老年维持性血液透析患者生存质量现状及其影响因素

Quality of life in elderly patients with maintenance hemodialysis and its influencing factors

【摘要】目的 探讨老年维持性血液透析(MHD)患者生存质量现状,并分析其影响因素。方法 选取南京医科大学第一附属医院2021年3月至2023年6月收治的140例老年MHD患者为研究对象,采用简明健康调查表(SF-36)调查患者生存质量,采用匹兹堡睡眠质量指数量表(PSQI)评估患者睡眠情况,采用汉密尔顿抑郁量表(HAMD)与汉密尔顿焦虑量表(HAMA)评估患者抑郁和焦虑情况。应用SPSS 26.0统计软件进行数据分析,根据数据类型分别采用t检验或单因素方差分析进行组间比较。采用Spearman相关分析老年MHD患者生存质量的影响因素与生理健康、心理健康之间的相关性。采用多元线性回归分析老年MHD患者生存质量的影响因素。结果 140例老年MHD患者SF-36量表中生理健康、心理健康得分分别为(213.85±17.19)分、(156.24±11.73)分。单因素分析结果显示,不同年龄、学历、婚姻状态、工作状况、家庭人均月收入、血液透析频率、睡眠情况、焦虑情况的老年MHD患者生理健康得分相比有显著差异(P＜0.05)；不同家庭人均月收入、医疗费用支付方式、社会支持、焦虑、抑郁的老年MHD患者心理健康得分相比有显著差异(P＜0.05)。Spearman相关性分析显示,家庭人均月收入、睡眠情况与生理健康得分呈正相关(r=0.396,0.462；P＜0.001)；年龄与生理健康得分呈负相关(r=-0.371; P<0.001)。家庭人均月收入、社会支持与心理健康得分呈正相关(r=0.387,0.525; P<0.001)；焦虑、抑郁与心理健康得分呈负相关(r=-0.403,-0.369；P＜0.001)。多元线性回归分析显示,年龄、家庭人均月收入及睡眠情况为老年MHD患者生理健康的影响因素(P＜0.05)；家庭人均月收入、社会支持、焦虑及抑郁为老年MHD患者心理健康的影响因素(P＜0.05)。结论 老年MHD患者生存质量偏低,年龄、家庭人均月收入、睡眠情况、社会支持、焦虑、抑郁均为其影响因素。

基金项目:江苏省自然科学基金(BK20191075)；江苏省卫生健康委员会医学科研立项项目(Z2020220)

【Abstract】Objective To explore the quality of life (QoL) in elderly patients with maintenance hemodialysis (MHD) and analyze its influencing factors. Methods A total of 140 elderly MHD patients admitted to the First Hospital Affiliated to Nanjing Medical University from March 2021 to June 2023 were selected as the study subjects. The 36-item short form health survey (SF-36) was used to assess QoL, the Pittsburgh sleep quality index (PSQI) was used to assess sleep status, and Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA) were used to assess depression and anxiety. SPSS 26.0 was used for data analysis. According to the data type, t test or one-way analysis of variance (ANOVA) was used for inter-group comparison. Spearman correlation analysis was used to analyze the relationships between the influencing factors of QoL and physical health and mental health. Multiple linear regression was used to analyze the influencing factors of QoL. Results The SF-36 score was (213.85±17.19) points for physical health and (156.24±11.73) points for mental health in the 140 elderly MHD patients. Univariate analysis showed that the physiological health scores were significantly different in age, education, marital status, working status, family per capita monthly income, hemodialysis frequency, sleep quality and anxiety (P<0.05), and that mental health scores differ significantly in family per capita monthly income, payment method of medical expenses, social support, anxiety and depression (P<0.05). Spearman correlation analysis showed that family per capita monthly income and sleep quality were positively correlated with physical health score (r=0.396,0.462; P<0.001), and age was negatively correlated with physical health (r=-0.371; P<0.001). Family per capita monthly income and social support were positively correlated with mental health (r=0.387,0.525; P<0.001), and anxiety and depression were negatively correlated with mental health (r=-0.403, -0.369; P<0.001). Multiple linear regression analysis showed that age, family per capita monthly income and sleep quality were the influencing factors of the physiological health (P<0.05), and that family per capita monthly income, social support, anxiety and depression were the influencing factors of mental health in elderly MHD patients (P<0.05). Conclusion QoL of elderly MHD patients is suboptimal age; family per capita monthly income, sleep quality, social support, and anxiety and depression are the influencing factors.

This work was supported by the Natural Science Foundation of Jiangsu Province (BK20191075) and the Medical Research Project ofHealth Commission of Jiangsu Province (Z2020220).