目标:接受维持性血液透析(MHD)的患者经常经历慢性疼痛,这会严重影响他们的生活质量(QOL)。这项研究的目的是评估MHD患者中慢性疼痛的患病率,并检查与QOL相关的因素。
方法:在2020年10月至2021年4月期间,对成都9个血液透析单位的1204例MHD患者进行慢性疼痛筛查,中国,296例慢性疼痛MHD患者纳入本研究.我们分析了临床人口学特征的数据,疼痛干扰和严重程度(简短疼痛清单),QOL(医疗结果研究36项简短形式健康调查-心理成分摘要[MCS]和身体成分摘要[PCS]),疼痛自我效能感(疼痛自我效能感问卷),和社会支持(社会支持评定量表)。
结果:本研究中MHD患者的慢性疼痛患病率为26.74%。最常见的疼痛部位是下背部(63.5%),下肢(55.0%),和头部(33.5%),36.5%的人没有实施任何缓解措施。在接受疼痛治疗或药物治疗的患者中,56.9%的人报告说,他们采取的措施减轻了不到一半的疼痛。根据MCS(53±16.76)和PCS(40.56±13.81)的评分,患有慢性疼痛的MHD患者的生活质量较差。逐步多元回归识别年龄,财务压力,疼痛干扰,社会支持,疼痛自我效能感作为生活质量的独立预测因子。疼痛自我效能感与社会支持显著相关(r=0.5,p<0.01),MCS(r=0.69,p<0.01),和PCS(r=0.8,p<0.01)。疼痛自我效能感在社会支持与MCS关系中的中介效应为70.31%,社会支持与PCS的关系为75.62%。
结论:慢性疼痛在中国MHD患者中普遍存在且管理不足,导致QOL恶化。医疗保健提供者应关注疼痛管理以及社会心理因素对患者生活质量的影响。进一步的研究应该加深我们对疼痛自我效能如何中介社会支持与生活质量之间关系的理解。
OBJECTIVE: Patients undergoing maintenance hemodialysis (MHD) frequently experience chronic pain, which can severely affect their quality of life (QOL). The objective of this study was to evaluate the prevalence of chronic pain in MHD patients and examine the factors associated with QOL.
METHODS: A cross-sectional questionnaire-based survey was conducted between October 2020 and April 2021, 1204 MHD patients from nine hemodialysis units were screened for chronic pain in Chengdu,
China, and 296 MHD patients with chronic pain were enrolled in this study. We analyzed data on clinicodemographic characteristics, pain interference and severity (Brief Pain Inventory), QOL (Medical Outcomes Study 36-item Short Form Health Survey - mental component summary [MCS] and physical component summary [PCS]), pain self-efficacy (Pain Self-Efficacy Questionnaire), and social support (Social Support Rating Scale).
RESULTS: The prevalence of chronic pain in MHD patients was 26.74% in this study. The most common areas of pain were lower back (63.5%), lower limbs (55.0%), and head (33.5%), 36.5% did not implement any measures to relieve it. Of the patients who did receive pain treatment or medication, 56.9% reported that the measures they took had less than half of the pain relief. MHD patients with chronic pain had poor QOL based on scores on the MCS (53 ± 16.76) and PCS (40.56 ± 13.81). Stepwise multiple regression identified age, financial strain, pain interference, social support, and pain self-efficacy as independent predictors of QOL. Pain self-efficacy was significantly associated with social support (r = 0.5, p < 0.01), MCS (r = 0.69, p < 0.01), and PCS (r = 0.8, p < 0.01). The mediating effects of pain self-efficacy were 70.31% on the relationship between social support and MCS, and 75.62% on the relationship between social support and PCS.
CONCLUSIONS: Chronic pain is prevalent and undermanaged in Chinese MHD patients, resulting in worse QOL. Healthcare providers should focus on pain management and the impact of psychosocial factors on patient QOL. Further research should deepen our understanding of how pain self-efficacy mediates the relationship between social support and QOL.