中国血液净化

中国血液净化 ›› 2015, Vol. 14 ›› Issue (05): 277-280.doi: 10.3969/j.issn.1671-4091.2015.05.005

• 临床研究 • 上一篇    下一篇

腹膜透析患者的症状负担相关因素调查与分析

黎渐英1, 蔡金辉1,林建雄1, 易春燕1, 陶黎阳2, 成守珍1, 阳晓1   

  1. 510080 广州,1中山大学附属第一医院肾内科
    510080 广州,2广州医科大学
  • 收稿日期:2014-12-30 修回日期:2015-03-20 出版日期:2015-05-12 发布日期:2015-05-29
  • 通讯作者: 成守珍 ljy19964@163.com E-mail:ljy19964@yahoo.com.cn

A symptom assessment instrument for peritoneal dialysis patients: Dialysis Symptom Index (DSI)

  • Received:2014-12-30 Revised:2015-03-20 Online:2015-05-12 Published:2015-05-29

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摘要： 【摘要】目的该研究的目的是通过透析症状评估量表(Dialysis Symptom Index,DSI)对腹膜透析(peritoneal dialysis,PD)患者的躯体症状和情感症状负担作出评估以及探讨症状负担与PD 患者的抑郁与生存质量的关系，探讨DSI 对PD 患者的有效性。方法收集2013 年10 月～2014 年10 月的中山大学附属第一医院腹膜透析中心随访患者的症状负担、抑郁、生存质量、人口统计学及实验室资料。使用DSI 评估患者的症状负担，Beck 抑郁量表(BDI)评估患者的抑郁情况，健康相关的生命质量量表(SF-36 量表)评估患者的生存质量。结果本研究纳入持续不卧床腹膜透析(CAPD)患者403 例，其中54.3%为男性患者，年龄中位数是60.5 岁，平均透析月是23.3±15.2 月。通过DSI 评估，该研究中CAPD 患者报告症状的平均数是10(7～13)，在CAPD 患者中发生率较高的症状分别是：皮肤干燥(71.5%)，易醒(70.5%), 疲倦(69.5%)，皮肤瘙痒(65.3%)，入睡困难(63.2%)，下肢水肿(61.6%)，口干(61.6%)；困扰患者程度高的症状是入睡困难，易醒，皮肤瘙痒，疲倦，皮肤干燥，骨关节痛，口干，下肢水肿。相关性分析结果显示DSI 总分与躯体功能(PCS)及精神功能(MCS)成负相关关系(r=-0.416 及-0.479，P＜0.01),与BDI 成正相关关系(r=0.558, P＜0.01)。使用多元线性回归分析CAPD 患者生存质量的独立危险因素结果显示透析症状量表得分(DSI 得分)是影响患者生存质量的独立危险因素(β=0.251，P=0.002)，即患者的症状负担是其生存质量的影响因素。结论CAPD 患者的症状负担与患者的抑郁状态密切相关，将影响患者的生存质量。DSI 能可靠有效地对PD 患者的症状作出评估，作为PD 患者随访评估工具，便于医护人员掌握并对腹膜透析患者的症状有效管理。

关键词: 腹膜透析, 症状

Abstract: 【Abstract】Objective Little is known about the prevalence, severity, overall impact of physical and emotional symptoms in patients with continuous ambulatory peritoneal dialysis (CAPD) due to the lack of a valid symptom assessment instrument. Previous studies suggested that the Dialysis Symptom Index (DSI) could be a useful tool for the assessment of physical and emotional symptom burden in patients receiving hemodialysis.This study aimed to understand total symptom burden among CAPD patients by using DSI, and to investigate the relationship between symptom burden, depression and quality of life. Methods This was a
cross-sectional study. Demographic information, clinical data and laboratory findings in CAPD patients were collected in our PD center from Oct. 2013 to Oct. 2014. DSI was used to identify patients’emotional and physical symptom burden. Depression and quality of life were assessed using the Beck Depression Inventory (BDI) and Short Form 36 (SF-36), respectively. DSI which includes 28 items highlights the important points about symptom burden and symptom assessment in CAPD patient. Results A total of 403 CAPD patients (54.3% males and 45.7% females, median age 60.5 years) were investigated. The mean duration of PD was 23.3±15.2 months. By DSI assessment, the prevalence of symptoms in CAPD patients were dry skin (71%), fatigue/tiredness (70%), pruritus (65%), constipation (32%), anorexia (38%), anxiety (36%), dyspnea (28%), nausea (33%), restless legs (28%), cough (45%), muscle cramps (36%), decreased interest in sex (24%), numbness or tingling in feet (30%), muscle soreness (31%), light headedness or dizziness (39%), swelling in legs (61%), trouble staying asleep (70%), bone or joint pain (46%), trouble falling asleep (63%), worrying(39%), irritable feeling (41%), headache (31%), sad feeling (21%), nervous feeling (33%), diarrhea (17%), chest pain (19%), concentration difficulties (38%), and vomiting (22%). Total DSI score was negatively correlated with SF-36 physical component score (PCS) (r =-0.416, P＜0.01), mental component score (MCS) (r=-0.479, P＜0.01), and positively correlated with BDI score (r=0.558, P＜0.01). Conclusion The symptom burden was closely related to depression, and significantly affected the quality of life in CAPD patient. DSI was a useful tool to evaluate the physical and emotional situations in CAPD patients, and may be useful for the design of specific intervention strategies to improve quality of life in CAPD patients.

Key words: Peritoneal Dialysis, Dialysis Symptom Index