维持性血液透析患者的疲乏现状及影响因素
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摘要
目的了解维持性血液透析患者的疲乏现况,分析其影响因素。方法采用一般情况调查表采集患者的性别、年龄、婚姻状况、子女个数、家庭住址、经济状况、医保、文化水平、工作性质、睡眠、饮食、心情等一般情况;采用疲劳量表FS-14作为调查问卷对研究对象进行疲乏程度评估。同期采集研究对象的实验室检查资料,包括血常规、肝功能、肾功能、电解质、贫血相关检测、骨代谢相关检测等。结果 121例透析患者,疲劳量表FS-14得分为(7.73±2.36)分,患者的疲乏发生率为79.33%,以躯体性疲乏为主;经多因素线性逐步回归分析发现:夜晚入睡时间(B=-0.307,t=-5.172,P=0.000)与维持性血液透析患者的疲乏程度呈负相关,而子女个数(B=0.324,t=2.641,P=0.011)、血清碱性磷酸酶(B=0.009,t=2.066,P=0.040)、血尿素氮(B=0.070,t=3.241,P=0.001)与维持性血液透析患者的疲乏程度呈正相关。结论疲乏在维持性血液透析患者中发生率高,应当在临床工作中引起重视,针对影响因素采取积极的预防和干预措施,对于改善血液透析患者的生活质量具有重要意义。
Objective To investigate the fatigue status in patients with maintenance hemodialysis(MH and analyze the relevant factors affecting it. Me thods A general conditions questionnaire was used to collect general conditions including patient's gender,age,marital status,number of children, home address, economic status,medical insurance,education level,job,sleep,diet,and mood,et al; Fatigue Scale FS-14 was used to assess the degree of fatigue. The clinical data of patients were collected at the same time, including blood routine, liver function,renal function,electrolytes,anemia-related examinations,and bone metabolism-related examinations,et al. Re s ults Among 121 investigated hemodialysis patients, the fatigue score of FS-14 was(7.73 ±2.36);79.33 percent of patients were troubled with fatigue, mainly involved in physical fatigue. When FS-14 score was used as a dependent variable, it was negatively correlated with the time of falling asleep at night(B=-0.307, t=-5.172,P = 0.000), and positively correlated with number of children(B = 0.324, t = 2.641, P = 0.011),alkaline phosphatase(B =0.009, t = 2.066, P = 0.040), and urea nitrogen(B = 0.070, t = 3.241, P =0.001); The data were analyzed by multivariate linear stepwise regression analysis. Conclus ions Fatigue is a high-frequency event in the patients with MH and should be taken into account in clinical work. It is of great value to improve life quality of hemodialysis patients by taking active measures against these factors.
Objective To investigate the fatigue status in patients with maintenance hemodialysis(MH and analyze the relevant factors affecting it. Me thods A general conditions questionnaire was used to collect general conditions including patient's gender,age,marital status,number of children, home address, economic status,medical insurance,education level,job,sleep,diet,and mood,et al; Fatigue Scale FS-14 was used to assess the degree of fatigue. The clinical data of patients were collected at the same time, including blood routine, liver function,renal function,electrolytes,anemia-related examinations,and bone metabolism-related examinations,et al. Re s ults Among 121 investigated hemodialysis patients, the fatigue score of FS-14 was(7.73 ±2.36);79.33 percent of patients were troubled with fatigue, mainly involved in physical fatigue. When FS-14 score was used as a dependent variable, it was negatively correlated with the time of falling asleep at night(B=-0.307, t=-5.172,P = 0.000), and positively correlated with number of children(B = 0.324, t = 2.641, P = 0.011),alkaline phosphatase(B =0.009, t = 2.066, P = 0.040), and urea nitrogen(B = 0.070, t = 3.241, P =0.001); The data were analyzed by multivariate linear stepwise regression analysis. Conclus ions Fatigue is a high-frequency event in the patients with MH and should be taken into account in clinical work. It is of great value to improve life quality of hemodialysis patients by taking active measures against these factors.
引文
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[5] CHALDER T,BERELOWITZ G,PAWLIKOWSKA T,et al. Development of a Fatigue Scale[J]. Journal of Psychosomatic Research,1993,37(2):147-153.
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[7]陈建强,吕志增,吴唐英,等.维持性血液透析患者疲劳状况与生存质量相关性分析[J].广东医学院学报,2016,34(3):329-331.
[8]王宗谦,卢新星.终末期肾病患者抑郁程度与生存质量各个维度之间的关系[J].吉林大学学报(医学版),2013,39(3):615-619.
[9]陆红珍.维持性血液透析患者生存质量影响因素分析与护理干预[J].黑龙江医学,2015,39(6):707-708.
[10]黄小波,李宗信,陈文强,等.慢性疲劳综合征患者疲劳程度与生活质量的相关性研究[J].中国行为医学科学,2006,15(8):687-688.
[11]STEPANSKI E J,WALKER MS,SCHWARTZBERG L S,et al. The relation of trouble sleeping,depressed mood,pain,and fatigue in patients with cancer[J]. Journal of Clinical Sleep Medicine Jcsm Official Publication of the American Academy of Sleep Medicine,2009,5(2):132.
[12]鲍蕾蕾,陈海飞,卞俊.复方灵芝孢子精油软胶囊抗疲劳耐缺氧能力研究[J].中国实验方剂学杂志,2014,20(14):130-133.
[13]张颖捷,杜万红.国内外抗疲劳研究进展[J].实用预防医学,2012,19(7):1112-1116.
[14]黄宝亮,丁传波,王佳奇,等.红参中精氨酸双糖苷对小鼠的抗疲劳作用[J].吉林大学学报(医学版),2017,43(5):897-902.
[15] KIDNEY DISEASE.Improving Global Outcomes(KDIGO)CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis,evaluation,prevention,and treatment of Chronic Kidney Disease-Mineral and Bone Disorder(CKD-MBD)[J]. Kidney International Supplement,2009,Suppl 113(113):S1-S130.
[16] REGIDOR D L,KOVESDY C P,MEHROTRA R,et al.Serum alkaline phosphatase predicts mortality among maintenance hemodialysis pPatients[J]. Journal of the American Society of Nephrology Jasn,2008,19(11):2193.
[17]MARUYAMA Y,TANIGUCHI M,KAZAMA J J,et al. A higher serum alkaline phosphatase is associated with the incidence of hip fracture and mortality among patients receiving hemodialysis in Japan[J]. NephrologyDialysis Transplant,2014,29(8):1532-1538.
[2] LENAERT B,BODDEZ Y,VLAEYEN J W S,et al.Learning to feel tired:A learning trajectory towards chronic fatigue[J]. Behav Res Ther,2018,100(1):54-66.
[3] BOSSOLA M,VULPIO C,TAZZA L. Fatigue in chronic dialysis patients[J]. Seminars in Dialysis,2011,24(5):550-555.
[4]庄冰,宋宗纬,骆静,等.维持性血液透析患者的透后疲乏及相关因素分析[J].中华肾脏病杂志,2018,34(4):249-254.
[5] CHALDER T,BERELOWITZ G,PAWLIKOWSKA T,et al. Development of a Fatigue Scale[J]. Journal of Psychosomatic Research,1993,37(2):147-153.
[6] LETCHMI S,DAS S,HALIM H,et al. Fatigue experienced by patients receiving maintenance dialysis in hemodialysis units[J]. Nursing&Health Sciences,2011,13(1):60.
[7]陈建强,吕志增,吴唐英,等.维持性血液透析患者疲劳状况与生存质量相关性分析[J].广东医学院学报,2016,34(3):329-331.
[8]王宗谦,卢新星.终末期肾病患者抑郁程度与生存质量各个维度之间的关系[J].吉林大学学报(医学版),2013,39(3):615-619.
[9]陆红珍.维持性血液透析患者生存质量影响因素分析与护理干预[J].黑龙江医学,2015,39(6):707-708.
[10]黄小波,李宗信,陈文强,等.慢性疲劳综合征患者疲劳程度与生活质量的相关性研究[J].中国行为医学科学,2006,15(8):687-688.
[11]STEPANSKI E J,WALKER MS,SCHWARTZBERG L S,et al. The relation of trouble sleeping,depressed mood,pain,and fatigue in patients with cancer[J]. Journal of Clinical Sleep Medicine Jcsm Official Publication of the American Academy of Sleep Medicine,2009,5(2):132.
[12]鲍蕾蕾,陈海飞,卞俊.复方灵芝孢子精油软胶囊抗疲劳耐缺氧能力研究[J].中国实验方剂学杂志,2014,20(14):130-133.
[13]张颖捷,杜万红.国内外抗疲劳研究进展[J].实用预防医学,2012,19(7):1112-1116.
[14]黄宝亮,丁传波,王佳奇,等.红参中精氨酸双糖苷对小鼠的抗疲劳作用[J].吉林大学学报(医学版),2017,43(5):897-902.
[15] KIDNEY DISEASE.Improving Global Outcomes(KDIGO)CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis,evaluation,prevention,and treatment of Chronic Kidney Disease-Mineral and Bone Disorder(CKD-MBD)[J]. Kidney International Supplement,2009,Suppl 113(113):S1-S130.
[16] REGIDOR D L,KOVESDY C P,MEHROTRA R,et al.Serum alkaline phosphatase predicts mortality among maintenance hemodialysis pPatients[J]. Journal of the American Society of Nephrology Jasn,2008,19(11):2193.
[17]MARUYAMA Y,TANIGUCHI M,KAZAMA J J,et al. A higher serum alkaline phosphatase is associated with the incidence of hip fracture and mortality among patients receiving hemodialysis in Japan[J]. NephrologyDialysis Transplant,2014,29(8):1532-1538.