居家腹膜透析患者衰弱现状及影响因素研究

doi:10.3761/j.issn.0254-1769.2025.11.013

摘要/Abstract

摘要：

目的调查居家腹膜透析患者衰弱现状并分析其影响因素，为早期识别高危人群并开展针对性临床干预提供依据。方法采用便利抽样法，于2024年10月—12月选取广东省中山市某三级甲等医院长期随访的205例居家腹膜透析患者作为调查对象，应用一般资料调查表、Fried衰弱表型量表、营养风险筛查表、运动自我效能量表、社会支持评定量表进行调查，采用有序多分类Logistic回归分析居家腹膜透析患者衰弱的影响因素。结果 201例居家腹膜透析患者衰弱的发生率为24.3%，衰弱前期的发生率为39.3%，36.3%的患者为无衰弱。有序多分类Logistic回归分析显示，年龄、居住地、原发疾病、睡眠状况、血清白蛋白浓度、运动自我效能水平是居家腹膜透析患者衰弱的影响因素（P<0.05）。结论居家腹膜透析患者衰弱发生率较高，年龄大、居住地为农村、原发疾病为其他类型、失眠、血清白蛋白浓度低、运动自我效能水平低的患者更易发生衰弱。腹膜透析专科医护人员应重视对此类患者衰弱的早期筛查，针对相关危险因素采取个性化干预措施以预防或延缓衰弱发生。

关键词: 居家腹膜透析, 衰弱, 影响因素分析, 护理

Abstract:

Objective To investigate the current situation of frailty in patients with home peritoneal dialysis and analyze its influencing factors，so as to provide bases for early identification of high-risk groups and targeted clinical intervention. Methods From October to December 2024，205 home-based peritoneal dialysis patients under long-term follow-up at a tertiary A hospital in Zhongshan，Guangdong Province，were selected by convenience sampling. The General Information Questionnaire，Fried Phenotype Scale，Nutritional Risk Screening Tool，Exercise Self-Efficacy Scale，and Social Support Rating Scale were used to investigate the influencing factors of frailty in home-based peritoneal dialysis patients by ordinal logistic regression analysis. Results A total of 201 valid questionnaires were collected. The prevalence of frailty among home-based peritoneal dialysis patients was 24.3%，while 39.3% were in the pre-frailty stage，and 36.3% showed no frailty. Ordinal logistic regression analysis revealed that age，residence location，primary disease，sleep status，serum albumin concentration，and exercise self-efficacy level were influencing factors of frailty in the home peritoneal dialysis patients（P<0.05）. Conclusion The incidence of frailty in patients with home peritoneal dialysis is higher，and patients with advanced age，living in rural areas，other types of primary diseases，insomnia，low serum albumin concentration and low exercise self-efficacy are more likely to develop frailty. Specialist doctors and nurses of peritoneal dialysis should pay attention to the early screening of frailty in patients with peritoneal dialysis at home，and take personalized intervention measures to prevent or delay the occurrence of frailty according to the relevant risk factors.

Key words: Home Peritoneal Dialysis, Frailty, Root Cause Analysis, Nursing Care

张蕾, 聂芳, 彭文君, 郭利群, 刘姗, 黄欣悦, 冯志芬. 居家腹膜透析患者衰弱现状及影响因素研究[J]. 中华护理杂志, 2025, 60(11): 1366-1372.

ZHANG Lei, NIE Fang, PENG Wenjun, GUO Liqun, LIU Shan, HUANG Xinyue, FENG Zhifen. The current status and influencing factors analysis of frailty in peritoneal dialysis patients at home[J]. Chinese Journal of Nursing, 2025, 60(11): 1366-1372.

图/表 3

表1 居家腹膜透析患者的一般资料及衰弱的单因素分析（n=201）

Table 1 Univariate analysis of frailty in home peritoneal dialysis patients（n=201）

表2 自变量赋值方式

Table 2 Independent variable assignment

表3 居家腹膜透析患者衰弱的有序多分类Logistic回归分析（n=201）

Table 3 Ordinal Logistic regression analysis of frailty in home peritoneal dialysis patients（n=201）

参考文献 27

[1]	《中国腹膜透析管理现状白皮书》项目组, 余学清. 中国腹膜透析管理现状白皮书[J]. 中华肾脏病杂志, 2022(12):1076-1104.
	Project Group of White Paper on the Status of Peritoneal Dialysis Management in China, Yu XQ. White paper on the current status of peritoneal dialysis management in China[J]. Chin J Nephrol, 2022(12):1076-1104. DOI
[2]	Collaboration GCKD. Global,regional,and national burden of chronic kidney disease,1990-2017:a systematic analysis for the global burden of disease study 2017[J]. Lancet, 2020, 395(10225):709-733.
[3]	全国腹膜透析病例信息登记系统. 中国医师协会肾脏内科医师分会2022年学术年会[EB/OL].(2022-07-21)[2025-01-16]. http://cna2022.i-con-ference.org/.
	National Peritoneal Dialysis Case Information Registration Sys-tem. Chinese Medical Doctor Association Renal Physicians Bra-nch Annual Conference 2022[EB/OL].(2022-07-21)[2025-01-16]. http://cna2022.i-conference.org/.
[4]	王晔, 高旭, 吴导花, 等. 持续非卧床腹膜透析患者自我管理能力现状及影响因素分析[J]. 中国医药导报, 2024, 21(15):30-32.
	Wang Y, Gao X, Wu DH, et al. Analysis of the current status and influencing factors of self-management ability of con-tinuous ambulatory peritoneal dialysis patients[J]. China Med Her, 2024, 21(15):30-32.
[5]	Chan GC, Ng JK, Cheng PM, et al. Dietary micronutrient intake and its relationship with the malnutrition-inflammation-frailty complex in patients undergoing peritoneal dialysis[J]. Nutrients, 2023, 15(23):4934.
[6]	李娜, 白彝华, 蒋红樱, 等. 长期维持性透析患者的衰弱现况及其影响因素[J]. 实用医学杂志, 2024, 40(3):330-335.
	Li N, Bai YH, Jiang HY, et al. Frailty of patients with long-term maintenance dialysis and its influencing factors[J]. J Pract Med, 2024, 40(3):330-335.
[7]	Kennard AL, Glasgow NJ, Rainsford SE, et al. Narrative review:clinical implications and assessment of frailty in patients with advanced CKD[J]. Kidney Int Rep, 2023, 9(4):791-806.
[8]	陈灿灿, 黄维凤, 陈春丽, 等. 健康信念模式信息传播联合运动干预在血液透析伴衰弱患者康复中的应用效果评价[J]. 中国健康教育, 2024, 40(7):666-670.
	Chen CC, Huang WF, Chen CL, et al. Application effect of education combined with physical exercise intervention on rehabilitation among hemodialysis patients with frailty[J]. Chin J Heal Educ, 2024, 40(7):666-670.
[9]	上海市肾内科临床质量控制中心专家组. 慢性肾脏病早期筛查、诊断及防治指南(2022年版)[J]. 中华肾脏病杂志, 2022, 38(5):453-464. DOI
	Expert Group on Kidney Clinical Quality Control Center in Shanghai. Guidelines for early screening,diagnosis,prevention and treatment of chronic kidney disease(2022 Edition)[J]. Chin J Nephrol, 2022, 38(5):453-464. DOI
[10]	Fried LP, Tangen CM, Walston J, et al. Frailty in older adults:evidence for a phenotype[J]. J Gerontol A Biol Sci Med Sci, 2001, 56(3):M146-M156.
[11]	卿伟, 邹兆华, 易子涵, 等. 维持性血液透析病人衰弱及衰弱前期风险预测模型的构建[J]. 护理研究, 2024, 38(2):233-239.
	Qing W, Zou ZH, Yi ZH, et al. Construction of risk prediction model for frailty and pre-frailty in patients with maintenance hemodialysis[J]. Chin Nurs Res, 2024, 38(2):233-239.
[12]	Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional Risk Screening(NRS 2002):a new method based on an analysis of controlled clinical trials[J]. Clin Nutr, 2003, 22(3):321-336. DOI PMID
[13]	Resnick B, Jenkins LS. Testing the reliability and validity of the Self-efficacy for Exercise Scale[J]. Nurs Res, 2000, 49(3):154-159. DOI PMID
[14]	Lee LL, Perng SJ, Ho CC, et al. A preliminary reliability and validity study of the Chinese version of the Self-efficacy for Exercise Scale for older adults[J]. Int J Nurs Stud, 2009, 46(2):230-238.
[15]	肖水源. 《社会支持评定量表》的理论基础与研究应用[J]. 临床精神医学杂志, 1994(2):98-100.
	Xiao SY. Theoretical basis and research application of Social Support Rating Scale[J]. J Clin Psychiatry, 1994(2):98-100.
[16]	朱丽娜, 林建雄, 林小燕, 等. 腹膜透析患者衰弱状况及其影响因素分析的横断面研究[J]. 现代临床护理, 2019, 18(9):1-6.
	Zhu LN, Lin JX, Lin XY, et al. A cross-sectional study on frailty of peritoneal dialysis patients and its influencing factors[J]. Mod Clin Nurs, 2019, 18(9):1-6.
[17]	陈管洁, 张海林, 尹丽霞, 等. 维持性血液透析患者认知功能障碍与衰弱的相关性[J]. 护理学杂志, 2021, 36(6):27-31.
	Chen GJ, Zhang HL, Yin LX, et al. Relationship between cog-nitive impairment and frailty in maintenance hemodialysis patients[J]. J Nurs Sci, 2021, 36(6):27-31.
[18]	Taylor JA, Greenhaff PL, Bartlett DB, et al. Multisystem phy-siological perspective of human frailty and its modulation by physical activity[J]. Physiol Rev, 2023, 103(2):1137-1191.
[19]	王思沛, 王研, 牛伟华, 等. 慢性心力衰竭患者躯体、认知、社会衰弱共存现状及影响因素研究[J]. 中华护理杂志, 2025, 60(3):311-318.
	Wang SP, Wang Y, Niu WH, et al. The current status and influencing factors of the coexistence of multiple frailty domains in patients with chronic heart failure[J]. Chin J Nurs, 2025, 60(3):311-318.
[20]	Cuevas MD, Ramírez RL, Contreras FJP, et al. Peritoneal dia-lysis in incident patients with primary glomerulonephritis. Results of a 20-year multicenter registry study[J]. Nefrologia, 2021, 41(1):53-61. DOI PMID
[21]	王丽娟, 张淼, 张鑫, 等. 维持性血液透析患者衰弱影响因素的Meta分析[J]. 中华护理教育, 2024, 21(3):365-372.
	Wang LJ, Zhang M, Zhang X, et al. Meta-analysis of influenc-ing factors of frailty in maintenance hemodialysis patients[J]. Chin J Nurs Educ, 2024, 21(3):365-372.
[22]	王洪梅, 李娜, 王红, 等. 住院老年眩晕患者衰弱现状及影响因素研究[J]. 中华护理杂志, 2023, 58(2):205-210. DOI
	Wang HM, Li N, Wang H, et al. The current situation and influential factors of frailty in elderly patients with vertigo[J]. Chin J Nurs, 2023, 58(2):205-210. DOI
[23]	Wen Q, Yan X, Ren Z, et al. Association between insomnia and frailty in older population:a meta-analytic evaluation of the observational studies[J]. Brain Behav, 2023, 13(1):e2793.
[24]	Frohnhofen H, Stenmanns C, Gronewold J, et al. Frailty pheno-type and risk factor for disturbed sleep[J]. Z Gerontol Geria-tr, 2023, 56(7):551-555.
[25]	刘颖, 张倩, 张春艳. 个体化饮食对腹膜透析患者营养状况及钙磷代谢的影响[J]. 齐鲁护理杂志, 2023, 29(5):17-20.
	Liu Y, Zhang Q, Zhang CY. Effect of individualized diet on nutritional status,calcium and phosphorus metabolism in patients with peritoneal dialysis[J]. J Qilu Nurs, 2023, 29(5):17-20.
[26]	杨雅楠, 于瑶, 邢凤梅, 等. 基于计划行为理论的干预对老年肌少症患者疾病认知、运动自我效能及日常生活能力的影响[J]. 现代预防医学, 2024, 51(14):2615-2619.
	Yang YN, Yu Y, Xing FM, et al. Impact of intervention based on planned behavior theory on disease cognition,exercise self-efficacy,and daily living ability in elderly patients with sarcopenia[J]. Mod Prev Med, 2024, 51(14):2615-2619.
[27]	熊文, 赵娜. 交互式健康教育联合运动疗法对腹膜透析患者运动功能、自护能力及生活质量的影响[J]. 中国医药科学, 2024, 14(15):135-138.
	Xiong W, Zhao N. Effects of interactive health education combined with exercise therapy on motor function,self-care ability and quality of life of peritoneal dialysis patients[J]. Chin Med Pharm, 2024, 14(15):135-138.