血液透析患者的心理状态及其相关因素分析

发布时间：2018-01-21 22:25

本文关键词： 维持性血液透析心理状态生活质量　出处：《新乡医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的评估维持性血液透析(Maintenance hemodialysis,MHD)患者的心理健康状况以及可能相关的影响因素,为提高MHD患者的心理健康水平提供科学依据。方法选取于2014年3月～2015年3月在我院肾病科血透中心接受规律血液透析治疗3个月以上的终末期肾病患者68例,具备一定交流能力、意识清晰且能接受并配合相关调查者,排除脑外伤、脑肿瘤、神志不清或有人格障碍者,本研究经受试者及其家属同意,将该组患者设为MHD组。选取同期在我院接受体检的健康志愿者68例作为对照组,均无精神病史或类似家族史。采用我院自制的调查问卷调查两组人员的一般情况,并应用自评抑郁量表(Self-rating depression scale,SDS)、自评焦虑量表(Self-rating anxiety scale,SAS)和36题健康状况调查问卷(The Short Form-36 Health Survey,SF-36)对其进行评定,采用症状自评量表测量两组患者的轻性心理障碍,并以该量表总均分为因变量分析可能影响MHD组患者心理健康状况的因素,同时行血常规、生化常规与甲状旁腺激素等检查。结果两组年龄、性别、文化程度、职业及经济状况等一般资料无统计学差异(P0.05)。MHD组患者的SDS总分为(54.6±11.77)分,抑郁发生率为60.29%(41/68),其中轻度抑郁19例,占27.94%,中度抑郁16例,占23.53%,重度抑郁6例,占8.82%。对照组SDS总分为(40.94±9.19)分,抑郁发生率为8.82%(6/68),其中轻度抑郁5例,占7.35%,中度抑郁1例,占1.47%,无重度抑郁者。MHD组SDS总分和抑郁发生率均明显高于对照组,比较差异均有统计学意义(P0.05)。MHD组患者的SAS总分为(44.999.55)分,焦虑发生率为33.82%(23/68),其中轻度焦虑18例,占26.47%,中度焦虑4例,占5.88%,重度焦虑1例,占1.47%。对照组SAS总分为(38.04±8.10)分,焦虑发生率为8.82%(6/68),其中轻度焦虑4例,占5.88%,中度焦虑2例,占2.94%,无重度焦虑。MHD组SAS总分和焦虑发生率均明显高于对照组,比较差异均有统计学意义(P0.05)。MHD组SF-36调查结果显示该组患者的生理机能、躯体疼痛、总体健康、精力、社会职能和精神健康等各维度得分均明显低于对照组,比较差异均有统计学意义(P0.05)。MHD组患者生理职能得分低于对照组,但比较差异无统计学意义(P0.05)。MHD组患者症状自评量表总均分为(2.13±0.27)分,对照组为(1.48±0.19)分,比较差异有统计学意义(P0.05)。MHD组患者症状自评量表评测结果显示,该组患者在躯体化、强迫、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执和精神病性各因子得分均明显高于对照组,比较差异均有统计学意义(P0.05)。以症状自评量表总均分为因变量,对可能影响MHD组患者心理健康状况的19项因素为自变量分别行单因素线性回归分析,结果显示患者的年龄、文化程度、经济状况、血清肌酐水平、血红蛋白含量、尿素清除指数和透析期间体重的增加量与症状自评量表总均分显著相关,经多元逐步回归分析年龄、家庭经济状况、家庭支持和并发症是影响患者心理健康状况的主要因素。结论血液透析患者普遍存在抑郁、焦虑等心理障碍；透析治疗和心理因素会影响血液透析患者的生活质量；年龄、并发症、家庭经济状况和家庭支持与血液透析患者的心理状况显著相关。
[Abstract]:Objective to evaluate the maintenance hemodialysis (Maintenance hemodialysis, MHD) factors of mental health status of patients and the effects may be related, provide scientific basis for improving the mental health level of patients with MHD. Methods from March 2014 to March 2015 in the Department of nephropathy of our hospital hemodialysis center received hemodialysis treatment for more than 3 months of the 68 patients with end-stage renal disease. An example, have certain communication skills, clear consciousness and can accept and cooperate with relevant investigators, excluding brain trauma, brain tumor, unconsciousness or personality disorders, this study through the subjects and their families to the group of patients as MHD group. Selected to undergo a medical examination in our hospital 68 cases of healthy volunteers as the control group had no history of mental illness or similar family history. The general situation questionnaire survey made in our hospital of the two groups, and the application of the self rating Depression Scale (Self-rating depres Sion scale, SDS), self rating Anxiety Scale (Self-rating anxiety scale, SAS) and 36 health survey questionnaire (The Short Form-36 Health Survey, SF-36) evaluated, using the symptom checklist of light psychological barriers of the two groups were measured, and the scale total score for the factor analysis of MHD patients mental health status may affect, and blood routine, biochemical routine and parathyroid hormone examination. The results of two groups of age, gender, educational level, there was no significant difference in general information occupation and economic situation (P0.05) in.MHD group were SDS score (54.6 + 11.77), depression the rate was 60.29% (41/68), including 19 cases of mild depression, moderate depression accounted for 27.94%, 16 cases, accounting for 23.53%, 6 cases of severe depression, accounting for 8.82%. control group SDS score was (40.94 + 9.19), the incidence of depression was 8.82% (6/68), including 5 cases of mild depression, moderate depression accounted for 7.35%. Depression in 1 cases, accounting for 1.47%, without severe depression in.MHD group SDS total score and the incidence of depression was significantly higher than the control group, there were statistically significant differences (P0.05) in.MHD group were SAS score (44.999.55), the incidence of anxiety was 33.82% (23/68), including 18 cases of mild anxiety accounted for 26.47%, moderate. Anxiety in 4 cases, accounted for 5.88%, severe anxiety accounted for 1 cases, 1.47%. control group SAS score was (38.04 + 8.10), the incidence of anxiety was 8.82% (6/68), of which 4 cases had mild anxiety, moderate anxiety accounted for 5.88%, 2 cases, accounting for 2.94%, without severe anxiety group.MHD total score and incidence of anxiety was SAS significantly higher than the control group, the differences were statistically significant (P0.05) the results of SF-36 survey group.MHD showed the physiological function of this group of patients, body pain, general health, energy, social function and mental health scores were significantly lower than the control group, there were statistically significant differences (P0.05) in.MHD group The physical function scores than the control group, but no significant difference (P0.05) of.MHD group patients SCL-90 total score was (2.13 + 0.27), control group (1.48 + 0.19), the difference was statistically significant (P0.05).MHD patients SCL-90 evaluation results show this group of patients, and forced on the body, interpersonal sensitivity, depression, anxiety, hostile, terror, paranoid and psychotic factors scores were significantly higher than the control group, the differences were statistically significant (P0.05). The SCL-90 total score as the dependent variable, the 19 factors of MHD patients mental health status may affect as independent variables respectively for single factor linear regression analysis, the results showed that the patients' age, education level, economic status, serum creatinine, hemoglobin, urea clearance index and weight gain during dialysis and SCL-90 total Equally significant correlation, stepwise multiple regression analysis age, family economic status, family support and complications are the main factors influencing the mental health status of the patients. Conclusion hemodialysis is prevalent in patients with depression, anxiety and other mental disorders; dialysis treatment and psychological factors affect the quality of life among hemodialysis patients; age, complications were significantly related to psychological the status of family economic status and family support and hemodialysis patients.

【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R459.5

【相似文献】