中国血液净化

›› 2006, Vol. 5 ›› Issue (1): 16-18.

• 论著 • 上一篇    下一篇

腹膜透析患者退出及社会支持状况调查分析

蒋红樱 张风莲 曹 颖 赵云珠   

  1. 650101 昆明,昆明医学院第二附属医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2006-01-12 发布日期:2006-01-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2006-01-12 Published:2006-01-12

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摘要：

目的 通过分析影响腹膜透析患者退出腹膜透析的因素，了解腹膜透析患者社会支持现状，讨论其对策，提高腹膜透析患者的社会支持。 方法 调查1999年1月～2005年7月在昆明医学院第二附属医院肾内科退出腹膜透析59例患者的透析时间和原因,死亡病例的死因，采用体格损害指数、Charlson指数来评估患者合并症情况。并应用肖水源的“社会支持评定量表”调查这些患者的社会支持现状。 结果 在3月内退出腹膜透析的患者有14例，其中死亡12例，移植1例，转血液透析1例。透析3月以上退出的有45例，其中死亡25例，移植5例，转血液透析5例，失访10例，透析后3月以上的死亡25例的病例中放弃治疗8例（32%），充血性心力衰竭5例（20%），呼吸衰竭3例（12%），中风2例（8%），心肌梗死2例（8%），腹膜炎2例（8%），恶性肿瘤1例（4%）及其他原因不明2例（8%）。Logistic回归分析提示Charlson指数、体格损伤指数、性别等对腹膜透析3月以上死亡患者的相对危险度分别是1.42、2.22、2.85，并均有统计学意义(P＜0.05)。透析3月以上腹膜透析患者有配偶者主观社会支持较无配偶高（P＜0.05)、年龄与主观社会支持成负相关(r= -0.296，P＜0.01)。经济状况与客观社会支持(r = 0.362，P＜0.01)主观社会支持(r=0.283，P＜0.05)成正相关。文化程度越高，客观社会支持越高(r=0.257，P＜0.01)。全自费者社会支持总分、客观支持分、主观支持分明显低于全公费及部分自费者(P＜0.01)，而部分自费者（包括医疗保险）的社会支持与全公费者差异无显著性。结论 自动放弃与心血管事件是透析3月以上患者死亡的主要因素，其中最主要的原因是因经济困难减量和停止透析所致；婚姻、年龄、付费方式是影响社会支持的重要因素。合并症是腹膜透析患者退出的危险因素。

关键词: 腹膜透析, 退出

Abstract: Objective To analyze the reason and risk factors associated with dropout of patients of continuous ambulatory peritoneal dialysis (CAPD), and to study the role of social support and to analyze factors that affect social support in these patients. Methods Between January 1999 and July 2005, fifty-nine patients droped all were enrolled. Patient’s demographic characteristics, duration of dialysis, date and cause of dropout, cause of death were recorded. Comorbidity at initiation of dialysis was assessed by Charlson index and plysical injury index. Patients social support was evaluated with Xiao,s social support scale. Results Among the 45 patients who dropped out within three months after initiation of CAPD, 25 cases died (8 died of rejecting treatment, 5 died of congestive heart failure, 3 died of respiration failure, 2 died of stroke, 2 died of acute myocardial infraction, 2 died of peritonitis, 1 died of malignancy, 2 died of others), 5 cases received renal transplantation, 5 cases were switched to hemodialysis. The relative risk (RR) of death established by logistic regression analysis for effect of comorbidity assessed by Charlson index and physical injury index, gender on patients dropping out within three months after initiation of CAPD were as follow: Charlson index, RR =1.42; physical injury index, RR =2.22; gender RR =2.85 (P ＜0.05). Subjective social support in patients with spouse was higher than those without spouse (P＜0.05). Subjective social support was negatively related with age (r =-0.296, P＜0.01) and positively related with economic condition (r= 0.362, P ＜0.01). Objective social support was positively associated with both economic condition (r=0.283, P＜0.01) and education (r = 0.257, P＜0.01). Conclusion Our study suggests that rejecting treatment and cardiovascular events is the primary cause of death in patients who dropped out within three month after initiation of CAPD; and economic condition and comorbidity are important risks for the dropout. Marriage status, age, education and the way of payment were factors affecting social support.

Key words: Dialysis, Dropout

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