A Comparison of Quality of Life in Haemodialysis and Peritoneal Dialysis Patients

Decreased quality of life of end-stage renal disease is further compromised by renal function replacement treatments such as haemodialysis (HD) and peritoneal dialysis (PD). Poor quality of life negatively affects treatment outcome. This study compared quality of life between HD and PD patients. Quality of life in 15 HD and 15 PD patients at a South African renal unit was compared using the SF-36 short form. There was no significant difference between HD and PD patients for total SF-36 score, but HD subjects reported more pain. Quality of life is similar in HD and PD patients, with the exception of higher pain levels in HD patients.     

慢性肾衰竭患者的人文关怀

慢性肾衰竭是一种长期的消耗性疾病,随着医学的进步,患者的生存时间明显延长,死亡率显著下降,但其并不能完全用以衡量医疗效果,保持良好的生理,心理及社会功能才是治疗的理想目标。这需要医务人员对患者实行有效的人文关怀,积极的心理治疗,提高患者的心理承受力和适应力,在延长患者生命的同时,改善和提高其生存质量。     

农村与城镇终末期肾病患者临床状况比较分析

对比分析农村与城镇终末期肾病患者的临床状况,旨在了解新农合政策带给农村终末期肾病患者的益处及今后还需完善和努力之处。对广西壮族自治区人民医院血液净化治疗中心2007年新增的238例终末期肾病患者按农村与城镇进行分组对比分析。96例农村患者,88例选择血液透析,8例放弃治疗;142例城镇患者,23例选择腹膜透析,108例血液透析,11例放弃。无论是城镇还是农村患者慢性肾炎为主要的原发病、都存在透析过晚、并发症发生率高、急诊透析率高的现象。与城镇组相比,农村组患者平均年龄、肾病知晓率、残余肾功能、血红蛋白、二氧化碳结合力、尿素清除指数低于城镇组（P〈0．05）;梗阻性肾病发病率、并发症发生率、急诊透析率、死亡率、失访率高于城镇组（P〈0．05）。新农合的实施使农村终末期肾病患者获得了治疗的机会,针对农村患者肾病知晓率低、临床状况差的特点,需加强农村慢性肾病的防治工作。     

慢性肾病、慢性肾功能衰竭全方位审视

慢性肾病（CKD）、慢性肾功能衰竭（CRF）是全身性疾病在肾脏的表现、特别与血管性免疫性和代谢性疾病相关。肾脏又是一个排泄器官,中西药的过度应用,尤其是具有毒性药物如雷公藤类、抗生素类累积性损伤肾脏。所以,根本性控制在于预防和少用药物。近年来因为应用了肾替代疗法、包括肾移植带来一些社会、经济、生活质量、移植肾来源等问题。本文以全新的理念提出质疑且对其共性治疗重新评估替代疗法,并重视个案分析对某些肾病的病名提出它的概念的非合理性,对其共性治疗的误导应予以反思。最后,建议逐步改变单纯生物医学模式的替代疗法,重视整体全方位地发挥自身潜在调节力量缓解或治愈或延长寿命,这样可以大大地减少CKD、CRF、ESRD的发病率。     

终末期肾脏疾病治疗的社会问题

终末期肾脏病是一种常见的导致劳动力丧失的疾病,在我国主要靠血液透析、腹膜透析或肾移植等替代治疗,医疗资源的不平衡分布致使只有部分患者能得以治疗,长期的替代治疗给患者的家庭造成巨大的经济负担,使患者对医护人员家庭成员等产生强烈的依赖感,从而使其处于焦虑、抑郁等负面心理状态,影响家庭与社会的稳定。针对这些社会和心理问题制定相关的行业规范是必需和必要的。     

心理咨询和治疗的知情同意原则及其影响因素

随着心理咨询和治疗的发展,患者的知情同意成为临床心理学实践的一个基本伦理观念和原则.首先提出心理咨询和治疗实践中的知情同意问题,介绍心理咨询和治疗知情同意的要素、过程、内容、意义和影响因素,并附心理咨询和治疗提供给患者的知情同意问卷,旨在引起从业者的注意和重视,并在临床实践中自觉地遵守.     

Type D personality,illness perception,social support and quality of life in continuous ambulatory peritoneal dialysis patients

The previous studies reported Type D was associated with poor quality of life (QoL), increased psychological distress, and impaired health status in cardiac patients. The aim of this study is to assess the relationships among Type D personality, illness perception, social support, and investigate the impact of Type D personality on QoL in continuous ambulatory peritoneal dialysis (CAPD) patients. Type D personality was assessed by the Chinese 14-item Type D Personality Scale (DS14). Illness perceptions were assessed using the Chinese version of the Brief Illness Perception Questionnaire (B-IPQ). Social support status was assessed by the well-validated social support rating scale (SSRS). Patients’ QoL was assessed by using Medical Outcomes Short Form 36 (SF-36), respectively. The Type Ds had significantly lower objective support score (8.18 ± 2.56 vs. 9.67 ± 3.28, p = 0.0001), subjective support score (6.71 ± 2.0 vs. 7.62 ± 1.93, p = 0.0001) and utilization of social support score (6.76 ± 2.0 vs. 7.61 ± 1.94, p = 0.0001) than that of the non-type Ds. Type Ds believed their illness had much more serious consequences (7.67 ± 2.64 vs. 6.27 ± 3.45, p < 0.001), and experience much more symptoms that they attributed to their illness (6.65 ± 2.54 vs. 7.31 ± 2.36, p = 0.023). Significant differences were found between Type Ds and non-Type Ds in PCS (40.53 ± 6.42 vs. 48.54 ± 6.21 p < 0.001) and MCS (41.7 1 ± 10.20 vs. 46.35 ± 9.31, p = 0.012). The correlation analysis demonstrated that Type D was negatively associated with physical component score (PCS) (r = –0.29, p < 0.01), mental component score (MCS) (r = –0.31, p < 0.01), and social support (r = –0.24, p < 0.001). Using multiple linear regression analysis, we found that Type D personality was independently associated with PCS (β = –0.32, p < 0.001) and MCS (β = –0.24, p < 0.001). Type D personality was a predictor of poor QoL in CAPD patients. The current study is the first to identify a strong association among Type D, illness perceptions, social support and QoL in CAPD patients. The worse illness perceptions and lower social support level therefore represent possible mechanisms to explain the link between Type D and poor QoL in CAPD patients.     

The influence of different dialysis modalities on the quality of life of patients with end-stage renal disease: A systematic literature review

Objectives: This study aims to generate evidence regarding the relationships of different dialysis modalities with HR-QOL.

Design: A systematic review was conducted to investigate the HR-QOL of patients treated with different dialysis modalities.

Methods: A literature search was conducted for English language articles in the CINAHL, Medline and PubMed databases published from January 1990 through May 2016. Specifically, we sought articles that would compare the HR-QOL of hemodialysis (HD) and peritoneal dialysis (PD) patients in terms of physiological, psychological and social functioning, as well as disease symptoms. Thirty-four articles met the study inclusion criteria and were included into the analysis.

Results: The research results indicated no significant differences in HR-QOL between HD and PD treatment. However, a higher percentage of patients who received PD had a better HR-QOL in terms of physiological, psychological, social and disease symptoms.

Conclusions: Despite the fact that the results of this study showed no difference in HR-QOL between HD and PD treatment, its review of relevant references can serve as a reference for health professionals. However, patients’ conditions must still be taken into account when making suggestions about which dialysis modality a patient should use.     

终末期肾病单病种付费实施现况及个人支付费用影响因素研究

单病种付费对于控制医疗费用的不合理增长与促进机构医疗服务质量的提高具有重要意义.通过对浙江省某市终末期肾病参保患者医疗费用支出、卫生服务利用等数据的收集,运用统计学分析工具,分析不同类型参保患者实际费用支出及卫生服务利用的差异,并探讨个人支付费用的影响因素.建议该市在终末期肾病单病种政策制定中建立动态的定额结算标准;鼓励与引导病情较轻的患者优先进行腹膜透析;并完善多层次的医疗保障制度,鼓励低收入家庭患者尽早就医.     

瑶医学“心肾相交论”内涵及临床指导意义

“心肾相交论”是瑶医药理论的脏腑生命观,心主要的功能是主宰其他脏腑的生理机能,对人的心理活动也进行调节;肾是气血化生之根源.如果心功能受损,那么其调节作用减弱,瑶医的整体观内涵得不到体现,人体作为一个整体的属性就不复存在,人体就会进入病理状态,甚至危及生命.对于肾,瑶医学认为人的出生、生长、发育和成熟直至衰老死亡的过程,是肾“气化”功能由盛到衰的自然过程.“心肾相交论”强调心肾功能的正常是人保存生命最基本的前提.通过探讨“心肾相交论”的学术思想,用以指导临床医疗实践,提高对瑶医药理论的认识.