维持性血液透析患者社会疏离感发展轨迹及其影响因素的研究

doi:10.3761/j.issn.0254-1769.2026.05.003

摘要/Abstract

摘要：

目的分析维持性血液透析（maintenance hemodialysis，MHD）患者社会疏离感的发展轨迹，并识别危险因素，为早期识别高危人群及制订个性化护理干预方案提供参考。方法便利选取2022年6月—2024年12月在宁波市某三级甲等综合医院进行治疗的320例MHD患者作为调查对象。采用一般疏离感量表评估MHD患者的社会疏离感水平，分别于透析第1周和透析第1、3、6个月时进行测量，通过潜变量混合增长模型分析最优潜在类别模型数并进行分类命名，采用多因素Logistic回归分析潜在类别间的独立影响因素。结果最终回收有效问卷300份。社会疏离感分为3个潜在类别，即社会疏离感缓慢下降型（36.00%）、社会疏离感持续上升型（38.00%）及高社会疏离感持续型（26.00%）。多因素Logistic回归分析结果显示，年龄、婚姻状况、居住地、透析龄、合并慢性病、社会影响、疾病接受度、家庭关怀度为MHD患者社会疏离感发展轨迹的独立影响因素（均P<0.05）。结论 MHD患者的社会疏离感发展轨迹存在异质性，提示临床医护人员可精准识别高危轨迹并实施差异化干预，减轻MHD患者的社会疏离感。

关键词: 血液透析, 社会疏离感, 危险因素, 潜变量混合增长模型, 轨迹, 护理

Abstract:

Objective To identify the developmental trajectory of social alienation and its risk factors in maintenance hemodialysis（MHD） patients，for early detection of high-risk individuals and development of personalized care. Methods A total of 320 MHD patients treated in the First Affiliated Hospital of Ningbo University from June 2022 to December 2024 were prospectively selected. The General Alienation Scale was used to assess the level of social alienation in MHD patients，with measurements taken at 1 week，1 month，3 months，and 6 months after dialysis initiation. The optimal number of latent classes was determined and named using a latent variable mixed growth model. Multivariate Logistic regression analyses were performed to identify independent influencing factors among the latent classes. Results A total of 300 patients were finally included in the study. Social alienation was divided into 3 latent classes，namely the slow-decreasing social alienation class（36.00%），the continuous-increasing social alienation class（38.00%），and the persistent high social alienation class（26.00%）. The results showed that age，marital status，place of residence，dialysis vintage，comorbid chronic diseases，social impact，disease acceptance，and family care were independent influencing factors for the developmental trajectory of social alienation in MHD patients（all P<0.05）. Conclusion The heterogeneity in social alienation trajectories among MHD patients underscores the need for clinicians to accurately identify high-risk trajectories and implement differentiated interventions to alleviate social alienation in MHD patients.

Key words: Hemodialysis, Social Alienation, Risk Factors, Latent Variable Mixed Growth Model, Trajectory, Nursing Care

庄珊珊, 徐超凡, 施亚凤, 曹越秀, 吕颖. 维持性血液透析患者社会疏离感发展轨迹及其影响因素的研究[J]. 中华护理杂志, 2026, 61(5): 598-604.

ZHUANG Shanshan, XU Chaofan, SHI Yafeng, CAO Yuexiu, LÜ Ying. Identification and strategic analysis of risk factors for social alienation in maintenance hemodialysis patients based on latent variable mixed growth model[J]. Chinese Journal of Nursing, 2026, 61(5): 598-604.

图/表 4

表1 调查对象的一般资料及社会疏离感发展轨迹的单因素分析（n=300）

Table 1 Univariate analysis of general data of respondents and developmental trajectory of social alienation（n=300）

表2 维持性血液透析患者社会疏离感发展的潜在类别拟合结果（n=300）

Table 2 Fitting results of latent classes for the development of social alienation in MHD patients（n=300）

图1 维持性血液透析患者社会疏离感发展轨迹注：T1为透析1周，T2~T4分别为透析1、3、6个月。GAS为一般疏离感量表。

Figure 1 Developmental trajectory diagram of social alienation in MHD patients

表3 维持性血液透析患者社会疏离感发展轨迹的多因素Logistic回归分析（n=300）

Table 3 Multivariate Logistic regression analysis of the developmental trajectory of social alienation in MHD patients（n=300）

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