基于聚类分析的青年维持性血液透析患者亚群分类研究  

Subtyping of young hemodialysis patients based on cluster analyses

作　　者：黄莉娟 段培蓓 潘园[3] 金彩香[3] HUANG Li-juan;DUAN Pei-bei;PAN Yuan;JIN Cai-xiang(School of Nursing,Nanjing University of Traditional Chinese Medicine,Nanjing 210023,China;Department of Nursing,The Affiliated Hospital of Nanjing University of Traditional Chinese Medicine,Nanjing 210029,China;Department of Nephrology,Nanjing Integrated Traditional Chineseand Western Medicine Hospital,Nanjing University of Traditional Chinese Medicine,Nanjing 210014,China)

机构地区：[1]南京中医药大学护理学院,南京210023 [2]南京中医药大学附属医院护理部,南京210029 [3]南京中医药大学附属南京市中西医结合医院肾内科,南京210014

出　　处：《中国血液净化》2019年第5期352-355,共4页Chinese Journal of Blood Purification

摘　　要：目的以影响青年维持性血液透析(maintenance hemodialysis,MHD)患者疾病管理行为的自我管理能力、自我效能和希望水平为基础,判断其分型,期望提出更有针对性的疾病管理策略。方法采用MHD患者自我管理行为量表(self-management scale for hemodialysis,SMSH)、慢性病自我效能量表(self-efficacy scale for chronic,SESC)及Herth希望量表(herth hope index,HHI),对入选患者测评,通过SPSS 22.0中的聚类分析方法分类,比较不同类型患者的一般特征。结果患者分4类,Ⅰ类"乐观熟练型"(24.7%),其自我管理能力、自我效能及希望水平得分均高于总体样本;Ⅱ类"盲目自信型"(16.7%),其自我效能及希望水平高于总体水平,但自我管理能力较差;Ⅲ类"忧虑参与型"(41.4%),其自我管理能力较好,但自我效能和希望水平略差;Ⅳ类"悲观无为型"(17.2%),其自我管理能力、自我效能及希望水平均较低。4类患者在文化程度(χ~2=16.707,P=0.010)、工作状况(χ~2=9.312,P=0.025)、主要照顾者类型(χ~2=57.570,P<0.001)及透析年限(χ~2=44.584,P<0.001)方面的差异有统计学意义。结论将青年HD患者分为4种亚型,有助于医护人员制定更有针对性的干预措施,为实现疾病管理同类型标准化提供依据。Objective To explore the possible subtypes of young maintenance hemodialysis patients based on patients'self-management ability,self-efficacy and hope.Methods A total of 198 young maintenance hemodialysis patients were assessed by Self-management Scale for Hemodialysis(SMSH),Self-Efficacy Scale for Chronic(SESC)and Herth Hope Index(HHI).Cluster analysis was performed to categorize patients based on their scores using SPSS 22.0 software.Results Four different subtypes could be found in these patients.Type I patients(24.7%of the patients)showed very good self-management abilities,positively and optimistically.Type II patients(16.7%of the patients)showed blind permissive management and good self-efficacy and hope but with poor self-management ability.TypeⅢpatients(41.4%of the patients)performed poorly in emotional accommodation but with good self-management ability.TypeⅣpatients(17.2%of the patients)were pessimistic with poor self-management ability,self-efficacy and hope.Education level(χ^2=16.707,P=0.010),job(χ^2=9.312,P=0.025),primary caregivers(χ^2=57.570,P<0.001)and dialysis duration(χ^2=44.584,P<0.001)were significant different between the four subtypes of patients.Conclusion To divide young hemodialysis patients into four subtypes can help medical staff develop better targeted interventions and provide a basis for standardization of disease management.

关 键 词：青年 维持性血液透析 疾病管理 聚类分析 

分 类 号：R473[医药卫生—护理学]