【摘要】目的了解血液透析患者参与血管通路的期待、实际决策现状及影响因素。方法选取2020年11 月～2021 年7 月河南省人民医院就诊的首次选择或更改血管通路的患者为研究对象，调查其一般资料，并采用决策倾向性量表(control preference scale，CPS)评价患者期待决策和实际决策情况，分析两者一致性，运用单因素分析和二元Logistic 回归分析探究决策的影响因素。结果本研究共发放问卷202 份，回收问卷202 份，有效问卷202 份，有效回收率100%。患者期待决策与实际决策参与一致性达0.74。期待决策中意识良好75 例(37.1%)，意识淡薄127 例(62.9%)。实际决策中意识良好52 例(25.7%)，意识淡薄150 例(74.3%)。二元Logistic 回归分析结果显示，年龄在35～59 患者(OR=28.179，95% CI：5.451～145.674，P＜0.001)、受教育程度为高中及中专的患者(OR= 0.026，95% CI：0.004～0.170，P＜0.001)、家庭月收入＞5000 的患者(OR=0.115，95% CI：0.032～0.409，P=0.004)、血管通路选择次数(OR=0.018，95% CI：0.002～0.141，P＜0.001)是患者实际决策参与的影响因素。结论血液透析患者参与血管通路期待决策与实际决策类型一致性良好，决策中意识淡薄型占主导。后续医护人员可根据影响因素并结合患者的决策需求，提供针对性指导干预方案，改善决策意识淡薄情况。
【Abstract】Objective To understand the expectation, actual decision-making status and influencing factors of hemodialysis patient participating in vascular access. Methods Patients who chose or changed vascular access for the first time in Henan Provincial People's Hospital from November 2020 to July 2021 were selected as the subjects of the study. Their general information was investigated. The expected decision and actual decision of the patients were evaluated by Control Preference Scale (CPS). The consistency of expected decision and actual decision was analyzed. Univariate and binary logistic regression analyses were used to explore the influencing factors of decision making. Results A total of 202 questionnaires were sent out and 202 were received and valid, with the effective recovery rate of 100%. The consistency between expected decision and actual decision participation of the patients was 0.74. For expected decision- making, 75 cases (37.1%) had good sense and 127 cases (62.9%) had weak sense; for practical decision-making, 52 cases (25.7%) had good consciousness and 150 cases (74.3% ) had weak consciousness. Binary logistic regression analyses showed that age between 35 to 59 years (OR=28.179, 95% CI: 5.451～145.674, P<0.001), high school or technical secondary school education level (OR=0.026, 95% CI: 0.004～0.170, P<0.001), family monthly income>5000 RMB (OR=0.115, 95% CI: 0.032～0.409, P=0.004), and the number of vascular access selection
(OR=0.018, 95% CI: 0.002～0.141, P<0.001) were the influential factor for actual decision-making participation of the patients. Conclusion The expected decision participation of vascular access in hemodialysis patients is consistent with the actual decision-making type, and the low consciousness type is dominant in decision- making. To improve the situation of weak awareness of decision- making participation, medical staff should provide intervention programs based on the influencing factors and the decision-making needs of the patients.
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