中青年维持性透析患者心理健康状况的纵向研究

doi:10.3761/j.issn.1672-9234.2023.11.014

摘要/Abstract

摘要：

目的纵向探索中青年维持性透析患者在不同时间段的心理健康状况水平及其变化趋势。方法选取2020年2月—2022年12月诊断为终末期肾病行透析的108例患者为研究对象，采用一般资料问卷、中文版简易心理状况评定量表Kessler 10分别在确诊、初次透析、透析1个月、2个月、3个月、6个月、9个月、12个月进行问卷调查。采用单因素重复测量方差分析比较不同时段中青年维持性透析患者心理健康状况得分的差异并进行两两比较。结果 108例中青年维持性透析患者从确诊到透析6个月内心理健康状况得分均分>30分；透析9~12个月内心理健康状况得分均分>22分。重复测量方差分析结果显示，在上述8个时间节点上，中青年维持性透析患者的心理健康状况有显著变化（F=212.89，P<0.001），确诊到初次透析这一时间段心理健康状况得分均>40分，但两两比较差异无统计学意义（P=0.103）；透析1~3个月患者心理健康状况得分下降，且各个时间节点心理健康状况得分比较均有统计学差异（P<0.05）；其他时间心理健康状况得分两两比较，差异均无统计学意义（P>0.05）。结论中青年维持性透析患者从诊断到规律透析12个月，其心理健康状况呈现不同水平。临床工作人员应密切关注从确诊到规律透析6个月这一时间段的中青年透析患者，及时识别患者可能出现的不良心理状况并提供有针对性的心理护理。

关键词: 透析, 应激, 心理学, 纵向研究, 问卷调查, 心理健康状况

Abstract:

Objective To explore the mental health status of young and middle-aged patients of maintenance dialysis at different time points and its change tendency. Methods From February 2020 to December 2022，a total of 108 dialysis patients diagnosed with end-stage renal disease，who underwent maintenance dialysis were selected as participants. The general information questionnaire and the Chinese version of the Kessler Psychological Distress Scale were used to conduct the questionnaire survey at different time points，including diagnosis，initial dialysis，one month，two-months，three-month，six-month，nine-month and 12-month. Single factor repeated measure ANOVA was used to compare the difference of mental health scores of the participants at different time points. Results The average score of mental health status of the participants was above 30 points within six months from diagnosis to regular dialysis，indicating poor mental health status. From nine to 12 months of regular dialysis，the average score of mental health status was above 22 points，suggesting the worsening of the mental health status. The results of single factor repeated measure ANOVA showed a significant change the mental health status of the participants at the eight time points（F=212.89，P<0.001）. The scores were all above 40 points from diagnosis to initial dialysis，with no statistical difference（P=0.103）. The score of mental health status decreased rapidly from one-month to three-month of dialysis，which reached statistical differences at each time point（P<0.05）. There was no significant difference in mental health status scores at other times（P>0.05）. Conclusion The mental health status of young and middle-aged patients of maintenance dialysis displays different levels from diagnosis to regular dialysis of 12-month. Clinical staff should pay close attention to young and middle-aged dialysis patients from their diagnosis to regular dialysis for six months. Timely identification of patients with possible adverse psychological conditions and provide targeted psychological care are needed.

Key words: Dialysis, Stress, Psychology, Longitudinal Studies, Questionnaire, Mental health status

李蕊, 吴越, 郑晓峰, 马路, 宋红. 中青年维持性透析患者心理健康状况的纵向研究[J]. 中华护理教育, 2023, 20(11): 1366-1370.

LI Rui, WU Yue, ZHENG Xiaofeng, MA Lu, SONG Hong. Longitudinal study of psychological condition in young and middle-aged patients of maintenance dialysis[J]. Chinese Journal of Nursing Education, 2023, 20(11): 1366-1370.

图/表 3

参考文献 18

[1]	Wang LM, Xu X, Zhang M, et al. Prevalence of chronic kidney disease in China:results from the sixth China chronic disease and risk factor surveillance[J]. JAMA Intern Med, 2023, 183(4):298-310. doi: 10.1001/jamainternmed.2022.6817
[2]	中国工程院医药卫生学部肾脏病前沿论坛[R]. 大连: 中国医师协会肾脏内科医师分会, 2022.
[3]	2018亚太地区肾脏病学术会议暨中华医学会肾脏病学分会2018年学术年会[R]. 北京: 中华医学会、中华医学会肾脏病学分会, 2018.
[4]	何丽芳, 李倩倩, 甘香. 病耻感对中青年维持性血液透析患者心理痛苦的影响[J]. 中华护理杂志, 2022, 57(21):2585-2591.
	He LF, Li QQ, Gan X. Influence of stigma on psychological distress among young and middle-aged maintenance hemodialysis patients[J]. Chin J Nurs, 2022, 57(21):2585-2591.
[5]	许晓娜, 江莎, 谢雪英,等. 血液透析患者心理痛苦与自我管理行为及希望水平的相关性研究[J]. 护士进修杂志, 2021, 36(10):931-935.
[6]	文雯. 维持性血液透析患者生活质量及影响因素分析[D]. 重庆: 重庆医科大学, 2015.
	Wen W. Analysis of quality of life and its influencing factors in maintenance hemodialysis patients[D]. Chongqing: Chongqing Medical University, 2015.
[7]	Stanković Z, Jasović-Gasić M, Lecić-Tosevski D. Psychological problems in patients with type 2 diabetes:clinical considerations[J]. Vojnosanit Pregl, 2013, 70(12):1138-1144. pmid: 24450259
[8]	上海慢性肾脏病早发现及规范化诊治与示范项目专家组,高翔,梅长林. 慢性肾脏病筛查诊断及防治指南[J]. 中国实用内科杂志, 2017, 37(1):28-34. doi: 10.19538/j.nk2017010108
[9]	Kessler RC, Aguilar-Gaxiola S, Alonso J, et al. The global burden of mental disorders:an update from the WHO World Mental Health (WMH) surveys[J]. Epidemiol Psichiatr Soc, 2009, 18(1):23-33. doi: 10.1017/s1121189x00001421 pmid: 19378696
[10]	徐凌忠, 王建新, 孙辉,等. Kessler 10在我国的首次应用研究及其重要意义[J]. 卫生软科学, 2005, 19(6):410-412,421.
[11]	周成超, 楚洁, 王婷,等. 简易心理状况评定量表Kessler 10中文版的信度和效度评价[J]. 中国临床心理学杂志, 2008, 16(6):627-629.
[12]	Santini ZI, Jose PE, York CE, et al. Social disconnectedness,perceived isolation,and symptoms of depression and anxiety among older Americans(NSHAP):a longitudinal mediation analysis[J]. Lancet Public Health, 2020, 5(1):e62-e70.
[13]	Levy J. 牛津临床透析手册[M]. 2版. 王梅译. 北京: 人民卫生出版社, 2006.
[14]	Hiramatsu T, Okumura S, Asano Y, et al. Quality of life and emotional distress in peritoneal dialysis and hemodialysis patients[J]. Ther Apher Dial, 2020, 24(4):366-372. doi: 10.1111/tap.v24.4
[15]	Riba MB, Donovan KA, Andersen B, et al. Distress management,version 3. 2019,NCCN clinical practice guidelines in on-cology[J]. J Natl Compr Canc Netw, 2019, 17(10):1229-1249. doi: 10.6004/jnccn.2019.0048
[16]	李雪, 孙晓晶. 自我管理行为对维持性血液透析患者自我感受负担的影响研究[J]. 中华护理杂志, 2016, 51(5):562-566.
	Li X, Sun XJ. A study on the relationship between self-perceived burden and self-management behavior among maintenance hemodialysis patients[J]. Chin J Nurs, 2016, 51(5):562-566.
[17]	陈可人, 李洁, 周敏,等. 家庭亲密度、适应性与产前抑郁的关系:基本心理需要满足的中介作用[J]. 天津医科大学学报, 2022, 28(2):186-190.
	Chen KR, Li J, Zhou M, et al. Relationship between family cohesion,adaptability and prenatal depression:the mediating role of basic psychology needs satisfaction[J]. J Tianjin Med Univ, 2022, 28(2):186-190.
[18]	陈啟念, 尤黎明, 张栢菱. 中国澳门地区维持性血液透析患者液体摄入依从性现状及影响因素分析[J]. 中华护理杂志, 2021, 56(10):1472-1477. doi: 10.3761/j.issn.0254-1769.2021.10.005
	Chen QN, You LM, Zhang BL. Research on the fluid intake compliance and influencing factors of patients on maintenance hemodialysis in Macao China[J]. Chin J Nurs, 2021, 56(10):1472-1477. doi: 10.3761/j.issn.0254-1769.2021.10.005