中国血液净化

›› 2007, Vol. 6 ›› Issue (12): 645-648.

• 论著 • 上一篇    下一篇

维持性血液透析患者失眠情况及其影响因素分析

张 莹 刘 俊 李兰英 陶慧琴 陈剑敏   

  1. 510515 广州，南方医科大学南方医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2007-12-12 发布日期:2007-12-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2007-12-12 Published:2007-12-12

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摘要： 目的 通过对广州南方医院血液透析中心患者失眠状况及相关因素进行调查，以探讨规律血液透析的失眠患病率及其影响因素。方法 以67例透析龄＞3月的患者为研究对象，分别采用阿森斯失眠量表(AIS)、Epworth嗜睡量表(ESS)、不宁腿诊断标准量表、匹兹堡睡眠质量指数(PSQI)进行评估。同时，记录患者的一般状况(性别、高血压、糖尿病、肾移植术后排斥、吸烟、喝茶、不宁腿综合征、嗜睡），透析参数(年龄、透析龄、干体重、体重指数、每周透析时间)和生化指标(血肌酐、尿素氮、Kt/V、血红蛋白、血细胞比积、铁蛋白、转铁蛋白饱和度、钾、校正总钙、磷、全段甲状旁腺激素、白蛋白、C-反应蛋白）。以AIS评分≥6分定为失眠，对失眠与非失眠2组进行统计学分析。结果 ①失眠患者占总人数的38.81%；②失眠组患者在PSQI的7项评分均显著高于非失眠组(P＜0.05）；③2组比较中，除不宁腿综合征、年龄、铁蛋白差异有显著性(P＜0.05)外，其余指标的差异均无显著性；④二分类Logistic 回归分析示不宁腿综合征和年龄是对失眠有显著影响的变量，其优势比分别为24.451、1.078。结论 我中心维持性血液透析患者的失眠率为38.81%，所有失眠患者同时合并睡眠障碍，特别表现在主观睡眠质量、睡眠时间、习惯睡眠效应和日间功能方面。不宁腿综合征和年龄是失眠的危险因素，铁的缺乏和(或)未被清除的部分中分子物质可能会影响睡眠。

关键词: 失眠, 血液透析, 不宁腿综合征, 年龄

Abstract: Objective To evaluate the prevalence of insomnia in our hemodialysis center and to analysis the influencing factors of insomnia. Methods Sixty-seven patients on maintenance hemodialysis were involved in this study. Insomnia, excessive daytime sleepiness(EDS), restless leg syndrome(RLS), sleep quality were diagnosed by the Athens Insomnia Scale(AIS), Epworth Sleepiness Scale(ESS), the criteria of the International Restless Legs Syndrome Study Group(IRLSSG), Pittsburgh Sleep Quality Index(PSQI) respectively. General state(gender, high blood pressure, diabetes, rejection after renal trans-plantation, smoking, drinking tea, RLS, EDS), dialysis data( age, duration of HD, dry weight, body mass index, times of HD weekly), biochemical parameters (serum creatinine, blood urea nitrogen, Kt/V, hemoglobin, haematocrit, ferritin, transferring saturation, potassium, calcium, phosphorus, intact parathyroid hormone, albumin, C-reactive protein) were collected at the same time. We divided our population into two groups: with insomnia (AIS score=6) and without insomnia (AIS score<6). Statistical analyses were made between the two groups. Results ①The questionnaire revealed the presence of insomnia (38.81%). ②The scores of seven components in the PSQI of insomnia group were higher than those of another group(P<0.05）.③There were significant differences in RLS, age and ferritin (P<0.05)between two groups. ④ Binary Logistic Regression analysis showed that RLS and age significantly influenced insomnia(P<0.05). The odds ratios were 24.451 and 1.078 respectively. Conclusion The prevalence of insomnia of maintenance hemodialysis patients from our center was 38.81%. Patients with insomnia also suffered from poor sleep quality, mainly in subjective sleep quality, sleep duration, habitual sleep efficiency, daytime dysfunction. RLS and age were risk factors of insomnia. The lack of ferrum and/or some middle molecules that can not be eliminated might influence sleep.

Key words: Hemodialysis, Restless leg syndrome, Age

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