目的 调查腹膜透析患者症状负担现状，分析患者症状负担的影响因素。 方法 纳入2023年10月—2024年1月在上海交通大学医学院附属仁济医院接受腹膜透析治疗并随访的患者，收集患者的一般资料和疾病相关信息，发放透析患者症状负担调查表、社会支持评定量表、症状管理自我效能量表进行问卷调查，评估患者的症状负担总分情况、社会支持水平和症状管理自我效能总分情况，通过单因素和多元线性回归，分析影响腹膜透析患者症状负担的因素。 结果 共纳入151例腹膜透析患者。患者的症状发生频率、严重程度、困扰程度3个维度得分分别是(16.50±13.70)分、(13.78±11.65)分、(17.44±15.40)分，症状负担总分前5项分别为皮肤干燥4(0,7)分、瘙痒3(0,6)分、乏力3(0,5)分、口干3(0,5)分、易惊醒0(0,5)分。患者症状管理自我效能与症状负担总分(r=-0.320,P＜0.001) 呈负相关，与症状负担总分的各维度：发生频率(r=-0.315, P＜0.001)，严重程度(r=-0.320,P＜0.001)和症状困扰程度(r=-0.326,P＜0.001)呈负相关。多元线性回归分析结果显示透析龄(β=4.254，P=0.003)、并发症数量(β=4.406，P=0.006)和症状管理得分(β=-1.108，P＜0.001)是影响透析患者症状负担的独立危险因素。 结论 透析龄和并发症数量是腹膜透析患者症状负担的客观影响因素，症状自我管理可以降低腹膜透析患者症状负担，提示医护人员在日常护理中需注重培训患者症状管理自我知识和技能。
Objective This study investigated the current situation of symptom burden and analyzed the factors affecting symptom burden in peritoneal dialysis (PD) patients. Methods A total of 151 PD patients treated from October 2023 to January 2024 were enrolled in this study. Their general data and disease related information were collected. Symptom burden, level of social support and self-efficacy in symptom management were evaluated by the questionnaire surveys of the Chinese version of the dialysis patient symptom burden questionnaire (Dialysis Frequency, Severity, and Symptom Burden Index, DFSSBI), the Social Support Revalued Scale (SSRS), and the Patient-Reported Outcomes Measurement Information System-Self-Efficacy for Managing Symptoms (PROMIS-SEMSX). Results The scores of symptom frequency, severity and distress in PD patients were 16.50±13.70, 13.78±11.65 and 17.44±15.40 respectively. The top five items contributing to symptom burden were dry skin with 4(0,7) points, itching with 3(0,6) points, fatigue with 3(0,5) points, dry mouth with 3(0,5) points, and easily awakened with 0(0,5) points. Correlation analysis showed that patients’ self-efficacy in symptom management was negatively associated with total symptom burden score (r=-0.320, P＜0.001) and the dimensions including symptom frequency (r=-0.315, P＜0.001), symptom severity (r=-0.320, P＜0.001), and the extent of symptom distress (r=-0.326, P＜0.001). Multivariate linear regression analysis showed that dialysis duration (β=4.254, P=0.003), number of complications (β=4.406, P=0.006), and symptom management scores (β=-1.108, P＜0.001) were the independent risk factors for symptom burden in PD patients. Conclusions Dialysis duration and the number of complications are the objective factors affecting the symptom burden in PD patients. Self-efficacy in symptom management can reduce symptom burden. Therefore, healthcare professionals should focus on the education of self-management knowledge and skills in daily care of PD patients.
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