医养结合综合干预对上海郊区老年慢性肾脏病患者生活质量和精神状态的影响

doi:10.3969/j.issn.1674-8115.2022.07.009

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (7): 904-910.doi: 10.3969/j.issn.1674-8115.2022.07.009

• 论著 · 公共卫生 • 上一篇

医养结合综合干预对上海郊区老年慢性肾脏病患者生活质量和精神状态的影响

王亚琨¹(), 许佳瑞²(), 吴茜茜¹, 张晓华¹, 朱迎春¹, 白寿军¹()

^1.复旦大学附属中山医院青浦分院肾内科，上海 201700
^2.复旦大学附属中山医院肾内科，上海 200032

收稿日期:2022-03-23 接受日期:2022-06-07 出版日期:2022-07-28 发布日期:2022-09-04
通讯作者: 白寿军 E-mail:kyky1818@163.com;carriexu2005@163.com;baishoujun@126.com
作者简介:王亚琨(1988—)，女，主治医师，硕士；电子信箱：kyky1818@163.com
许佳瑞(1984—)，女，副主任医师，博士；电子信箱：carriexu2005@163.com第一联系人：（王亚琨、许佳瑞并列第一作者）
基金资助:
上海市青浦区科学技术委员会软课题(R2021-07);上海市“科技创新行动计划”技术标准项目基金(19DZ2205600);上海市“科技创新行动计划”长三角科技创新共同体领域项目(21002411500)

Effect of combination of medical care and nursing on the quality of life and mental state of elderly patients with chronic kidney disease in Shanghai suburbs

WANG Yakun¹(), XU Jiarui²(), WU Qianqian¹, ZHANG Xiaohua¹, ZHU Yingchun¹, BAI Shoujun¹()

^1.Department of Nephrology, Qingpu Branch of Zhongshan Hospital, Fudan University, Shanghai 201700, China
^2.Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai 200032, China

Received:2022-03-23 Accepted:2022-06-07 Online:2022-07-28 Published:2022-09-04
Contact: BAI Shoujun E-mail:kyky1818@163.com;carriexu2005@163.com;baishoujun@126.com
Supported by:
Soft Project of Qingpu District Science and Technology Committee of Shanghai(R2021-07);Shanghai “Science and Technology Innovation Plan” Technical Standard Project(19DZ2205600);Shanghai “Science and Technology Innovation Plan” Yangtze River Delta Scientific and Technological Innovation Community Project(21002411500)

摘要/Abstract

摘要：

目的·探索医养结合综合干预对上海郊区老年慢性肾脏病患者生活质量和焦虑/抑郁症状的影响。方法·选取居住在上海市青浦区2家养老机构的老年慢性肾脏病患者，分别用广泛性焦虑量表（Generalized Anxiety Disorder Scale-7，GAD-7）评估其焦虑状态，用老年抑郁量表（The Geriatric Depression Scale，GDS）评估其抑郁症状，用健康调查简表（The Mos 36-item Short Form Health Survey，又称SF-36量表）评估其生活质量。根据患者是否有焦虑/抑郁症状，分为有精神症状组（A组）和无精神症状组（B组）；再随机将A组分为医养结合干预组（A1组）和非医养结合干预组（A2组）。A1组采用医养结合工作模式，B组及A2组采用传统慢病管理模式（非医养结合工作模式）。分析GAD-7评分及GDS评分与SF-36量表8个维度评分的相关性。多因素Logistic回归分析老年慢性肾脏病患者生活质量的独立危险因素。干预6个月后进行效果评价，再次分别用上述3个量表评估其焦虑/抑郁症状及生活质量，比较医养结合干预前后焦虑/抑郁症状和生活质量的差异。结果·共纳入80例老年慢性肾脏病患者，其中A组54例（67.5%），B组26例（32.5%），焦虑和抑郁症状的发生率分别为37.5%和30.0%；A组中A1组27例，A2组27例。GAD-7评分及GDS评分与生活质量6个维度评分（生理功能、生理职能、一般健康状况、精力、情感职能、精神健康）均呈负相关（均P<0.05）。Logistic回归分析结果提示焦虑/抑郁症状是影响老年CKD患者生活质量的独立危险因素。A1组患者医养结合综合干预6个月后，与干预前比较焦虑/抑郁状态评分显著降低（均P<0.05）；而A2组干预前后评分比较，差异无统计学意义。干预前，A1、A2组的8个生活质量维度评分均显著低于B组（均P<0.05），A1组和A2组间差异无统计学意义；医养结合干预6个月后，A1组6个维度评分显著高于A2组以及干预前的A1组（均P<0.05），生理职能、社会功能无明显变化。结论·上海郊区老年慢性肾脏病患者的焦虑/抑郁症状会降低其生活质量；医养结合综合干预可改善该群体的焦虑/抑郁症状，提高其生活质量。

关键词: 医养结合, 慢性肾脏病, 生活质量, 焦虑, 抑郁

Abstract:

Objective·To explore the effect of the combination of medical care and nursing on the quality of life and the anxiety/depression symptom of the elderly patients with chronic kidney disease (CKD) in Shanghai surburbs.

Method·The elderly patients with CKD living in two nursing homes in Qingpu District, Shanghai were selected. The anxiety symptom was assessed by Generalized Anxiety Disorder Scale-7 (GAD-7), the depression symptom was assessed by The Geriatric Depression Scale (GDS), and the quality of life was assessed by The MOS 36-item Short Form Health Survey (SF-36). According to whether they had anxiety/depression symptom, they were divided into one group with mental symptoms (group A) and the other group without mental symptoms (group B). Then, the patients in group A were randomly divided into medical care and nursing-combined intervention group (group A1) and conventional group (group A2). Except group A1, group A2 and group B both adopted the traditional chronic disease management mode. The correlations of the scores of SF-36 in 8 dimensions with the GAD-7 score and the GDS score were analyzed. Multivariate Logistic regression analysis was used to analyze the independent risk factors of life quality of elderly patients with CKD. The mental symptoms and the quality of life before and after the 6-month interventions were compared to evaluate the combination of medical care and nursing.

Results·A total of 80 elderly patients with CKD were enrolled, including 54 cases (67.5%) in group A and 26 cases (32.5%) in group B, whose incidences of anxiety symptom and depression symptom were 37.5% and 30.0%, respectively. Group A included 27 cases in group A1 and 27 cases in group A2. The GAD-7 score and the GDS score were negatively correlated with the scores of 6 dimensions of quality of life (physiological function, role-physical, general health, vitality, role-emotional, and mental health), respectively (P<0.05). Logistic regression analysis showed that anxiety/depression symptom was an independent risk factor of the quality of life of elderly CKD patients. After the combined intervention of medical care and nursing for 6 months, the scores of GAD-7 and GDS in group A1 were significantly lower than those before intervention (P<0.05), while there was no statistical difference in the scores before and after the intervention in group A2. Before intervention, the scores of 8 dimensions of quality of life in group A1 and A2 were significantly lower than those in group B (P<0.05), and there was no significant difference between A1 and A2 groups. After 6 months of intervention, the scores of 6 dimensions in group A1 were significantly higher than those in group A2 and those in group A1 before the intervention (P<0.05), and there were no obvious changes in role-physical and social functioning.

Conclusion·The anxiety/depression symptom of elderly patients with CKD in Shanghai surburbs can reduce their quality of life; the combination of medical care and nursing can improve the anxiety/depression symptom of these patients and their quality of life as well.

Key words: medical care and nursing, chronic kidney disease (CKD), quality of life, anxiety, depression

中图分类号:

R692.5

王亚琨, 许佳瑞, 吴茜茜, 张晓华, 朱迎春, 白寿军. 医养结合综合干预对上海郊区老年慢性肾脏病患者生活质量和精神状态的影响[J]. 上海交通大学学报（医学版）, 2022, 42(7): 904-910.

WANG Yakun, XU Jiarui, WU Qianqian, ZHANG Xiaohua, ZHU Yingchun, BAI Shoujun. Effect of combination of medical care and nursing on the quality of life and mental state of elderly patients with chronic kidney disease in Shanghai suburbs[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(7): 904-910.

图/表 5

参考文献 26

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Item	Group A1 （n=27）	Group A2 （n=27）	Group B （n=26）	P value
Male/n （%）	12 （44.4）	15 （55.6）	16 （61.5）	0.684
Age/year	74.1±10.2	72.4±8.4	73.6±8.2	0.721
Nursing home （A/B）/n	12/15	14/13	12/14	0.702
Marital status （married/divorced/widowed）/n	17/3/7	15/5/7	15/5/6	0.801
Smoking/n （%）	10 （37.0）	9 （33.3）	9 （34.6）	0.412
High school or above/n （%）	11 （40.7）	10 （37.0）	10 （38.5）	0.891
Hypertension/n （%）	14 （51.9）	13 （48.1）	12 （46.2）	0.109
Diabetes/n （%）	9 （33.3）	8 （29.6）	8 （30.8）	0.531
Coronary heart disease/n （%）	7 （25.9）	8 （29.6）	6 （23.1）	0.682
Hyperuricemia/n （%）	17 （63.0）	18 （66.7）	17 （65.4）	0.711
Cerebral stroke/n （%）	6 （22.2）	5 （18.5）	5 （19.2）	0.752
CKD stage/n （%）				0.669
Stage 1‒2	4 （14.8）	2 （7.4）	3 （11.5）
Stage 3	9 （33.3）	8 （29.6）	11 （42.3）
Stage 4	11 （40.7）	13 （48.1）	9 （34.6）
Stage 5	3 （11.1）	4 （14.8）	3 （11.5）
Dialysis mode/n （%）				0.672
Non-dialysis	25 （92.6）	24 （88.9）	25 （96.2）
Haemodialysis	1 （3.7）	2 （7.4）	1 （3.8）
Peritoneal dialysis	1 （3.7）	1 （3.7）	0 （0）

Item	Group A1 （n=27）	Group A2 （n=27）	Group B （n=26）	P value
Male/n （%）	12 （44.4）	15 （55.6）	16 （61.5）	0.684
Age/year	74.1±10.2	72.4±8.4	73.6±8.2	0.721
Nursing home （A/B）/n	12/15	14/13	12/14	0.702
Marital status （married/divorced/widowed）/n	17/3/7	15/5/7	15/5/6	0.801
Smoking/n （%）	10 （37.0）	9 （33.3）	9 （34.6）	0.412
High school or above/n （%）	11 （40.7）	10 （37.0）	10 （38.5）	0.891
Hypertension/n （%）	14 （51.9）	13 （48.1）	12 （46.2）	0.109
Diabetes/n （%）	9 （33.3）	8 （29.6）	8 （30.8）	0.531
Coronary heart disease/n （%）	7 （25.9）	8 （29.6）	6 （23.1）	0.682
Hyperuricemia/n （%）	17 （63.0）	18 （66.7）	17 （65.4）	0.711
Cerebral stroke/n （%）	6 （22.2）	5 （18.5）	5 （19.2）	0.752
CKD stage/n （%）				0.669
Stage 1‒2	4 （14.8）	2 （7.4）	3 （11.5）
Stage 3	9 （33.3）	8 （29.6）	11 （42.3）
Stage 4	11 （40.7）	13 （48.1）	9 （34.6）
Stage 5	3 （11.1）	4 （14.8）	3 （11.5）
Dialysis mode/n （%）				0.672
Non-dialysis	25 （92.6）	24 （88.9）	25 （96.2）
Haemodialysis	1 （3.7）	2 （7.4）	1 （3.8）
Peritoneal dialysis	1 （3.7）	1 （3.7）	0 （0）

Dimension of SF-36	GAD-7 score	GDS score
Physical functioning	-0.362^①	-0.291^⑥
Role-physical	-0.442^②	-0.378^⑦
Bodily pain	0.092	0.117
General health	-0.421^③	-0.391^④
Vitality	-0.492^④	-0.481^④
Social functioning	0.045	0.049
Role-emotional	-0.418^⑤	-0.268^⑧
Mental health	-0.501^④	-0.582^④

Dimension of SF-36	GAD-7 score	GDS score
Physical functioning	-0.362^①	-0.291^⑥
Role-physical	-0.442^②	-0.378^⑦
Bodily pain	0.092	0.117
General health	-0.421^③	-0.391^④
Vitality	-0.492^④	-0.481^④
Social functioning	0.045	0.049
Role-emotional	-0.418^⑤	-0.268^⑧
Mental health	-0.501^④	-0.582^④

Factor	OR （95%CI）	P value
Gender （female=0/male=1）	0.877 （0.318‒0.956）	0.006
Age （every 1 year added）	1.189 （1.024‒3.073）	0.000
Educational level （junior high school or below=0/high school or above=1）	0.993 （0.498‒0.998）	0.018
Diabetes （no=0/yes=1）	1.652 （1.102‒3.834）	0.020
Dialyses （no=0/yes=1）	3.154 （1.496‒8.887）	0.000
Anxiety/depression symptom （no=0/yes=1）	2.134 （1.019‒5.883）	0.002

医养结合综合干预对上海郊区老年慢性肾脏病患者生活质量和精神状态的影响

Effect of combination of medical care and nursing on the quality of life and mental state of elderly patients with chronic kidney disease in Shanghai suburbs

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Metrics

Group	GAD-7 score			GDS score
Group	0 month	6 months	P value	0 month	6 months	P value
Group A1
Patients with anxiety symptom （n=16）	13.14±3.28	7.81±3.09^①	0.000	‒	‒	‒
Patients with depression symptom （n=11）	‒	‒	‒	21.89±3.48	16.08±3.52^②	0.001
Group A2
Patients with anxiety symptom （n=14）	14.02±3.04	14.19±2.11	0.893	‒	‒	‒
Patients with depression symptom （n=13）	‒	‒	‒	20.25±2.91	19.25±2.91	0.346

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Dimension of SF-36	0 month			6 months
Dimension of SF-36	Group A1	Group A2	Group B	Group A1	Group A2	Group B
Physical functioning	38.8±21.8^①	41.9±23.7^②	58.1±21.3	50.8±25.9^⑪	44.1±24.2^⑦	50.2±19.9
Role-physical	45.4±27.2^③	47.1±22.9^④	60.2±21.7	49.9±25.3	42.8±26.4	57.1±22.9
Bodily pain	50.4±27.2^①	47.1±26.8^②	73.1±16.8	67.9±18.5^⑪	49.8±20.4^⑧	71.2±18.4
General health	44.1±21.8^①	46.7±20.2^⑤	63.9±18.5	57.8±18.2^⑫	50.1±19.9^⑨	62.3±20.8
Vitality	39.2±24.1^①	38.1±20.4^②	59.2±14.6	53.2±24.9^⑪	40.2±19.5^⑧	60.1±20.8
Social functioning	31.2±19.1^①	33.1±20.9^②	40.3±19.8	30.2±17.1	35.2±20.2	42.1±15.9
Role-emotional	53.6±27.6^①	51.9±24.2^②	77.4±14.1	68.1±21.6^⑬	50.1±29.2^⑧	74.1±19.5
Mental health	51.2±26.1^①	50.4±24.8^⑥	70.1±18.6	66.8±19.1^⑭	52.4±20.1^⑩	72.4±21.8

Dimension of SF-36	0 month			6 months
Dimension of SF-36	Group A1	Group A2	Group B	Group A1	Group A2	Group B
Physical functioning	38.8±21.8^①	41.9±23.7^②	58.1±21.3	50.8±25.9^⑪	44.1±24.2^⑦	50.2±19.9
Role-physical	45.4±27.2^③	47.1±22.9^④	60.2±21.7	49.9±25.3	42.8±26.4	57.1±22.9
Bodily pain	50.4±27.2^①	47.1±26.8^②	73.1±16.8	67.9±18.5^⑪	49.8±20.4^⑧	71.2±18.4
General health	44.1±21.8^①	46.7±20.2^⑤	63.9±18.5	57.8±18.2^⑫	50.1±19.9^⑨	62.3±20.8
Vitality	39.2±24.1^①	38.1±20.4^②	59.2±14.6	53.2±24.9^⑪	40.2±19.5^⑧	60.1±20.8
Social functioning	31.2±19.1^①	33.1±20.9^②	40.3±19.8	30.2±17.1	35.2±20.2	42.1±15.9
Role-emotional	53.6±27.6^①	51.9±24.2^②	77.4±14.1	68.1±21.6^⑬	50.1±29.2^⑧	74.1±19.5
Mental health	51.2±26.1^①	50.4±24.8^⑥	70.1±18.6	66.8±19.1^⑭	52.4±20.1^⑩	72.4±21.8