围透析期患者疲劳发展轨迹及其影响因素的纵向研究

Longitudinal study on fatigue development trajectory and its influencing factors in peri-dialysis patients

目的探索围透析期患者疲劳发展轨迹并分析其影响因素。方法采用便利抽样法,选取2020年2月-2023年3月我院收治的诊断为终末期肾病行透析治疗的172例围透析期患者为研究对象。采用一般资料问卷、中文版FACIT疲劳量表、透析症状量表、匹兹堡睡眠质量指数分别在首次确诊、初次透析、透析1月、透析2月、透析3月进行问卷调查。采用Pearson相关分析的方法分析透析症状、睡眠质量与疲劳间的相关性;采用潜类别增长模型及单因素分析进行数据处理。结果识别出围透析期患者疲劳轨迹分为3个潜在类别,分别为疲劳缓解组(15.7%)、轻中度疲劳递增组(62.2%)、持续高疲劳组(22.1%)。Pearson相关分析结果显示:透析症状量表得分与疲劳得分间呈负相关(r=-0.586,P=0.012);睡眠质量得分与疲劳得分间呈负相关(r=-0.426,P=0.047);不同轨迹类别在年龄(χ2=13.701,P=0.033)、性别(χ2=6.749,P=0.34)、慢性病数量(χ2=11.104,P=0.025)、BMI(χ2=10.168,P=0.038)、是否贫血(χ2=12.665,P=0.013)和NYHA心功能分级(χ2=10.118,P=0.038)方面,差异均有统计学意义。结论围透析期患者从确诊到透析3月呈现3种不同疲劳轨迹类型。透析症状负担及睡眠质量与患者疲劳密切相关,加强透析患者症状管理、提高睡眠质量是改善患者疲劳感的有效方法。护理人员可根据围透析期患者疲劳影响因素,积极改善可控因素,最大程度的缓解围透析期患者疲劳。

Objective To explore the developmental track of fatigue in peri-dialysis patients and analyze its influencing factors.Methods A total of 172 peri-dialysis patients diagnosed with end-stage renal disease who received dialysis treatment from February 2020 to March 2023 were selected as subjects by convenience sample method.General data questionnaire,Chinese version of FACIT Fatigue Scale,Dialysis Symptom Scale,and Pittsburgh Sleep Quality Index were used to conduct questionnaire survey at the first diagnosis,initial dialysis,1 month,2 months,and 3 months of dialysis,respectively.Pearson correlation analysis was used to analyze the correlation between dialysis symptoms,sleep quality,and fatigue.Latent class growth model and single factor analysis were used for data processing.Results The fatigue trajectory of peri-dialysis patients was identified into 3 potential categories,namely,fatigue relief group(15.7%),moderate fatigue increasing group(62.2%),and sustained high fatigue group(22.1%).Pearson correlation analysis showed that score of Dialysis Symptom Scale was negatively correlated with fatigue score(r=-0.586,P=0.012);There was a negative correlation between sleep quality score and fatigue score(r=-0.426,P=0.047);Age(χ2=13.701,P=0.033),sex(χ2=6.749,P=0.34),number of chronic diseases(χ2=11.104,P=0.025),BMI(χ2=10.168,P=0.038),anemia(χ2=12.665,P=0.013)and NYHA cardiac function classification(χ2=10.118,P=0.038)in different trajectory categories were statistically significant difference.Conclusion Peri-dialysis patients show 3 different fatigue trajectories from diagnosis to 3 months of dialysis.The burden of dialysis symptom and the quality of sleep are closely related to the fatigue of patients.Strengthening the symptom management of dialysis patients and improving the quality of sleep are effective methods to improve the fatigue of patients.According to the influencing factors of peri-dialysis patients'fatigue,nursing staff can actively improve the controllable factors to relieve the fatigue of peri-dialysis patients to the greatest extent.