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透析戒断和焦虑和抑郁症状:一个前性队列研究
Essam S El-Magd1, Robbert W Schouten2,3, Els Nadort4
1Department of Nephrology, OLVG Hospital, Amsterdam, The Netherlands. e.s.el-magd@olvg.nl.
焦虑和抑郁症显著增加了患者透析中止的风险. 识别这些心理健康因素可以帮助患者和临床医生做出明智的生命终结决策.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 精神病学是一个精神病学.
- 老年学是一门学科.
背景情况:
- 从透析中选择性取消是患者生命末期的关键决定.
- 虽然已知伴随性疾病等临床因素会影响戒断,但焦虑和抑郁症的影响仍未得到充分研究.
研究的目的:
- 调查焦虑和抑郁症状在透析戒断中的纵向作用.
- 确定精神健康症状是否是透析戒断的独立预测因素.
主要方法:
- 一项前性多中心研究跟踪了687名透析患者.
- 焦虑和抑郁症状在基线时使用贝克焦虑清单 (BAI) 和贝克抑郁清单 (BDI) 进行评估.
- 多变量考克斯比例危险模型分析了精神健康症状和透析戒断之间的关联,控制了临床因素.
主要成果:
- 在长达3.2年的中位数随访期间,7%的患者停止了透析治疗.
- 基线焦虑 (HR 2.31) 和抑郁症状 (HR 2.56) 与透析中止风险增加有显著的相关性.
- 这种关联在考虑体质并发症后也仍然显著.
结论:
- 焦虑和抑郁症状是透析戒断的重要独立预测因素.
- 患有较高焦虑和抑郁症的透析患者更容易退出治疗.
- 了解这些心理因素对于做出明智的决策和制定透析患者生命末期护理临床指南至关重要.
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