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背景:对疾病治疗的认知评价,直接影响患者的应对活动和身心反应,医学应对是影响临床治疗的重要因素之一。目的:比较血液透析及肾移植患者医学应对方式的特点和影响因素。设计、时间及地点:问卷调查,于2005-01/2006-01在首都医科大学附属北京友谊医院泌尿科完成。对象:选择在首都医科大学附属北京友谊医院门诊接受血液透析治疗的患者及门诊随诊的肾移植患者各60例。接受血液透析治疗/肾移植手术时间≥3个月,移植肾功能正常;自愿参加调查。方法:采用问卷调查法,由调查者采用统一的解释性语言,指导患者填写下列问卷。①一般情况问卷:包括性别、年龄、文化程度、职业、婚姻状况、子女情况、家庭收入、医疗付费方式、医疗费用对家庭的影响、接受血液透析治疗/肾移植手术时间等。②医学应对问卷:包含面对、回避和屈服3个分量表,各条目按1~4级计分,其分量表得分越高,表明个体越倾向于采用这种应对方式。主要观察指标:计算血液透析及肾移植患者的医学应对问卷各分量表得分,并与常模进行比较;分析患者的一般情况与各分量表得分的相关性。结果:120例患者全部进入结果分析,无脱落。①两组患者在医疗付费方式、医疗费用对家庭的影响以及血液透析/移植时间方面,差异存在显著性意义(P<0.05)。②血液透析患者医学应对方式问卷中面对、屈服量表得分均低于肾移植患者(P<0.05),两组患者的回避量表得分差异无显著性意义(P>0.05)。③血液透析患者医学应对方式中面对量表得分低于常模(P<0.05),回避、屈服量表得分均高于常模(P<0.05)。肾移植患者的面对量表得分与常模相似,差异无显著性意义(P>0.05);回避、屈服量表得分均高于常模(P<0.05)。④血液透析患者的面对量表得分与性别相关(r=-0.277,P<0.05);屈服量表得分与家庭收入相关(r=-0.287,P<0.05)。肾移植患者的面对量表得分与婚姻状态相关(r=0.282,P<0.05)。结论:治疗方法和心理社会因素影响终末期肾病患者的医学应对方式。与血液透析患者相比,肾移植患者更多采用面对、屈服的应对方式。血液透析患者的面对得分与其性别相关,屈服得分与家庭收入相关;肾移植患者的面对得分与其婚姻状况相关。
Background: Cognitive evaluation of disease treatment directly affects patients’ coping activities and physical and psychological reactions. Medical coping is one of the important factors affecting clinical treatment. Objective: To compare the characteristics and influencing factors of medical coping style in patients undergoing hemodialysis and renal transplantation. DESIGN, TIME AND SETTING: The questionnaire was completed at the Department of Urology, Beijing Friendship Hospital, Capital Medical University from January 2005 to January 2006. PARTICIPANTS: Sixty patients with hemodialysis patients and outpatient follow-up renal transplant patients were enrolled in Beijing Friendship Hospital affiliated to Capital Medical University. Hemodialysis treatment / kidney transplant surgery time ≥ 3 months, normal renal graft function; voluntarily participate in the survey. Methods: Using questionnaire survey method, the investigators adopted a unified interpretive language to guide patients to fill in the following questionnaires. ① General Questionnaire: Including gender, age, educational background, occupation, marital status, children’s condition, family income, medical payment, impact of medical expenses on the family, hemodialysis treatment / renal transplant operation time. ②Medical coping questionnaire: Including face, avoidance and submission of three subscales, each item by grade 1 to 4 scoring, the higher the subscale score, indicating that individuals are more inclined to adopt this coping style. MAIN OUTCOME MEASURES: Scores of the medical coping questionnaires in hemodialysis and renal transplant patients were calculated and compared with those in the norm, and correlations between the patient’s general condition and the subscales were analyzed. Results: All 120 patients entered the result analysis without falling off. ① The two groups of patients in the medical payment, the impact of medical expenses on the family and hemodialysis / transplantation time, the difference was significant (P <0.05). (2) In the questionnaire of hemodialysis patients’ medical coping style, the scores of the yield scale were lower than those of the kidney transplantation group (P <0.05). There was no significant difference between the two groups in the scale of avoidance scale (P> 0.05). (3) The scale of medical coping in hemodialysis patients was lower than that of norm (P <0.05), avoidance and yield scale scores were higher than the norm (P <0.05). The face-to-face scale of kidney transplant patients was similar to that of norm, but the difference was not significant (P> 0.05). The score of avoidance and yield scale was higher than that of norm (P <0.05). (4) The scale of face-to-face scale in hemodialysis patients was related to gender (r = -0.277, P <0.05). The scale of scale was correlated with family income (r = -0.287, P <0.05). The face-to-face scale of kidney transplant patients correlated with marital status (r = 0.282, P <0.05). Conclusion: The treatment methods and psychosocial factors influence the medical coping style of patients with end-stage renal disease. Compared with hemodialysis patients, kidney transplant patients more face to face, yielding coping styles. The face-to-face scores of hemodialysis patients were related to their gender, yield points correlated with family income, and the face-to-face scores of kidney transplant patients were related to their marital status.