05).Conclusion The incidence of fatigue is high in patients undergoing MHD.The SONG-HD scale is convenient to use in assessing the fatigue level of patients undergoing MHD.After adjusting for confounding factors,fatigue in patients undergoing MHD is associated with reduced levels of pre-dialysis carbon dioxide binding capacity and serum albumin.