中青年维持性透析患者心理健康状况的纵向研究

Longitudinal study of psychological condition in young and middle-aged patients of maintenance dialysis

目的纵向探索中青年维持性透析患者在不同时间段的心理健康状况水平及其变化趋势。方法选取2020年2月—2022年12月诊断为终末期肾病行透析的108例患者为研究对象,采用一般资料问卷、中文版简易心理状况评定量表Kessler 10分别在确诊、初次透析、透析1个月、2个月、3个月、6个月、9个月、12个月进行问卷调查。采用单因素重复测量方差分析比较不同时段中青年维持性透析患者心理健康状况得分的差异并进行两两比较。结果108例中青年维持性透析患者从确诊到透析6个月内心理健康状况得分均分>30分;透析9~12个月内心理健康状况得分均分>22分。重复测量方差分析结果显示,在上述8个时间节点上,中青年维持性透析患者的心理健康状况有显著变化(F=212.89,P<0.001),确诊到初次透析这一时间段心理健康状况得分均>40分,但两两比较差异无统计学意义(P=0.103);透析1~3个月患者心理健康状况得分下降,且各个时间节点心理健康状况得分比较均有统计学差异(P<0.05);其他时间心理健康状况得分两两比较,差异均无统计学意义(P>0.05)。结论中青年维持性透析患者从诊断到规律透析12个月,其心理健康状况呈现不同水平。临床工作人员应密切关注从确诊到规律透析6个月这一时间段的中青年透析患者,及时识别患者可能出现的不良心理状况并提供有针对性的心理护理。

Objective To explore the mental health status of young and middle-aged patients of maintenance dialysis at different time points and its change tendency.Methods From February 2020 to December 2022,a total of 108 dialysis patients diagnosed with end-stage renal disease,who underwent maintenance dialysis were selected as participants.The general information questionnaire and the Chinese version of the Kessler Psychological Distress Scale were used to conduct the questionnaire survey at different time points,including diagnosis,initial dialysis,one month,two-months,three-month,six-month,nine-month and 12-month.Single factor repeated measure ANOVA was used to compare the difference of mental health scores of the participants at different time points.Results The average score of mental health status of the participants was above 30 points within six months from diagnosis to regular dialysis,indicating poor mental health status.From nine to 12 months of regular dialysis,the average score of mental health status was above 22 points,suggesting the worsening of the mental health status.The results of single factor repeated measure ANOVA showed a significant change the mental health status of the participants at the eight time points(F=212.89,P<0.001).The scores were all above 40 points from diagnosis to initial dialysis,with no statistical difference(P=0.103).The score of mental health status decreased rapidly from one-month to three-month of dialysis,which reached statistical differences at each time point(P<0.05).There was no significant difference in mental health status scores at other times(P>0.05).Conclusion The mental health status of young and middle-aged patients of maintenance dialysis displays different levels from diagnosis to regular dialysis of 12-month.Clinical staff should pay close attention to young and middle-aged dialysis patients from their diagnosis to regular dialysis for six months.Timely identification of patients with possible adverse psychological conditions and provide targeted psychological care are needed.