不同腹膜透析方式下患者及照护者生命质量差异的混合方法研究

Mixed Methods Study on the Health-related Quality of Life between Peritoneal Dialysis Patients and Caregivers

目的探讨持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)与自动腹膜透析(automated peritoneal dialysis,APD)患者和照护者生命质量的差异。方法基于聚敛式设计的混合方法,于2020年8-10月对江苏省昆山市医疗机构中189名透析患者采用肾病专用生命质量量表(KDQOL-36)进行整群抽样调查,采用健康状况调查问卷简表(SF-36)对130名照护者进行方便抽样调查。通过t检验比较不同透析方式的患者生命质量差异和照护者生命质量差异。同时对13名患者和照护者进行半结构化访谈,通过主题分析法了解其生命质量主观体验。结果APD患者生命质量在PCS和KDCS分量表的得分均高于CAPD患者,差异有统计学意义(t值分别为-9.35和-13.54,P<0.05)。APD照护者生命质量的PCS和MCS得分均高于CAPD照护者,差异有统计学意义(t值分别为-7.19和-2.41,P<0.05)。访谈结果发现,选择APD的患者和照护者社会参与体验更佳。结论APD患者和照护者生命质量更优,且APD技术对于提升患者社会参与、减轻照护负担有重要作用。

Objective To analyze the difference of health-related quality of life(HRQOL)between continuous ambulatory peritoneal dialysis(CAPD)and automatic peritoneal dialysis(APD)patients and caregivers.Methods A mixed-methods,convergent design was adopted.From August to October 2020,a cluster sampling survey was conducted on 189 dialysis patients in medical institutions in Kunshan City,Jiangsu Province with the kidney disease quality of life instrument(KDQOL-36),and 130 caregivers were investigated with the MOS item short from health survey(SF-36)by convenience sampling.T test was used to compare the HRQOL.Semi-structured interviews were conducted with 13 patients and caregivers,and thematic analysis were used to get an in-depth understanding of their quality of life.Results The scores of PCS and KDCS subscale in APD patients were significantly higher than that in CAPD patients(t=-9.35,t=-13.54,P<0.05).The scores of PCS and MCS subscale in APD caregivers were signi-ficantly higher than that of CAPD caregivers(t=-7.19,t=-2.41,P<0.05).Qualitative analysis found that APD patients or caregivers had a better social engagement experience.Conclusion APD patients and their caregivers have better quality of life,and APD plays an important role in enhancing the social engagement of patients and caregivers and reduce the burden of care.