血液透析患者症状的相关研究

发布时间：2019-04-19 06:27

【摘要】：研究背景：目前,血液透析是终末期肾脏病患者的主要替代治疗手段,然而,长期血液透析的患者生活质量依然低下,症状是其最主要的影响因素。因此,为了改善血液透析患者的生活质量,我们有必要在该人群中开展症状管理,而全面的症状评估则是开展症状管理的基础。研究目的：(1)基于不适症状理论,从症状的发生率、发生频率、严重程度、困扰程度4个方面全面描述我国血液透析患者的症状特点；(2)基于透析症状指数(DSI)的得分(困扰程度得分),探讨不同症状间的相关性,并在此基础上进行集群分析；(3)初步探讨不同人口学资料和疾病特征对血液透析患者经历症状的影响。研究方法：本研究为描述性研究,便利抽取2015年3月～10月在北京市某3家三级综合医院的血液净化中心进行血液透析的186例患者,采用自行设计的一般资料调查表和改编的透析症状量表分别调查血液透析患者的一般资料和经历的症状情况。研究结果：(1)本研究中,血液透析患者经历症状的中位数为10种,其中发生率最高的症状依次为疲乏(68.8%)、瘙痒(66.1%)、皮肤干燥(64.5%)、易醒(60.8%)、口干(59.7%)和入睡困难(54.3%)。从发生频率来看,有38.2%的患者表示过去一周内皮肤干燥的问题频繁出现,居于所有症状的首位。严重程度和困扰程度最高的症状均为疲乏,在过去一周内,有46.2%的患者认为其经历了较为严重的疲乏,20.4%的患者认为疲乏对他们的困扰较多。(2)Spearman相关分析的结果显示,不同症状之间具有显著相关性。探索性因子分析(主成分分析法)确立了5种症状群,分别为心理症状群、水电解质症状群、尿毒症毒素一般症状群、胃肠道症状群、性功能障碍症状群,总的方差贡献率为60.063%。(3)分别以症状发生频率、严重程度、困扰程度总分的平方根为因变量,在此基础上进行多元线性回归分析,结果显示,对发生频率和严重程度总分的平方根有影响的变量均为冠心病、血清钾、高血压、糖尿病,4个因素可解释前者总变异的13.1%,后者总变异的15.8%：对困扰程度总分的平方根有影响的是冠心病、血清钾、高血压,3个因素可解释总变异的12.2%。结论：血液透析患者普遍经历多种不适症状,这些症状之间存在着或强或弱的相关性,是研究者和临床医务人员正确认识该人群症状经历的关键。由于人口学资料和疾病特征的差异,不同血液透析患者症状的发生频率、严重程度和困扰程度亦不尽相同。因此,为了开展有效的症状管理,全面而准确的症状评估对于血液透析患者至关重要。
[Abstract]:Background: at present, hemodialysis is the main alternative therapy for patients with end-stage renal disease. However, the quality of life of patients with long-term hemodialysis is still low, and symptoms are the main influencing factors. Therefore, in order to improve the quality of life of hemodialysis patients, we need to carry out symptom management in this group, and comprehensive symptom assessment is the basis of symptom management. Objective: (1) based on the theory of discomfort symptoms, the symptom characteristics of hemodialysis patients in China were comprehensively described from the aspects of incidence, frequency, severity, and degree of distress in terms of the incidence of symptoms, the frequency of occurrence, the severity of symptoms and the degree of distress. (2) based on the score of dialytic symptom index (DSI), the correlation between different symptoms was discussed, and the cluster analysis was carried out on this basis. (3) to investigate the effects of different demographic data and disease characteristics on the symptoms of hemodialysis patients. Methods: this study was a descriptive study to facilitate the selection of 186 patients who underwent hemodialysis in the blood purification centers of three third-level general hospitals in Beijing from March to October 2015. A self-designed general data questionnaire and a modified dialysis symptom scale were used to investigate the general data and symptoms of hemodialysis patients. Results: (1) in this study, the median number of symptoms experienced by hemodialysis patients was 10, and the highest incidence of symptoms was fatigue (68.8%), pruritus (66.1%), dry skin (64.5%), and the highest incidence of symptoms was fatigue (68.8%), pruritus (66.1%), dry skin (64.5%). It was easy to wake up (60.8%), dry mouth (59.7%) and difficulty falling asleep (54.3%). In terms of frequency, 38.2% of patients reported frequent dry skin problems in the past week, ranking first among all symptoms. The symptoms with the highest severity and distress were fatigue, and 46.2% of patients in the past week thought they had experienced more severe fatigue. 20.4% of the patients thought fatigue was more troubling to them. (2) the results of Spearman correlation analysis showed that there was a significant correlation between different symptoms. Exploratory factor analysis (principal component analysis) established five symptom groups, namely psychological symptom group, water electrolyte symptom group, uremic toxin general symptom group, gastrointestinal symptom group, sexual dysfunction symptom group, and the other five symptom groups: psychological symptom group, water electrolyte symptom group, uremic toxin general symptom group, gastrointestinal symptom group, sexual dysfunction symptom group. The total variance contribution rate was 60.063%. (3) the square root of symptom occurrence frequency, severity and total disturbance degree were regarded as dependent variables respectively, and on this basis, multivariate linear regression analysis was carried out, the results showed that the frequency of symptoms, the degree of severity and the square root of total distress degree were the dependent variables. Coronary heart disease (CHD), serum potassium, hypertension and diabetes were the four factors that affected the square root of the total frequency and severity of the disease. Four factors could explain 13.1% of the total variation in the former. 15.8% of the total variation in the latter: coronary heart disease, serum potassium and hypertension were the factors that affected the square root of the total score of distress. The three factors could explain 12.2% of the total variation. Conclusion: hemodialysis patients generally experience a variety of discomfort symptoms, and there is a strong or weak correlation between these symptoms, which is the key for researchers and clinical medical staff to correctly understand the symptom experience of this group. Because of the difference of demographic data and disease characteristics, the frequency, severity and distress degree of symptoms in different hemodialysis patients are also different. Therefore, in order to carry out effective symptom management, comprehensive and accurate symptom assessment is essential for hemodialysis patients.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R473.5

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