不同肾替代治疗对终末期肾病患者生存质量的影响及相关因素的研究

发布时间：2018-05-26 21:03

本文选题：终末期肾病 + 生存质量　；参考：《昆明医科大学》2014年硕士论文

【摘要】：目的：比较血液透析、腹膜透析及肾移植对终末期肾病患者生存质量的影响,并探讨其相关影响因素。方法：选择2.011年3月-2013年7月在昆明医科大学第一附属医院、昆明医科大学第二附属医院及云南省肾脏病医院行维持性血液透析、持续不卧床腹膜透析或肾移植3个月以上、年满18岁的终末期肾病患者354例为研究对象,其中血液透析组患者160例,腹膜透析组患者52例,肾移植组患者142例,采用肾病生存质量评估简表(KDQ0L—SFTM1.2量表)进行问卷调查,评估其生存质量,同时收集每个患者的临床及实验室资料。结果：1.三组患者生存质量的比较 ①肾移植组在SF-36总评分及其8个分支领域评分、KDTA总评分及其分支领域症状(SPL)、肾病的影响(EKD)、肾病带来的负担(BKD)、性功能(SexF)的评分均高于血液透析组和腹膜透析组,差异有统计学意义(p0.05)；此外,肾移植组尚在工作状况(WS)领域得分高于血液透析组,在睡眠(Sleep)、社会支持(Sos)领域得分高于腹膜透析组,差异有统计学意义(p0.05)； ②血液透析组在睡眠(Sleep)、社会支持(Sos)领域评分高于腹膜透析组,而在精力状况(Energ)、肾病的影响(EKD)、工作状况(WS)领域评分低于腹膜透析组,差异有统计学意义(p0.05)； ③肾移植组在SF-36的生理健康及心理健康总评分均高于血液透析组和腹膜透析组,差异有统计学意义(p0.05),而血液透析组和腹膜透析组在上述两个领域的评分差异无统计学意义。2.社会人口学指标与生存质量 ①一般资料比较：三组患者的性别、年龄段、民族、婚姻状况、文化程度的构成差异无统计学意义(p0.05); ②社会人口学资料与SF-36总评分：血液透析组：SF-36总评分在不同年龄段内差异有统计学意义(p0.05)；腹膜透析组：SF-36总评分在不同性别、年龄段、民族、婚姻状况、文化程度间差异均无统计学意义(p0.05)；肾移植组：SF-36总评分在不同的年龄段、婚姻状况间差异有统计学意义(p0.05)； ③社会人口学资料与KDTA总评分：血液透析组和腹膜透析组的KDTA总评分在不同性别、年龄段、民族、婚姻状况、文化程度间差异均无统计学意义(p0.05)；肾移植组的KDTA总评分在不同婚姻状况、文化程度间差异有统计学意义(p0.05)。 3.相关性分析 ①血液透析组的SF-36总评分及KDTA总评分、腹膜透析组的SF-36总评分均与年龄呈负相关,而肾移植组的SF-36总评分与年龄呈正相关； ②三组患者的SF-36总评分均与血红蛋白呈正相关； ③血液透析组和肾移植组的SF-36总评分及KDTA总评分、腹膜透析组的SF-36总评分均与血清白蛋白呈正相关; ④血透组的SF-36总评分、肾移植组的SF-36总评分及KDTA总评分均与文化程度呈正相关； ⑤肾移植组的SF-36总评分及KDTA总评分均与血肌酐呈负相关。结论：肾移植组在SF一36总评分及其各个分支领域评分、KDTA总评分及其多个分支领域评分均高于血液透析组及腹膜透析组,血液透析组在睡眠(Sleep)、社会支持(Sos)领域高于腹膜透析组,在精力状况(Energ)、肾病的影响(EKD)工作状况(WS)领域评分低于腹膜透析组,表明肾移植患者总体生存质量优于血液透析及腹膜透析患者。三组患者的生存质量与年龄、文化程度、血清白蛋白、血红蛋白、血肌酐等因素有关,临床中注意监测上述指标有助于提高患者的生存质量。
[Abstract]:Objective : To compare the effects of hemodialysis , peritoneal dialysis and renal transplantation on the quality of life of patients with end - stage renal disease .

Methods : From March to July 2013 , 354 patients with end - stage renal disease in Kunming Medical University , Second Affiliated Hospital of Kunming Medical University and kidney disease hospital in Yunnan Province were selected as the subjects .

Results : 1 . Comparison of the quality of life of three groups of patients

The total score of SF - 36 and the score of 8 branches , the total score of KDTA and the symptom ( SPL ) , the effect of renal disease ( EKD ) , the burden of nephropathy ( BKD ) and sex function were higher than those in hemodialysis and peritoneal dialysis group ( p < 0.05 ) .
In addition , the score of kidney transplantation group in the field of work ( WS ) was higher than that in hemodialysis group . In the sleep ( Sleep ) and social support ( Sos ) field , the score was higher than that in peritoneal dialysis group ( p . 05 ) .

( 2 ) In the hemodialysis group , the score of sleep and social support ( Sos ) was higher than that in peritoneal dialysis group , while in the energy condition ( Energ ) , the effect of kidney disease ( EKD ) , the score of working condition ( WS ) was lower than that in peritoneal dialysis group , the difference was statistically significant ( p . 05 ) ;

( 3 ) The total score of SF - 36 was higher than that in hemodialysis group and peritoneal dialysis group ( p < 0.05 ) , but there was no statistical significance in the score difference between hemodialysis group and peritoneal dialysis group .

( 1 ) General data comparison : There was no significant difference in the composition of sex , age , nationality , marital status and degree of culture among the three groups ( p . 05 ) ;

( 2 ) Social demology data and SF - 36 total score : the total score of SF - 36 in hemodialysis group was statistically significant ( p < 0.05 ) .
The total score of SF - 36 was no significant difference between different sex , age , nationality , marital status and cultural degree ( p . 05 ) .
The total score of SF - 36 was in different age groups , and the difference between marital status was significant ( p < 0.05 ) .

( 3 ) There was no significant difference between social demology data and KDTA total score : the total score of KDTA between hemodialysis group and peritoneal dialysis group in different sex , age group , nationality , marital status and culture degree ( p . 05 ) ;
The total score of KDTA in kidney transplantation group was statistically significant ( p . 05 ) .

3 . Correlation analysis

The total score of SF - 36 in hemodialysis group and total score of KDTA were negatively correlated with age , while SF - 36 in renal transplantation group was positively correlated with age .

The SF - 36 scores of three groups were positively correlated with hemoglobin ;

( 3 ) The total score of SF - 36 and total KDTA score of hemodialysis group and renal transplantation group were positively correlated with serum albumin .

( 4 ) The total score of SF - 36 and the total score of SF - 36 and total KDTA were positively correlated with the degree of culture .

The total score of SF - 36 and the total KDTA score of renal transplantation group were negatively correlated with serum creatinine .

Conclusion : The total score of SF - 36 and the scores of its branches , the total score of KDTA and the scores of its branches were higher than those in hemodialysis group and peritoneal dialysis group . In the field of sleep and social support ( Sos ) , the score of patients with renal transplantation was lower than that in peritoneal dialysis group . The quality of life of patients with renal transplantation was better than those in hemodialysis and peritoneal dialysis . The quality of life was related to age , degree of culture , serum albumin , hemoglobin , blood creatinine and other factors .
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5

【参考文献】