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| 新型冠状病毒肺炎疫情常态化防控下影响慢性肾脏病患者治疗的社会及心理因素分析 |
| 赵志斌1,王琥2,朱超2,刘可2,张琼2,沈元弟2,王红宇3,汪海燕2,赖学莉2,郭志勇2,郁姣2,董睿2* |
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(1. 海军军医大学(第二军医大学)中医系针灸推拿学教研室, 上海 200433;
2. 海军军医大学(第二军医大学)第一附属医院肾内科, 上海 200433;
3. 安徽省利辛县人民医院肾内科, 亳州 236700
*通信作者) |
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| 摘要: |
| 目的 探索新型冠状病毒肺炎（COVID-19）疫情常态化防控下影响慢性肾脏病患者治疗连续性的社会人口学因素及心理因素。方法 选择2020年4月至2021年3月在海军军医大学（第二军医大学）第一附属医院肾内科就诊治疗的277例慢性肾脏病患者并分为3组：未透析组（102例）、血液透析（HD）组（108例）、腹膜透析（PD）组（67例）。对所有患者以线上、线下结合的方式进行问卷调查，问卷包括自编基本情况调查表、焦虑自评量表（SAS）和抑郁自评量表（SDS）。比较3组患者的一般社会人口学资料和焦虑、抑郁情况，采用二元多因素logistic回归模型分析社会人口学因素及心理因素对患者中断或延误治疗的影响。结果 3组慢性肾脏病患者在年龄分布、婚姻状况、职业、医保类型、照顾者类型、是否有迫切的住院需求及治疗延误或中断情况的差异均有统计学意义（P均<0.05）。65例PD组患者SAS平均得分为（38.15±15.83）分，其中无焦虑患者53例（81.5%）、轻度焦虑患者7例（10.8%）、中重度焦虑患者5例（7.7%）；104例HD组患者SAS平均得分为（36.86±14.03）分，其中无焦虑患者81例（77.9%）、轻度焦虑患者18例（17.3%）、中重度焦虑患者5例（4.8%）；两组的SAS平均分与焦虑严重程度分级差异均无统计学意义（P均>0.05）。65例PD组患者SDS平均得分为（53.42±13.30）分，其中无抑郁患者22例（33.8%）、轻度抑郁患者21例（32.3%）、中重度抑郁患者22例（33.8%）；104例HD组患者SDS平均得分为（50.79±10.76）分，其中无抑郁患者36例（34.6%）、轻度抑郁患者56例（53.8%）、中重度抑郁患者12例（11.6%）；两组的SDS平均分与抑郁严重程度分级差异均无统计学意义（P均>0.05）。组内比较结果显示，PD、HD组患者的抑郁发生率和严重程度均高于焦虑的发生率和严重程度。二元多因素logistic回归分析显示，高中学历水平（OR=5.618，95% CI 2.136～14.776，P<0.01）、未婚（OR=6.916，95% CI 1.441～33.185，P=0.016）、离婚（OR=5.588，95% CI 1.442～21.664，P=0.013）、有迫切的住院需求（OR=8.655，95% CI 3.847～19.476，P<0.01）能正向促进维持性透析患者在COVID-19疫情常态化防控条件下更好地保持治疗的连续性；而在未透析人群中未发现与治疗过程的中断或延误相关的社会人口学及心理因素（P>0.05）。结论 学历、婚姻状况、住院需求的迫切性均与慢性肾脏病维持性透析患者治疗的连续性相关。 |
| 关键词: 慢性肾脏病 心理因素 社会人口学 logistic回归分析 透析 |
| DOI：10.16781/j.CN31-2187/R.20220269 |
| 投稿时间：2022-04-01修订日期：2022-08-25 |
| 基金项目:国家自然科学基金（81300613）. |
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| Analysis of social and psychological factors influencing the treatment of patients with chronic kidney disease under the regular epidemic prevention and control of coronavirus disease 2019 |
| ZHAO Zhi-bin1,WANG Hu2,ZHU Chao2,LIU Ke2,ZHANG Qiong2,SHEN Yuan-di2,WANG Hong-yu3,WANG Hai-yan2,LAI Xue-li2,GUO Zhi-yong2,YU Jiao2,DONG Rui2* |
(1. Department of Acupuncture and Massage, School of Traditional Chinese Medicine, Naval Medical University (Second Military Medical University), Shanghai 200433, China;
2. Department of Nephrology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China;
3. Department of Nephrology, People's Hospital of Lixin County, Bozhou 236700, Anhui, China
*Corresponding author) |
| Abstract: |
| Objective To explore the sociodemographic and psychological factors influencing the continuity of treatment of patients with chronic kidney disease under the regular epidemic prevention and control of coronavirus disease 2019 (COVID-19). Methods A total of 277 patients with chronic kidney disease who were admitted to Department of Nephrology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Apr. 2020 to Mar. 2021 were enrolled and divided into 3 groups:non-dialysis group (n=102), hemodialysis (HD) group (n=108), and peritoneal dialysis (PD) group (n=67). All patients were investigated by online and offline questionnaires, including self-designed basic situation questionnaire, self-rating anxiety scale (SAS), and self-rating depression scale (SDS). The general sociodemographic data, anxiety and depression of the 3 groups were compared, and the influence of sociodemographic and psychological factors on the interruption or delay of treatment was analyzed by binary logistic regression model. Results There were significant differences in age distribution, marital status, occupation, medical insurance type, caregiver type, whether there was an urgent need for hospitalization and whether treatment was delayed or interrupted among the 3 groups (all P<0.05). The average SAS score of 65 PD patients was 38.15±15.83, including 53 (81.5%) patients without anxiety, 7 (10.8%) patients with mild anxiety, and 5 (7.7%) patients with moderate to severe anxiety. The average SAS score of 104 patients in the HD group was 36.86±14.03, including 81 (77.9%) patients without anxiety, 18 (17.3%) patients with mild anxiety, and 5 (4.8%) patients with moderate to severe anxiety. There were no significant differences in the mean score of SAS or anxiety severity grading between the 2 groups (both P>0.05). The mean SDS scores of 65 PD patients were 53.42±13.30, including 22 (33.8%) patients without depression, 21 (32.3%) patients with mild depression, and 22 (33.8%) patients with moderate to severe depression. The mean SDS scores of 104 patients in the HD group were 50.79±10.76, including 36 (34.6%) patients without depression, 56 (53.8%) patients with mild depression, and 12 (11.6%) patients with moderate to severe depression. There were no significant differences in mean SDS scores or depression severity grading between the 2 groups (both P>0.05). The results of intra-group comparison showed that the incidence and severity of depression were higher than those of anxiety in both groups. Multivariate binary logistic regression analysis showed that high school education level (odds ratio[OR]=5.618, 95% confidence interval[CI]) 2.136-14.776, P<0.01), and unmarried (OR=6.916, 95% CI 1.441-33.185, P=0.016), divorced (OR=5.588, 95% CI 1.442-21.664, P=0.013), urgent need for hospitalization (OR=8.655, 95% CI 3.847-19.476, P<0.01) could positively promote the continuity of treatment in maintenance dialysis patients under the regular epidemic prevention and control of COVID-19. In the non-dialysis group, no sociodemographic and psychological factors were found to be associated with the interruption or delay of treatment (P>0.05). Conclusion Education, marital status, and urgent need for hospitalization are correlated with the continuity of treatment in patients with chronic kidney disease on maintenance dialysis. |
| Key words: chronic kidney disease psychological factors sociodemography logistic regression analysis dialysis |
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