老年血液透析患者日常生活活动能力的影响因素调查分析  

Investigation of self-care ability and frailty of daily living activities in elderly hemodialysis patients and risk factor assessment

作　　者：杨柳[1] 何雯雯[1] 郝旭磊 张茜茜 王海燕 宋田雪 田志永 贾婉宁 王永娥 YANG Liu;HE Wen-wen;HAO Xu-lei(Department of Nephrology,China-Japan Friendship Hospital,Beijing 100029,China;不详)

机构地区：[1]中日友好医院血液净化中心,北京100029

出　　处：《中日友好医院学报》2024年第1期25-30,共6页Journal of China-Japan Friendship Hospital

基　　金：中日友好医院护理部项目(ZRHL-LCFC-22-03)。

摘　　要：目的:评价老年维持性血液透析(MHD)患者日常生活活动(ADL)自理能力,探讨其影响因素。方法:纳入中日友好医院血液净化中心228例老年MHD患者,采用老年人生活自理能力评估表和衰弱筛查量表进行现况调查,并进行相关性、单因素及多因素回归分析。结果:本组患者平均年龄70.9±7.2岁,男性占51%,23.7%的患者在日常生活(进食、个人卫生、穿衣、入厕及排泄和移动)中存在不同程度的依赖。单因素分析显示年龄、透析血流量、非计划下机和关注事件(骨折、心血管事件、门急诊住院)在不同ADL能力组间的差异有统计学意义(P<0.05);衰弱发生率高达85%,衰弱与ADL自理能力中度相关(r=0.503,P<0.01)。多因素Logistic回归分析,ADL可自理者发生ADL轻度、中度依赖的风险因素包括衰弱(OR=0.22、0.124,P<0.01)和年龄(OR=1.104、1.117,P<0.01);透析龄是ADL完全不能自理的风险因素(OR=1.151,P<0.01)。结论:老年MHD患者ADL自理能力与衰弱关系密切,衰弱进展增加了自理能力下降的风险。发生临床事件、设置较低的血流量、透析龄增加和非计划下机行为均与ADL自理能力下降有关,临床护理中应给予关注,尽早识别患者ADL能力下降并进行早期护理干预。Objective:To evaluate the self-care ability of activity of daily living(ADL)and weakness of elder⁃ly patients with maintenance hemodialysis(MHD),and to explore dialysis-related risk factors.Methods:A total of 228 elderly MHD patients from the Blood Purification Center of China-Japan Friendship Hospital were in⁃cluded.Cross-sectional survey was conducted using the assessment scale of self-care ability and frailty screen⁃ing scale of the elderly,and correlation analysis,univariate and multivariate regression analyses were carried out.Results:The mean age of the patients was 70.9±7.2 years,among them 51%were males,and 23.70%had various degrees of dependence on daily life(eating,personal hygiene,dressing,toileting and excretion and movement).Univariate analysis showed that age,dialysis blood flow,unplanned dismounting and events of con⁃cern(fracture,cardiovascular events,outpatient emergency hospitalization)were statistically significant between different ADL ability groups(P<0.05).The incidence of frailty was as high as 85%,and the correlation coeffi⁃cient with ADL capacity was 0.503(P<0.01).The multi-classification logistic regression equation showed that frailty(OR=0.22,0.124,P<0.01)and age(OR=1.104,OR=1.117,P<0.01)were risk factors for mild and moderate dependence of ADL in ADL self-care patients.Dialysis age(OR=1.151,P=0.014)was an independent risk fac⁃tor for ADL who could take care of themselves.Conclusion:Self-care of daily living in elderly MHD patients was strongly associated with prevalent frailty,and that progression of frailty exponentially increased the risk of declining self-care.The occurrence of clinical events,setting a lower blood flow,increasing dialysis age and having unplanned off-board behavior were associated with a decline in self-care in daily life.Attention should be given in clinical care to early recognition of declining ADL in elderly hemodialysis patients and early nursing intervention.

关 键 词：维持性血液透析 老年患者 日常生活活动 衰弱 

分 类 号：R473[医药卫生—护理学]