维持性血液透析患者运动障碍综合征发生现状及影响因素分析

doi:10.3761/j.issn.0254-1769.2022.21.003

摘要/Abstract

摘要：

目的探讨维持性血液透析患者运动障碍综合征的发生现状及影响因素，为临床防治、干预提供理论基础。方法采用横断面研究，于2020年9月—12月选取在上海市某三级甲等医院血液透析中心进行规律血液透析，且年龄≥45岁、透析时间≥3个月的患者作为研究对象。采用双能X线骨密度仪、人体成分分析仪、测力仪等测量人体参数，并系统收集患者资料，评估运动障碍综合征的发生率及独立影响因素。结果 146例患者中，71例（48.6%）合并运动障碍综合征，Logistic回归分析显示，营养不良-炎症评分（OR=3.344）、中心型肥胖（OR=3.932）、伸膝肌力体重指数（OR=5.772）、相位角（OR=6.206）、合并脑血管疾病（OR=3.855）、贫血（OR=0.188）、心血管疾病（OR=3.431）是透析患者合并运动障碍综合征的影响因素（P<0.05）。结论中老年维持性血液透析患者运动障碍综合征发生率较高，营养不良-炎症评分≥8分，中心型肥胖、低伸膝肌力体重指数、低相位角、合并心血管及脑血管疾病的患者更易发生运动障碍综合征，建议尽早识别及筛查相关风险因素，采取综合性干预手段，减少维持性血液透析患者运动障碍综合征的发生。

关键词: 维持性血液透析, 运动功能, 运动障碍综合征, 影响因素分析, 护理

Abstract:

Objective To investigate the incidence and influencing factors of dysmobility syndrome（DMS） in maintenance hemodialysis（MHD） patients，and to provide theoretical bases for clinical prevention. Methods Data of MHD patients with the age of over 45 years and dialysis time of over 3 months were collected from a hemodialysis center of a Shanghai hospital from September to December 2020. Dual-energy X-ray absorptiometry，body composition analyzer and dynamometer were used to measure human parameters. Logistic regression model was used to analyze the independent influencing factors. Results The overall incidence of DMS in MHD patients was 48.6%（71 cases）. Logistic regression identified that patients with and without DMS were statistically different（P<0.05）in MIS（OR=3.344），concentric obesity（OR=3.932），knee extension strength/weight（OR=5.772），phase angle（OR=6.206），history of cerebrovascular（OR=3.855），cardiovascular（OR=3.431） disease and anemia（OR=0.188）. Conclusion The incidence of DMS in middle-aged and elderly MHD patients was high. MIS≥8，concentric obesity，low knee extensor muscle strength/weight and phase angle，history of anemia，cerebrovascular and cardiovascular disease are influencing factors of DMS in MHD patients. Health staff should evaluate influencing factors early to decrease the incidence of DMS.

Key words: Maintenance Hemodialysis, Motor Function, Dysmobility Syndrome, Influencing Factors Analysis, Nursing Care

朱张逸, 张昆, 李馨, 余晨, 许方蕾, 任鹏娜, 王爱丽. 维持性血液透析患者运动障碍综合征发生现状及影响因素分析[J]. 中华护理杂志, 2022, 57(21): 2578-2584.

ZHU Zhangyi, ZHANG Kun, LI Xin, YU Chen, XU Fanglei, REN Pengna, WANG Aili. Investigation and analysis of influencing factors related to dysmobility syndrome in maintenance hemodialysis patients[J]. Chinese Journal of Nursing, 2022, 57(21): 2578-2584.

图/表 4

表1 维持性血液透析患者运动障碍综合征各分支指标发生率比较[例（百分率，%）]

Table 1 Diagnostic indicators of dysmobility syndrome in maintenance syndrome patients[cases（percentage，%）]

表2 不同特征的维持性血液透析患者运动障碍综合征发生率比较[例（百分比，%）]

Table 2 Univariate analysis of the influencing factors of dysmobility syndrome[cases（percentage，%）]

表3 自变量赋值方式

Table 3 Independent variable assignment

表4 维持性血液透析患者运动障碍综合征的Logistic回归分析结果

Table 4 Results of Logistic regression analysis of dysmobility syndrome among maintenance hemodialysis patients

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