目的 通过调查单中心腹膜透析患者药物依从性的现状，分析影响PD患者药物依从性的危险因素。 方法 本研究利用中文版Morisky药物依从性8项量表评估新疆自治区人民医院肾病科腹膜透析中心155例腹膜透析患者药物依从性情况，并进一步分析相关影响因素，然后使用接收者操作特征(ROC)曲线评估逻辑回归模型的预测能力。 结果 腹膜透析患者用药依从性好112例(占72.258%)，依从性差43例(占27.742%)；单因素分析得出透析龄(χ2=9.121,P=0.010)、吸烟史(χ2=7.504,P=0.006)、是否南疆地区分布(χ2=5.195,P=0.023)和共同决策分数(t=2.594,P=0.010)等影响因素组间比较差异有统计学意义；Logistic回归多因素分析显示透析龄(OR=1.011,95% CI:1.000～1.022,P=0.047)、地区分布(OR=2.450,95% CI:1.020～5.886,P=0.045)和共同决策分数(OR=1.093,95% CI:1.001～1.192,P=0.047)可能是影响患者药物依从性的主要因素，利用ROC评估预测模型的区分度为良好(AUC=0.685)。 结论 应结合患者常居住地，共同决策参与情况对其获得信息的机会进行综合评估，改善患者对药物治疗的理性认知，从而提高药物治疗依从性，也为腹膜透析专科护士高质量目标导向护理管理PD患者提供佐证。
Objective To investigate the status quo of drug compliance and the risk factors affecting drug compliance in peritoneal dialysis (PD) patients in a single center. Methods The Chinese version of Morisky drug compliance eight-item scale was used to evaluate the drug compliance and its relevant factors in a total of 155 PD patients treated in the Peritoneal Dialysis Center, Department of Nephrology, People's Hospital of Xinjiang Autonomous Region. The receiver operating characteristics (ROC) curve was used to evaluate the predictive ability of logistic regression model. Results Good drug compliance was found in 112 PD patients (72.258%), and poor drug compliance was found in 43 PD patients (27.742%). Univariate analyses showed that dialysis age (χ2=9.121, P=0.010), smoking history (χ2=7.504, P=0.006), regional distribution (χ2=5.195, P=0.023) and joint-decision score (t=2.594, P=0.010) significantly affected the differences among groups. Multivariate logistic regression demonstrated that dialysis age (OR=1.011, 95% CI: 1.000~1.022, P=0.047), regional distribution (OR=2.450, 95% CI: 1.020~5.886, P=0.045) and joint-decision score (OR=1.093, 95% CI: 1.001~1.192, P=0.047) were the main factors affecting drug compliance in PD patients. ROC curve had a better ability to assess the differentiation performance of the prediction model (AUC=0.685). Conclusion The chance of the PD patients to access information based on their resident place and their participation in joint-decision making should be comprehensively evaluated, so as to promote their rational cognition and compliance of the drug therapy, and to provide evidences for professional PD nurses to carry out high-quality and goal-oriented nursing management of PD patients.
[1]Mehrotra R. Peritoneal dialysis education: challenges and innovation[J]. Semin Dial,2018,31(2):107-1l0.
[2]吴婧倩,刘砚墨,杨颖昕.腹膜透析患者用药依从性及相关影响因素分析[J].实用药物与临床,2018,21(5):530-532.
[3]Osterberg L., Blaschke T. Adherence to medication.?N. Engl. J. Med.?2005,353:487-497.
[4]李连珍,赵建荣.影响腹膜透析患者依从性因素的调查与分析[J].中国血液净化,2016,15(7):377-380.
[5]刘霞,蒲俐,周雪丽,李阔,何学勤,秦敏,马登艳.罗沙司他在腹膜透析患者中服药依从性及其影响因素的研究[J].华西医学,2021,36(9):1205-1209.
[6]汪海燕,曹艳佩,郭志勇,赖学莉,席惠君.国际腹膜透析协会腹膜透析相关指南对腹膜透析护理工作的启示[J].中国血液净化,2021,20(6):398-400,404.
[7]陈强,曲珊珊,黄欣.中文版MMAS-8评价心血管慢病患者用药依从性的信效度分析与实践[J].中国药房,2019,30(2):268-271.
[8]Levente Kriston, Isabelle Scholl, Lars Holzel, et al. The 9-item Shared Decision Making Questionnaire (SDM-Q-9). Development and psychometric properties in a primary care sample[J].Patient Education and Counseling,2010,80:94-99.
[9]赵慧萍,左力.医患共同决策在腹膜透析领域的应用及面临的挑战[J].中国血液净化,2021,20(8):505-508.
[10]赵慧萍,王梅.2020年国际腹膜透析学会《处方高质量、目标为导向的腹膜透析》指南推荐解读[J].中国血液净化,2020,19(12):793-797.
[11]Holley, JL，DeVore, CC.Why all prescribed medications are not taken: results from a survey of chronic dialysis patients[J].Adv Perit Dial.2006,22 :162-166.
[12]李奕华,龙杰,刘俊荣.医患共同决策实施现状及策略探析[J].医学与哲学,2022,43(20):21-25.
[13]刘慧,裴华莲,李莉,张菁菁,吴志英.新疆地区持续非卧床腹膜透析患者培训需求调查及预警模型的建立[J].护士进修杂志,2020,35(6):568-571.
[14]Neumann, D,Mau, W,Wienke, A,at al.Peritoneal dialysis is associated with better cognitive function than hemodialysis over a one-year course[J].KIDNEY INT. 2018,93(2):430-438.
[15]Viggiano D,Wagner CA,Martino C.el al. Mechanisma of cognitive dysfunction in CKD J'. Nat Rey Nephrol,2020,16(8):452-469.
[16]荣冬靖,张育安,张玉林,等.维持性血液透析患者认知状况与血管硬化的相关性.昆明医科大学学报,2020,41(4):121-126.
[17]汪玲珍,林静霞,彭鹿,袁凤玲,吴萌,邓丽丽.腹膜透析合并高磷血症患者服用降磷药物依从性的质性研究[J].中国中西医结合肾病杂志,2020,21(12):1098-1100.
[18]王晓燕, 袁勇贵. 慢性肾脏病患者认知障碍发生机制的研究进展[J].中华神经医学杂志, 2021,20(4):417-421.
[19]阮梦娜,陈旭娇,陈思秀,杨博,许晶,张彤,邢小红,毛志国.腹膜透析患者血清蛋白结合毒素水平及影响因素分析[J].第二军医大学学报,2017,38(10):1238-1243.
[20]杨明榴.不同血压控制水平对腹膜透析患者残余肾功能和心血管事件风险的影响[J].临床与病理杂志,2021,41(9):2018-2023.
[21]张志宏.建立高质量目标导向性腹膜透析[J].肾脏病与透析肾移植杂志,2021,30(2):180-184.
[22]Parfenov, VA,Zhivolupov, SA,?Poverennova, IE et al.Treatment of?Cognitive?Impairment and the Role of Demographic Factors in Disease Progression: The Final Results of the Russian Observational Program "DIAMANT"[J].EUR NEUROL,2020,83(6):591-601.
[23]国家卫生计生委脑卒中防治工程委员会,脑卒中防治系列指导规范编审委员会.2016中国血管性认知障碍诊疗指导规范[J].心脑血管病防治,2017,17(1):3-6.
[24]中华医学会老年医学分会老年神经病学组,脑小血管病认知功能障碍诊疗指南中国撰写专家组.脑小血管病相关认知功能障碍中国诊疗指南(2019)[J].中华老年医学杂志,2019,38(4):345-354.
[25]Meyer, AM,Podolski, N,Pickert, L et al.Strategies to prevent age-related?cognitive?decline[J].DEUT MED WOCHENSCHR. 2020-02-01;145(3):146-150.
