维持性血液透析患者自我调节疲劳的影响因素及路径分析

doi:10.3761/j.issn.0254-1769.2024.02.004

摘要/Abstract

摘要：

目的基于应激作用过程理论，构建维持性血液透析患者自我调节疲劳影响因素的结构方程模型，为制订缓解患者自我调节疲劳的干预方案提供参考。方法 2022年4月—11月采用一般资料调查表、自我调节疲劳量表、透析患者症状困扰量表、生活定向测验问卷修订版、领悟社会支持量表、简易疾病感知问卷和医学应对方式问卷对420例维持性血液透析患者进行问卷调查。结果维持性血液透析患者自我调节疲劳得分为（49.52±10.93）分，自我调节疲劳与症状困扰、疾病感知、回避应对方式、屈服应对方式均呈显著正相关（r=0.476、0.428、0.303、0.611，均P<0.01）；与领悟社会支持、气质性乐观均呈显著负相关（r=-0.410、-0.652，均P<0.01）；与面对应对方式无显著相关性（r=-0.032，P>0.05）。Bootstrap分析显示，屈服应对方式、气质性乐观、领悟社会支持、疾病感知在症状困扰和自我调节疲劳间的中介效应显著（95%CI：0.027~0.203），症状困扰对自我调节疲劳的总效应为（P<0.001，95%CI：0.576~0.751），直接效应为（P<0.001，95%CI：0.170~0.357），间接效应为（P<0.001，95%CI：0.332~0.485），中介效应占总效应值的61.1%。结论维持性血液透析患者自我调节疲劳程度较高，有待进一步改善。医护人员应及时评估和干预患者的症状困扰，重点引导患者调整心态，乐观看待疾病，为患者提供心理引导和压力应对策略，减少患者消极应对的行为倾向，引导患者正确感知社会关系中的支持与关怀，帮助患者树立正确的疾病认知，从而降低患者的自我调节疲劳。

关键词: 维持性血液透析, 自我调节疲劳, 症状困扰, 影响因素分析, 护理

Abstract:

Objective Based on the process theory of stress effect，the structural equation model of the influencing factors of self-regulatory fatigue in maintenance hemodialysis patients is constructed，which provides theoretical bases and references for the formulation of intervention programs to relieve self-regulatory fatigue in patients. Method A total of 420 maintenance hemodialysis patients were surveyed using General Information Questionnaire，Self-Regulatory Fatigue Scale，Dialysis Symptom Index，Life Orientation Test-Revised，Perceived Social Support Scale，Brief Illness Perception Questionnaire and Medical Coping Styles Questionnaire. Results Total score of self-regulatory fatigue in maintenance hemodialysis patients was（49.52±10.93），and self-regulatory fatigue showed significant positive correlation with symptom distress，the illness perception，avoidance coping style，yieldly coping（r=0.476，0.428，0.303，0.611，all P<0.01）；self-regulatory fatigue showed significant negative correlation with perceived social support and dispositional optimism（r=-0.410，-0.652，all P<0.01）；it showed no significant correlation with facing coping（r=-0.032，P>0.05）. The Bootstrap analysis revealed that the mediation effect of yielding coping，dispositional optimism，perceived social support，and illness perception between symptom distress and self-regulatory fatigue was significant（95%CI：0.027~0.203）. The overall effect of symptom distress on self-regulatory fatigue was （P<0.001，95%CI：0.576~0.751）；the direct effect was（P<0.001，95%CI：0.170~0.357）；the indirect effect was（P<0.001，95%CI：0.332~0.485）；the mediation effect accounted for 61.1% of the total effect value. Conclusion Maintenance hemodialysis patients have a high degree of self-regulatory fatigue，which needs to be further improved. Medical staff should timely identify and evaluate the symptom distress of patients，focus on guiding patients to adjust optimistic disease，provide patients with psychological guidance and stress coping strategies，reduce the negative coping behavior tendency，guide the patients correctly perceive support and care in social relations，help patients set up the correct disease cognition，thus reducing the patient’s self-regulatory fatigue.

Key words: Maintenance Hemodialysis, Self-Regulatory Fatigue, Symptom Distress, Root Cause Analysis, Nursing Care

曾豪洁, 赵莉, 张陈, 范艺禧, 罗文煜, 周金凤. 维持性血液透析患者自我调节疲劳的影响因素及路径分析[J]. 中华护理杂志, 2024, 59(2): 156-163.

ZENG Haojie, ZHAO Li, ZHANG Chen, FAN Yixi, LUO Wenyu, ZHOU Jinfeng. Analysis of influencing factors and pathway of self-regulatory fatigue in maintenance hemodialysis patients[J]. Chinese Journal of Nursing, 2024, 59(2): 156-163.

图/表 5

表1 调查对象的一般资料及不同人口学、疾病特征的维持性血液透析患者自我调节疲劳得分比较（n=420）

Table 1 Comparison of self-regulatory fatigue scores among MHD patients with different demographic and disease characteristics（n=420）

表2 维持性血液透析患者自我调节疲劳与症状困扰、疾病感知、气质性乐观、领悟社会支持、应对方式的相关分析结果（r值，n=420）

Table 2 Correlation analysis of self-regulatory fatigue, symptom distress, dispositional optimism, illness perception, perceived social support and coping style in MHD patients（r value，n=420）

表3 维持性血液透析患者自我调节疲劳影响因素的多元线性回归分析结果（n=420）

Table 3 Multiple linear regression analysis of self-regulatory fatigue in MHD patients（n=420）

图1 维持性血液透析患者自我调节疲劳影响因素的结构方程模型（标准化）

Figure 1 Structural equation model for self-regulatory fatigue in maintenance hemodialysis patients（standardized）

表4 Bootstrap中介效应检验（标准化）

Table 4 Bootstrap Test of mediation effect（normalized）

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