腹膜透析病人生活品質及其相關因素之研究-以台北市某醫學中心腹膜透析病人為例

Abstract

本研究旨在探討腹膜透析病人生活品質及其相關因素，以台北市某醫學中心腹膜透析中心門診病人為對象，採結構式問卷為研究工具，共取得256份有效問卷，回收率77.6%，另外也收集白蛋白、血色素及蛋白質異化速率等控制資料，並以單因子變異數分析、皮爾森積差相關、多元逐步迴歸分析等進行統計分析，主要發現如下: 一、 研究對象生活品質總分之平均得分為87.76±14.08分。生活品質各範疇中，得分最高為環境範疇，其次是社會關係範疇，再其次是生理與心理範疇。 二、 研究對象心理困擾程度大都介於｢身心適應良好｣至｢輕度情緒困擾｣間。45.3%的研究對象沒有明顯心理困擾，困擾問題以睡眠困難為主。 三、 研究對象有高程度的社會支持，且以來自醫護人員的社會支持度高於家人親友的社會支持度。 四、 研究對象教育程度愈高、有工作及退休者與有一種其他慢性病的人，生活品質愈好；年紀、經濟狀況與心理困擾呈現負相關；有伴侶關係者及透析時間在5年以下者有較高的社會支持度。 五、 研究對象心理困擾與生活品質呈現負相關；社會支持與生活品質呈現正相關；營養狀況只有白蛋白與生活品質的心理範疇有正相關及血紅素與生活品質的社會關係範疇有負相關，其餘營養指標對於生活品質均沒有達到統計上的顯著相關。 六、 研究對象之職業、心理困擾及醫護人員社會支持對生活品質總分有顯著預測力；職業、合併症及心理困擾對生活品質生理範疇有顯著預測力。白蛋白、心理困擾與家人親友社會支持對生活品質心理範疇有顯著預測力；性別、職業、心理困擾及家人親友社會支持對生活品質社會關係範疇有顯著預測力；心理困擾及醫護人員社會支持對生活品質之環境範疇有顯著預測力。

The purpose of this study was to investigate the quality of life (QOL) and its related factors in peritoneal dialysis (PD) patients. Structured questionnaires were used to evaluate the patients in the outpatient clinics of a PD center in Taipei City. A total of 256 valid responses were gathered with a response rate of 77.6%. Controlling factors such as serum albumin level, hemoglobin level and protein catabolic rate were collected and analyzed using univariate ANOVAs, Pearson product-moment correlations and multiple stepwise regressions. The major findings were as follows: 1. The mean total QOL score of the study subjects was 87.76±14.08. The domain that presented the highest score was ‘Environment’, followed by the ‘Social Relationships’ domain, then the ‘Physical’ and ‘Psychological’ domains. 2. The levels of psychological distress of the study subjects were between ‘being physically and mentally well’ and ‘having mild emotional distress’. 45.3% of the study subjects had no remarkable psychological distress, the major source of distress was sleeping difficulty. 3. The study subjects had high levels of social support that were higher from the medical staff than from family and friends. 4. Study subjects with higher educational levels, having a job, being retired, or having only one other chronic disease had higher QOL scores. Age and economic status showed negative correlations with psychological distress. Study subjects in a relationship or under dialysis for less than 5 years had higher social support. 5. Psychological distress levels of the study subjects were negatively correlated with QOL. Social support was positively correlated with QOL. Serum albumin level correlated positively with the psychological domain of QOL while hemoglobin level correlated negatively with the social relationships domain of QOL. Other nutrition indicators did not have a statistically significant correlation with QOL. 6. Occupation, psychological distress and social support from medical staff of the study subjects had a significant predictive value for the total QOL scores. Occupation, comorbidity and psychological distress had a significant predictive value for the physical domain of QOL. Serum albumin level, psychological distress and social support from family and friends had a significant predictive value for the psychological domain of QOL. Sex, occupation, psychological distress and social support from family and friends had a significant predictive value for the social relationships domain of QOL. Psychological distress and social support from medical staff had a significant predictive value for the environment domain of QOL.