本文選題：終末期腎病 + 生存質量��； 參考：《昆明醫(yī)科大學》2014年碩士論文

【摘要】：目的：比較血液透析、腹膜透析及腎移植對終末期腎病患者生存質量的影響,并探討其相關影響因素。 方法：選擇2.011年3月-2013年7月在昆明醫(yī)科大學第一附屬醫(yī)院、昆明醫(yī)科大學第二附屬醫(yī)院及云南省腎臟病醫(yī)院行維持性血液透析、持續(xù)不臥床腹膜透析或腎移植3個月以上、年滿18歲的終末期腎病患者354例為研究對象,其中血液透析組患者160例,腹膜透析組患者52例,腎移植組患者142例,采用腎病生存質量評估簡表(KDQ0L—SFTM1.2量表)進行問卷調查,評估其生存質量,同時收集每個患者的臨床及實驗室資料。 結果：1.三組患者生存質量的比較 ①腎移植組在SF-36總評分及其8個分支領域評分、KDTA總評分及其分支領域癥狀(SPL)、腎病的影響(EKD)、腎病帶來的負擔(BKD)、性功能(SexF)的評分均高于血液透析組和腹膜透析組,差異有統(tǒng)計學意義(p0.05)；此外,腎移植組尚在工作狀況(WS)領域得分高于血液透析組,在睡眠(Sleep)、社會支持(Sos)領域得分高于腹膜透析組,差異有統(tǒng)計學意義(p0.05)； ②血液透析組在睡眠(Sleep)、社會支持(Sos)領域評分高于腹膜透析組,而在精力狀況(Energ)、腎病的影響(EKD)、工作狀況(WS)領域評分低于腹膜透析組,差異有統(tǒng)計學意義(p0.05)； ③腎移植組在SF-36的生理健康及心理健康總評分均高于血液透析組和腹膜透析組,差異有統(tǒng)計學意義(p0.05),而血液透析組和腹膜透析組在上述兩個領域的評分差異無統(tǒng)計學意義。2.社會人口學指標與生存質量 ①一般資料比較：三組患者的性別、年齡段、民族、婚姻狀況、文化程度的構成差異無統(tǒng)計學意義(p0.05); ②社會人口學資料與SF-36總評分：血液透析組：SF-36總評分在不同年齡段內差異有統(tǒng)計學意義(p0.05)；腹膜透析組：SF-36總評分在不同性別、年齡段、民族、婚姻狀況、文化程度間差異均無統(tǒng)計學意義(p0.05)；腎移植組：SF-36總評分在不同的年齡段、婚姻狀況間差異有統(tǒng)計學意義(p0.05)； ③社會人口學資料與KDTA總評分：血液透析組和腹膜透析組的KDTA總評分在不同性別、年齡段、民族、婚姻狀況、文化程度間差異均無統(tǒng)計學意義(p0.05)；腎移植組的KDTA總評分在不同婚姻狀況、文化程度間差異有統(tǒng)計學意義(p0.05)。 3.相關性分析 ①血液透析組的SF-36總評分及KDTA總評分、腹膜透析組的SF-36總評分均與年齡呈負相關,而腎移植組的SF-36總評分與年齡呈正相關； ②三組患者的SF-36總評分均與血紅蛋白呈正相關； ③血液透析組和腎移植組的SF-36總評分及KDTA總評分、腹膜透析組的SF-36總評分均與血清白蛋白呈正相關; ④血透組的SF-36總評分、腎移植組的SF-36總評分及KDTA總評分均與文化程度呈正相關； ⑤腎移植組的SF-36總評分及KDTA總評分均與血肌酐呈負相關。 結論：腎移植組在SF一36總評分及其各個分支領域評分、KDTA總評分及其多個分支領域評分均高于血液透析組及腹膜透析組,血液透析組在睡眠(Sleep)、社會支持(Sos)領域高于腹膜透析組,在精力狀況(Energ)、腎病的影響(EKD)工作狀況(WS)領域評分低于腹膜透析組,表明腎移植患者總體生存質量優(yōu)于血液透析及腹膜透析患者。三組患者的生存質量與年齡、文化程度、血清白蛋白、血紅蛋白、血肌酐等因素有關,臨床中注意監(jiān)測上述指標有助于提高患者的生存質量。
[Abstract]:Objective : To compare the effects of hemodialysis , peritoneal dialysis and renal transplantation on the quality of life of patients with end - stage renal disease .

Methods : From March to July 2013 , 354 patients with end - stage renal disease in Kunming Medical University , Second Affiliated Hospital of Kunming Medical University and kidney disease hospital in Yunnan Province were selected as the subjects .

Results : 1 . Comparison of the quality of life of three groups of patients

The total score of SF - 36 and the score of 8 branches , the total score of KDTA and the symptom ( SPL ) , the effect of renal disease ( EKD ) , the burden of nephropathy ( BKD ) and sex function were higher than those in hemodialysis and peritoneal dialysis group ( p < 0.05 ) .
In addition , the score of kidney transplantation group in the field of work ( WS ) was higher than that in hemodialysis group . In the sleep ( Sleep ) and social support ( Sos ) field , the score was higher than that in peritoneal dialysis group ( p . 05 ) .


( 2 ) In the hemodialysis group , the score of sleep and social support ( Sos ) was higher than that in peritoneal dialysis group , while in the energy condition ( Energ ) , the effect of kidney disease ( EKD ) , the score of working condition ( WS ) was lower than that in peritoneal dialysis group , the difference was statistically significant ( p . 05 ) ;


( 3 ) The total score of SF - 36 was higher than that in hemodialysis group and peritoneal dialysis group ( p < 0.05 ) , but there was no statistical significance in the score difference between hemodialysis group and peritoneal dialysis group .

( 1 ) General data comparison : There was no significant difference in the composition of sex , age , nationality , marital status and degree of culture among the three groups ( p . 05 ) ;

( 2 ) Social demology data and SF - 36 total score : the total score of SF - 36 in hemodialysis group was statistically significant ( p < 0.05 ) .
The total score of SF - 36 was no significant difference between different sex , age , nationality , marital status and cultural degree ( p . 05 ) .
The total score of SF - 36 was in different age groups , and the difference between marital status was significant ( p < 0.05 ) .


( 3 ) There was no significant difference between social demology data and KDTA total score : the total score of KDTA between hemodialysis group and peritoneal dialysis group in different sex , age group , nationality , marital status and culture degree ( p . 05 ) ;
The total score of KDTA in kidney transplantation group was statistically significant ( p . 05 ) .

3 . Correlation analysis

The total score of SF - 36 in hemodialysis group and total score of KDTA were negatively correlated with age , while SF - 36 in renal transplantation group was positively correlated with age .


The SF - 36 scores of three groups were positively correlated with hemoglobin ;


( 3 ) The total score of SF - 36 and total KDTA score of hemodialysis group and renal transplantation group were positively correlated with serum albumin .

( 4 ) The total score of SF - 36 and the total score of SF - 36 and total KDTA were positively correlated with the degree of culture .


The total score of SF - 36 and the total KDTA score of renal transplantation group were negatively correlated with serum creatinine .

Conclusion : The total score of SF - 36 and the scores of its branches , the total score of KDTA and the scores of its branches were higher than those in hemodialysis group and peritoneal dialysis group . In the field of sleep and social support ( Sos ) , the score of patients with renal transplantation was lower than that in peritoneal dialysis group . The quality of life of patients with renal transplantation was better than those in hemodialysis and peritoneal dialysis . The quality of life was related to age , degree of culture , serum albumin , hemoglobin , blood creatinine and other factors .
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R692.5

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