【摘要】目的探索中老年维持性血液透析患者症状困扰、生命质量现况及相关性，分析症状困扰的影响因素。方法采用便利抽样法，使用一般人口学问卷、血液透析患者症状困扰量表、12 条目简短生命质量量表对160 例中老年维持性血液透析患者进行问卷调查。结果中老年维持性血液透析患者排名最高的前10 名症状的发生率为71.88%～55.63%；生命质量总体得分(37.4±6.8)分、生理健康层面(40.3±6.3)分、心理健康层面(34.6±6.0)分均低于国内常模(t 值分别为- 34.686、22.060、- 30.430，P 均＜0.001)；症状困扰程度与生命质量呈负相关(r=-0.511，P＜0.001)；多元回归显示年龄、居住地、收入、患病数量是症状困扰的影响因素(β 值分别为1.819、-2.606、-2.128、2.055，P 值分别为0.009、0.021、0.003、0.006)。结论中老年维持性血液透析患者普遍经历多种不适症状，生命质量偏低，不同人口学特征及患病情况等差异，症状困扰程度不同，应根据患者具体情况制定个性化护理措施,减轻患者症状负担，提高生命质量。
【Abstract】Objective To explore the status and the correlation of symptom distress and quality of life in middle-aged and elderly maintenance hemodialysis (MHD) patients, and to analyze the influencing factors for symptom distress. Methods A total of 160 MHD patients were recruited by convenience sampling method. The investigation included general information questionnaire, dialysis symptom index and the 12-item short from health survey. Results The overall quality of life score was 37.4±6.8 points, among which physiological health score was 40.3±6.3 points and mental health score was 34.6±6.0 points, all lower than the domestic norm. (t=-34.686, 22.06 and -30.43 respectively, P＜0.001). Symptom distress was negatively correlated with quality of life (r=-0.511, P<0.001). Multiple regression showed that age, residence place, income and number of diseases were the influencing factors for symptom distress (β=1.819, -2.606, -2.128 and 2.055 respectively; P=0.009, 0.021, 0.003 and 0.006 respectively). Conclusion The middle-aged and elderly MHD patients generally experience a variety of uncomfortable symptoms, and their quality of life is relatively low. Different demographic characteristics and disease conditions lead to different levels of symptom distress. Medical staff should design individualized nursing measures according to the specific conditions of the patients to reduce the symptom burden and improve the quality of life of the patients.
[1]中关村肾病血液病净化创新联盟.中国血液净化耗材市场研究报告 2019-2025[R].北京: 中关村肾病血液病净化创新联盟, 2020.
[2]吴晓丹, 郑美春, 张美芬, 等.癌症患者症状困扰测评工具的研究进展[J].中华护理杂志, 2016, 51(2):200-205
[3]Maurizio B, Gilda P, Anna P, et al.Treating symptoms to improve the quality of life in patients on chronic hemodialysis.[J].International Urology & Nephrology, 2019, 21(5):885-887
[4]Weisbord S D, Fried L F, Arnold R M, et al.Development of a symptom assessment instru-ment for chronic hemodialysis patients: the dialysis symptom index[J].J Pain Symptom Mana-ge, 2004, 27(3):226-240
[5]何燕, 赵龙超, 刘丹萍, 李宁秀.和-在人群生命质量调查中的性能比较研究[J].现代预防医学, 2017, 44(5):852-862
[6]李宁秀, 刘丹萍, 刘朝杰, 等.成都市城市居民-评价研究[J].四川大学学报医学版, 2010, 41(6):1044-1046
[7]刘洋, 沙丽艳, 李慧, 等.血液透析病人症状群分类及与实验室指标的相关性研究[J].护理研究, 2020, 34(4):632-636
[8]Karasneh R, Al-Azzam S, Altawalbeh S M, et al.Predictors of symptom burden among hem-odialysis patients: a cross-sectional study at 13 hospitals[J].International Urology and Nephrology, 2020, 52(5):959-967
[9]邹宝林, 黄燕林, 覃廖缓.老年维持性血液透析病人症状困扰与焦虑、抑郁水平的相关性[J].护理研究, 2017, 31(13):1648-1650
[10]郝艳华, 姜亚芳.维持性血液透析患者症状经历的调查研究[J].中华护理杂志, 2016, 51(3):299-303
[11]刘正翠, 游励红, 肖红波, 等.维持性血液透析患者症状群的确立及其与生活质量的相关性研究[J].中国血液净化, 2018, 17(11):33-37
[12]张帆, 周文琴, 王蔚琼.维持性血液透析病人疲乏影响因素及非药物干预的研究进展[J].护理研究, 2019, 33(17):2997-3000
[13]王颖, 毕慧欣.维持性血液透析患者皮肤瘙痒相关机制的研究进展[J].中国血液净化, 2021, 20(1):43-46
[14]何玉婷, 门春翠, 牛庆雨, 等.维持性腹膜透析患者皮肤瘙痒的发生情况和影响因素分析[J].中国血液净化, 2019, 18(9):653-657
[15]王宏伟, 张洁尘.老年皮肤瘙痒症诊断与治疗专家共识[J].中国皮肤性病学杂志, 2018, 32(11):1233-1237
[16]Fleishman T T, Dreiher J, Shvartzman P.Patient-reported outcomes in mainte-nance hemodi-alysis: a cross-sectional, multicenter study[J].Quality of Life Research, 2020, 29(9):2345-2354
[17]陈作伟.维持性血液透析患者症状负担、自我管理行为与生存质量相关性研究[D].延吉:延边大学, 2018.
[18]李九红, 黄伶智, 任小红, 等.维持性血液透析患者症状困扰与睡眠质量和生活质量的相关性研究[J].中国护理管理, 2016, 16(1):25-29
[19]Antari G, Widyanthari D M.Symptom burden and health-related quality of life in hemodia-lysis patients[J]. Enfermería Clínica, 2020, 30:117-120.[J].Enfermería Clínica, 2020, 30:117-120
[20]牛洪艳, 刘金凤, 祝喜鹰, 等.以奥马哈系统为框架的个案管理模式在血液透析患者中的应用[J].当代护士中旬刊, 2021, 28(7):12-15
[21]贺千芸, 祝坤.对老年焦虑患者临床症状及生活质量的影响[J].心理月刊, 2021, 16(19):1-3
[22]曹晓翼, 张颖君, 石梅, 等.血液透析患者症状负担的影响因素研究[J].护理学杂志, 2017, 32(5):17-20
[23]陈灿灿.维持性血液透析患者希望、家庭功能、心理控制源与自我管理行为的关系研究[D].合肥: 安徽医科大学, 2020.
[24]易子涵, 侯梦佳, 李茜, 等.农村慢性病老年人自我忽视与健康促进生活方式的相关性研究[J].现代预防医学, 2020, 47(23):4299-4302
[25]吴艳梅, 南海涛, 铁云丽, 等.陕西省居民健康素养水平及影响因素分析[J].预防医学, 2019, 31(12):1210-1214
