中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (04): 265-269.doi: 10.3969/j.issn.1671-4091.2017.04.013

• 透析心理学 • 上一篇    下一篇

老年维持性血液透析患者抑郁相关因素分析

吴红艳1,罗斌1,陈小瑜2,刘关键3,吴红梅4   

  1. 1成都市康福肾脏病医院血液透析中心 2重庆市九龙坡区人民医院肾脏内科
    3循证医学与临床流行病学中心4老年医学中心
  • 收稿日期:2016-07-14 修回日期:2017-02-20 出版日期:2017-04-12 发布日期:2017-04-12
  • 通讯作者: 吴红梅 drwhm@163.com E-mail:1021196935@qq,com

Related factors for depression in elderly patients on hemodialysis

  • Received:2016-07-14 Revised:2017-02-20 Online:2017-04-12 Published:2017-04-12

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摘要： 目的了解老年维持性血液透析患者抑郁发生情况及其相关影响因素，提出有针对性的干预措施。方法对177 例老年维持性血液透析患者进行老年综合评估，并收集患者的基本资料和实验室数据。将患者分为抑郁组和非抑郁组。结果177 例老年维持性血液透析患者抑郁的患病率为27.68%(49/177)，单因素分析两组患者的性别(χ2 =4.731，P=0.030)、教育程度(χ2 = 10.767，P=0.001)、血红蛋白(t=-2.255，P=0.026)、日常生活活动能力包括躯体性日常生活活动能力(OR 5.625，95% CI2.695～11.740，P＜0.001) 及工具性日常生活活动能力(OR 4.950，95% CI 2.447～10.009，P＜0.001)、步态平衡(OR 4.950，95% CI 2.447～10.009，P＜0.001)、视力(OR 0.160，95% CI 0.059～0.431，P＜0.001)、便秘(OR 2.913，95% CI 1.463～5.798，P=0.002)、营养状况包括营养不良风险(OR8.261，95% CI 1.865～36.582，P＜0.001)和营养不良(OR 24.117，95% CI 5.069～114.733，P＜0.001)、社会支持况状包括客观支持(t=- 2.876，P=0.005)，主观支持(t=- 2.419，P=0.017)及支持利用度(t=- 3.505，P=0.001)，两组相比较差异具有统计学意义。多因素逐步回归分析显示：教育程度低(OR0.178，95% CI 0.071～0.444，P＜0.001)、躯体性日常生活能力受损(OR 2.644，95% CI 1.026～6.815，P=0.044)、营养状况下降包括营养不良风险(OR 11.475，95% CI 2.247～58.609，P=0.003)和营养不良(OR 11.920，95% CI 2.141～66.348，P=0.005)、社会支持利用度低(OR 0.740，95% CI 0.611～0.895，P=0.002)及便秘(OR 2.729，95% CI 1.102～6.758，P=0.030)是老年维持性血液透析患者发生抑郁的独立相关因素。结论老年维持性血液透析患者抑郁的发生率较高，直接影响患者的生活质量，应采取有效的治疗及护理方式，改善患者抑郁状态，提高患者的整体生活质量，延长生命。

关键词: 维持性血液透析, 老年综合评估, 抑郁, 相关因素

Abstract: Objective We investigated the prevalence of depression and its related factors in elderly patients on maintenance hemodialysis (MHD) in order to provide effective intervention strategies. Methods A total of 177 cases of elderly MHD patients were divided into depression group and non-depression group according
to the Comprehensive Geriatric Assessment. Their basic information and laboratory data were collected and analyzed. Results The prevalence of depression was 27.68% in the 177 elderly MHD patients. Univariate analysis showed that there were statistical significances between the two groups in gender (χ2=4.731,
P=0.030), education level (χ2=10.767, P=0.001), hemoglobin (t=-2.255, P=0.026), daily living activities including daily living physical activities (OR 5.625, 95% CI 2.695～11.740) and daily living instrumental activities (OR 4.950, 95% CI 2.447～10.009, P＜0.001), gait balance (OR 4.950, 95% CI 2.447～10.009, P＜
0.001), vision (OR 0.160, 95% CI 0.059～0.431, P＜0.001), constipation (OR 2.913, 95% CI 1.463～5.798, P=0.002), nutrition status including malnutrition risk (OR 8.261, 95% CI 1.865～36.582, P＜0.001) and malnutrition (OR 24.117, 95% CI 5.069～114.733, P＜0.001), social support conditions including objective support (t=-2.876, P=0.005), subjective support (t=-2.419, P=0.017) and support utilization (t=-3.505, P=0.001). Multivariate logistic regression analyses demonstrated that low education (OR 0.178，95% CI 0.071～0.444, P＜0.001), impaired daily living physical activities (OR 2.644, 95% CI 1.026～6.815, P=0.044), abnormal nutrition status including malnutrition risk (OR 11.475, 95% CI 2.247～58.609, P=0.003) and malnutrition (OR 11.920, 95% CI 2.141～66.348, P=0.005), low degree of social support utilization (OR 0.740, 95% CI 0.611～0.895, P=0.002) and constipation (OR 2.729, 95% CI 1.102～6.758, P=0.030) were the independent risk factors for depression in elderly MHD patients. Conclusion The higher prevalence of depression impacts directly on the quality of life in elderly MHD patients. Effective treatment and nursing care are the ways to improve the quality of life and prolong life in such patients.

Key words: Maintenance hemodialysis, Comprehensive Geriatric Assessment, Depression, Risk factor