目的 基于维持性血液透析患者的容量管理能力特征进行亚群分类，分析其影响因素。 方法 2023年9月—11月采用便利抽样法选取江苏大学附属医院、镇江市第二人民医院及杏康连锁透析中心镇江分中心血液净化中心的维持性血液透析患者作为研究对象，采用一般资料调查表、容量管理行为量表、透析口渴评分量表、领悟社会支持量表、液体摄入依从障碍量表和液体摄入自我效能量表、血液透析知识水平问卷对其进行调查，使用潜在剖面分析探索血液透析患者容量管理特征的潜在分型，利用单因素分析、无序多分类Logistic回归分析探讨维持性血液透析患者容量管理特征的影响因素。 结果 共纳入322例患者，其中高能力低障碍型76例(23.6%)、管理能力中等型143例(44.4%)、低能力高障碍型103例(32.0%)。回归分析结果显示：以高能力低障碍型为参照组，受教育程度为初中(OR=6.576,95% CI:1.132～38.187，P=0.036；OR=10.671,95% CI:2.238～50.882，P=0.003)、透析龄在1～5年(OR=10.777,95% CI:2.422～47.966，P=0.002；OR=4.922,95% CI:1.457～16.628，P=0.010)、糖尿病(OR=16.729,95% CI:3.312～84.498，P=0.001；OR=5.034,95% CI:1.067～23.744，P=0.041)、知识水平(OR=0.405,95% CI:0.297～0.551，P＜0.001；OR=0.445,95% CI:0.331～0.598，P＜0.001)和社会支持(OR=0.884,95% CI:0.830～0.942，P＜0.001；OR=0.883,95% CI:0.832～0.937，P＜0.001)是血液透析患者容量管理特征潜在类别的影响因素。 结论 维持性血液透析患者的容量管理特征存在异质性，医护人员应甄别不同类型患者的管理问题，采取针对性的干预措施，以最大程度地提升患者的容量管理能力。
Objective To classify the subgroups of maintenance hemodialysis (MHD) patients based on their volume management capacity characteristics and to analyze the influencing factors. Methods The MHD patients treated in the Affiliated Hospital of Jiangsu University Hospital, Zhenjiang Second People's Hospital, and Xingkang Chain Dialysis Center of Zhenjiang Hemodialysis Branch Center from September to November 2023 were recruited by convenience sampling method. General information questionnaire, Volume Management Behavior Scale, Dialysis Thirst Rating Scale, Perceived Social Support Scale, Fluid Intake Compliance Barrier Scale, Fluid Intake Self-Efficacy Scale, and Hemodialysis Knowledge Level Questionnaire were used for the investigation. Latent profile analysis (LPA) was employed to explore the potential typologies of volume management characteristics in MHD patients. Univariate and multinomial logistic regression were used to evaluate the influencing factors. Result We recruited 322 MHD patients for this study, of whom 76 (23.6%) were classified as high ability-low barrier, 143 (44.4%) as moderate management ability, and 103 (32.0%) as low ability-high barrier. Logistic regression showed that when the high ability-low barrier patients were used as the reference group, education level of junior high school (OR=6.576, 95% CI: 1.132～38.187, P=0.036; OR=10.671, 95% CI: 2.238～50.882, P=0.003), dialysis duration of 1-5 years (OR=10.777, 95% CI: 2.422～47.966, P=0.002; OR=4.922, 95% CI: 1.457～16.628, P=0.010), diabetes (OR=16.729, 95% CI: 3.312～84.498, P=0.001; OR=5.034, 95% CI: 1.067～23.744, P=0.041), knowledge level (OR=0.405, 95% CI: 0.297～0.551, P＜0.001; OR=0.445, 95% CI: 0.331～0.598, P＜0.001), and social support (OR=0.884, 95% CI: 0.830～0.942, P＜0.001; OR=0.883, 95% CI: 0.832～0.937, P＜0.001) were the influencing factors for latent classes of volume management characteristics in MHD patients. Conclusion The volume management characteristics is heterogeneous in MHD patients. Healthcare professionals should identify management issues in different types of patients and implement targeted interventions to increase the patients' volume management capabilities.
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