Related factors of anxiety and treatment satisfaction in maintenance hemodialysis patients under the mode of medical cluster
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摘要:目的
分析医联体模式下维持性血液透析(MHD)患者焦虑状态及治疗满意度的相关因素。
方法纳入本医联体集团2021年7月—2023年6月因并发症于本部病房住院的MHD患者为研究对象。记录患者的人口学指标及营养指标; 测定患者残肾功能; 使用量表评估患者焦虑状态及满意度; 比较本部中心及医联体转入患者的各项指标水平; 统计并分析医联体转入患者焦虑评分及满意度评分的相关影响因素。
结果本研究共纳入患者188例, 本部组(n=70)与医联体组(n=118)患者的人口学指标及营养指标、残余肾功能比较，差异无统计学意义(P>0.05)，但医联体组患者的焦虑评分高于本部组，治疗满意度评分低于本部组，差异有统计学意义(P < 0.05或P < 0.01)。多元线性逐步回归分析显示，改良定量主观整体营养评分(MQSGA)、上臂肌围(AMC)及平均动脉压是焦虑评分的影响因素(P < 0.05)，而年龄、透析龄、MQSGA评分及AMC是患者满意度评分的影响因素(P < 0.05)。
结论医联体模式下MHD患者存在一定程度的焦虑状态，治疗满意度仍有提升空间，且均受多种因素影响。
Abstract:ObjectiveTo analyze the relevant factors of anxiety status and treatment satisfaction of maintenance hemodialysis (MHD) patients under the mode of medical cluster.
MethodsMHD patients admitted to the ward of medical union due to complications from July 2021 to June 2023 were included as the study objects. Demographic characteristicsand nutritional status were recorded, and residual renal functions were determined. The anxiety state and satisfaction of patients were evaluated by the scales. The index levels of patients transferred from the center of the department and the medical union group were compared. The related influencing factors of anxiety score and satisfaction score of transferred patients from medical union groupwere analyzed.
ResultsA total of 188 patients were included in this study, including 118 patients in headquarters group and 70 patients in medical union group. There were no significant differences in demographic and nutritional indicators or residual renal function between the two groups(P>0.05), while the mean anxiety score of the medical union group was higher, satisfaction score for treatment was lower than that of the headquarters group (P < 0.05 or P < 0.01). Multiple linear stepwise regression analysis showed that modified quantitative subjective global assessment (MQSGA) score, arm muscle circumference (AMC) and mean arterial pressure were the influencing factors of anxiety score, while age, dialysis age, MQSGA score and AMC were the influencing factors of patients'satisfaction score.
ConclusionMHD patients under the mode of medical cluster have a state of anxiety, and the treatment satisfaction should be improved. Both are affected by a variety of factors.
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图 3 医联体转诊患者满意度评分影响因素的多元线性回归分析
A: 满意度评分与MQSGA评分关系; B: 满意度评分与AMC关系; C: 满意度评分与年龄关系; D: 满意度评分与透析龄关系。
表 1 2组患者一般特征及焦虑满意度评分(x±s)[n(%)]
一般资料 分类 本部组(n=70) 医联体组(n=118) t/χ2/z P 性别 男 49(70.00) 75(63.56) 0.812 0.368 女 21(30.00) 43(36.44) 住院病因 血管通路修复 22(31.43) 39(33.05) 1.417 0.702 感染性疾病 18(25.71) 32(27.12) 心脑血管事件 21(30.00) 27(22.88) 其他 9(12.86) 20(16.95) *年龄/岁 60.00(14.00) 58.00(9.00) 0.837 0.404 透析龄/月 39.69±12.64 37.37±13.77 0.870 0.386 住院时间/d 8.57±3.18 9.21±4.80 -1.099 0.273 BMI/(kg/m2) 22.25±3.01 22.00±2.45 0.604 0.547 AMC/cm 22.30±3.20 21.48±2.69 1.801 0.074 MAP/mmHg 106.41±15.31 105.33±10.24 0.527 0.600 Kru/(mL/min) 1.99±0.88 2.02±0.75 -0.567 0.572 MQSGA评分/分 12.03±2.69 12.78±3.18 -1.655 0.100 焦虑评分/分 9.07±3.12 13.97±3.53 -9.921 < 0.001 满意度评分/分 22.26±1.10 21.56±2.25 2.439 0.016 BMI: 体质量指数; AMC: 上臂肌围; MAP: 平均动脉压; Kru: 残存肾尿素清除率; MQSGA: 改良定量主观整体营养评价。*表示年龄为非正态分布数据资料，以中位数(四分位数间距)表示。 
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表 2 医联体转诊患者中不同性别及住院病因的焦虑评分比较(x±s)
指标 分类 n 焦虑评分/分 t/F P 性别 男 75 13.43±3.54 -2.268 0.025 女 43 14.93±3.33 住院病因 血管通路修复 39 13.37±2.52 0.797 0.693 感染性疾病 32 14.22±3.95 心脑血管事件 27 15.00±2.94 其他 20 13.26±4.48
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表 3 医联体转诊患者焦虑评分的Pearson相关性分析
指标 r P 年龄/岁 0.122 0.187 透析龄/月 -0.105 0.259 住院时间/d 0.059 0.523 BMI/(kg/m2) -0.213 0.021 AMC/cm -0.334 < 0.001 MAP/mmHg 0.224 0.015 Kru/(mL/min) 0.009 0.922 MQSGA评分/分 0.457 < 0.001
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表 4 医联体转诊患者中不同性别及住院病因的满意度评分比较(x±s)
指标 分类 n 满意度评分/分 t/F P 性别 男 75 21.68±2.33 0.716 0.475 女 43 21.37±2.09 住院病因 血管通路修复 39 22.16±2.09 0.513 0.878 感染性疾病 32 21.22±2.31 心脑血管事件 27 22.50±1.00 其他 20 21.93±1.47
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表 5 医联体转诊患者满意度评分的Pearson相关性分析
指标 r P 年龄/岁 -0.384 < 0.001 透析龄/月 -0.203 0.028 住院时间/d -0.099 0.284 BMI/(kg/m2) 0.130 0.161 AMC/cm 0.251 0.006 MAP/mmHg -0.061 0.511 Kru/(mL/min) -0.112 0.228 MQSGA评分/分 -0.355 < 0.001
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