血液净化治疗患者压力知觉影响因素及其预测效能分析-现代医学

血液净化治疗患者压力知觉影响因素及其预测效能分析

单位：1. 蚌埠市第一人民医院血液净化中心, 安徽蚌埠 233000;
2. 蚌埠市第一人民医院神经外科, 安徽蚌埠 233000

分类号：R473.5

出版年·卷·期（页码）：2025·44·第五期（791-797）

摘要：

目的： 分析血液净化治疗患者压力知觉影响因素及其预测效能。方法： 选取2022年6月至2024年6月我院收治的血液净化患者120例为研究对象，采用中文版知觉压力量表(CPSS)评价其压力知觉现状，按照中位数将其分为高压力组(n=57)和低压力组(n=63)，比较两组的一般资料，采用二元Logistic回归分析影响血液净化患者高压力的危险因素，再通过受试者工作特征(ROC)曲线分析各项变量预测血液净化患者高压力的效能。结果： 患者整体的CPSS评分平均为(30.33±6.48)分，其中高压力组的平均为(35.72±3.88)分，低压力组的平均为(25.46±4.04)分，两组比较差异有统计学意义(P＜0.05)。两组女性比例、合并慢性病(≥1种)比例、文化程度低(≤初中)比例、无家庭照顾者的比例、透析时间比较，差异具有统计学意义(P＜0.05)，而两组的年龄、体质指数(BMI)、肾病家族史、吸烟史、饮酒史、合并糖尿病、高血压、冠心病、工作状态、婚姻状态、居住状态、医保类型、家庭月收入比较，差异无统计学意义(P＞0.05)。女性、合并慢性病(≥1种)、文化程度低(≤初中)、无家庭照顾者、透析时间长都是影响血液净化患者高知觉压力的危险因素(P＜0.05)。联合预测的曲线下面积(AUC)为0.862，优于女性、慢性病种类、文化程度、家庭照顾者、透析时间这些单一因素的AUC，同时联合预测的敏感度和特异度良好，分别为89.47%、73.02%。结论： 血液净化患者普遍面临较高的压力知觉，其中女性、合并慢性病(≥1种)、文化程度低(≤初中)、无家庭照顾者及透析时间长是危险因素。联合性别、慢性病种类、文化程度、家庭照顾者、透析时间多指标预测患者高压力知觉的效能最佳，具有较高的敏感度和特异度。针对上述高危因素，应采取有效措施减轻患者压力，提高生活质量。

Objective: Analysis on influencing factors and predictive efficacy of pressure perception in patients with blood purification therapy. Methods: A total of 120 patients with blood purification admitted to our hospital from June 2022 to June 2024 were selected as the research objects. The Chinese version of Perceived Stress Scale(CPSS) was used to evaluate the current situation of their pressure perception. According to the median, they were divided into high pressure group(n=57) and low pressure group(n=63). The general data of the two groups were compared. Binary Logistic regression was used to analyze the risk factors of high pressure in patients with blood purification, and receiver operating characteristic(ROC) curve was used to analyze the variables to predict the efficacy of high pressure in patients with blood purification. Results: The average CPSS score of the patients was 30.33±6.48, including 35.72±3.88 in the high pressure group and 25.46±4.04 in the low pressure group. The difference between the two groups was statistically significant(P＜0.05). The differences between the two groups were statistically significant(P＜0.05) in female, proportion with ≥1 type of chronic diseases, proportion with low education(≤junior middle school), proportion without family caregivers and dialysis time. There was no significant difference in age, body mass index(BMI), family history of kidney disease, smoking history, drinking history, combined diabetes, hypertension, coronary heart disease, working status, marital status, residential status, type of medical insurance and family monthly income between the two groups(P＞0.05).Female, with≥1 type of chronic diseases, low education(≤junior middle school), without family caregivers, and long dialysis time were risk factors for high perceived stress in patients with blood purification(P＜0.05). The area under the curve(AUC) value of the combined prediction was 0.862, which was better than the AUC value of female, with ≥1 type chronic diseases, education(≤junior middle school), family caregivers, dialysis time. At the same time, the sensitivity and specificity of the combined prediction were 89.47% and 73.02%, respectively. Conclusion: Blood purification patients generally face high levels of stress perception, among which female, with≥1 type of chronic diseases, low education(≤junior middle school), without family caregivers, and long dialysis time are risk factors. The combination of female, with chronic diseases, education, family caregiver, and dialysis time is the most effective in predicting patients' perception of high stress, with high sensitivity and specificity. Effective measures should be taken to reduce patients' stress and improve their quality of life based on the above-mentioned high-risk factors.

参考文献：

[1] 刘丽霞,胡振杰.脓毒症急性肾损伤血液净化治疗的现状与展望[J].中国实用内科杂志,2023,43(12):989-995.
[2] 刘颖,孙艳玲,胡静雅,等.不同血液净化模式对尿毒症患者短期并发症及预后的影响[J].中华肾脏病杂志,2022,38(3):203-210.
[3] 安娜,韩启秀.基于交互分析模式的团体教育对尿毒症血液净化治疗患者心理弹性及知觉压力的影响[J].生命科学仪器,2023,21(S1):485.
[4] 张帆,杨雪球,赵宸,等.血液透析病人抑郁和焦虑状态影响因素及生活质量分析[J].蚌埠医学院学报,2022,47(9):1171-1175.
[5] FAN M,ZHU S,LIU M,et al.Nursing based on humanistic care concept for continuous blood purification for patients with severe sepsis in the intensive care unit[J].Altern Ther Health Med,2024,30(7):96-102.
[6] JAMES M,BOUCHARD J,HO J,et al.Canadian Society of Nephrology commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury[J].Am J Kidney Dis,2013,61(5):673-685.
[7] 吕书红,田本淳,杨廷忠,等.严重急性呼吸综合征流行期间公众知觉压力及其对健康行为的影响[J].中华预防医学杂志,2010,44(2):128-133.
[8] COHEN S,KAMARCK T,MERMELSTEIN R.A global measure of perceived stress[J].J Health Soc Behav.1983,24(4):385-96.
[9] LU Y,ZHAI S,LIU Q,et al.Correlates of symptom burden in renal dialysis patients:a systematic review and meta-analysis[J].Ren Fail,2024,46(2):2382314.
[10] KISOMI Z S,TAHERKHANI O,MOLLAEI M,et al.The moderating role of social support in the relationship between death anxiety and resilience among dialysis patients[J].BMC Nephrol,2024,25(1):100.
[11] 夏京华,朱文博,周跃,等.维持性血液透析患者焦虑及抑郁非药物干预最佳证据总结[J].中华现代护理杂志,2024,30(24):3250-3256.
[12] 施亚凤,翁亚萍,孔静娴.抑郁状态联合焦虑状态对绝经后维持血液透析患者转归的影响[J].中国妇幼保健,2023,38(19):3677-3680.
[13] 任娇娇,郭红萍,薛福平,等.中青年维持性血液透析患者社会回归情况调查及进入透析前后社会功能退化程度的影响因素分析[J].中国血液净化,2024,23(7):510-514.
[14] WALKER R C,WALKER C,REYNOLDS A,et al.Consumer values,perspectives and experiences of psychological health when living with dialysis at home:an in-depth interview study[J].Perit Dial Int,2024,44(3):185-193.
[15] WANG G,ZHUO N,LIU Z.Anxiety and depression among patients with end-stage renal disease undergoing hemodialysis[J].Int Urol Nephrol,2024,56(7):2449-2450.
[16] 史秋寅,王雪菲,汤卫红,等.经皮冠状动脉介入治疗患者压力知觉现状及影响因素分析[J].现代医学,2023,51(4):524-530.
[17] 汪洋,赵波,陈曦.慢性肾衰竭维持性血液透析患者焦虑、抑郁状态与生活质量的相关性[J].医学综述,2023,29(17):3508-3512.
[18] 吴林珂,陈晓霞,张亚峰,等.医联体模式下维持性血液透析患者焦虑状态与治疗满意度的相关因素研究[J].实用临床医药杂志,2023,27(20):64-69.
[19] 李颖,骆瑞,张静,等.家属参与式护理管理模式对慢性肾衰竭腹膜透析患者遵医行为、自护能力及心理状态的影响[J].现代中西医结合杂志,2023,32(4):565-568,577.
[20] 赵君,杨红美,李楠,等.基于人格特征性分类多维度干预模式对维持性血液滤过性透析患者心理状态及营养状况的影响[J].中国医药导报,2023,20(25):177-181.
[21] CAI H,WU Z,XU J,et al.Mitigating social isolation among peritoneal dialysis patients:the impact of educational level,physical activity,and familial support[J].Risk Manag Healthc Policy,2024,17:2271-2280.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录