腹膜透析和血液透析对难治性心衰患者睡眠和生活质量的影响

    Comparison of peritoneal dialysis and hemodialysis on sleep and life quality in patients with refractory congestive heart failure

      摘要
    • 摘要: 目的 探讨腹膜透析（peritoneal dialysis，PD）和血液透析（hemodialysis，HD）对难治性充血性心力衰竭（refractory congestive heart failure，RCHF）患者睡眠质量和生活质量的影响。方法 回顾分析2010年01月1日至2017 年12月31因RCHF在南京大学医学院附属南京鼓楼医院肾脏科接受PD（31例）或HD（17例）治疗患者的临床和随访资料。收集患者透析前和6个月后临床、实验室检查资料、简明健康调查问卷（the MOS item short from health survey，SF-36）和匹兹堡睡眠质量指数量表（Pittsburgh sleep quality index，PSQI）数据，通过自身前后对照比较两种治疗方式对患者临床、实验室指标以及睡眠和生活质量的影响，Logistic回归分析透析方式对患者生活质量的影响。结果 两组患者临床心功能分级和B型脑钠肽水平在治疗后均较治疗前显著改善（P<0.01），两种治疗方式间比较无显著差异（P>0.05）；两组患者左心射血分数在治疗后均无明显改善（P>0.05）。HD患者除在催眠药和日间功能障碍外，其他5项睡眠质量指标均有显著改善（P<0.05），PD治疗患者除在催眠药外，其他6项睡眠质量指标均有显著改善（P<0.05）。两种治疗方式均显著改善患者PSQI总分值（P<0.05），两种治疗方式间比较PSQI总分值无显著差异（P>0.05）。HD对除情感职能外的其他7项生活质量指标均有显著改善作用（P<0.01）；PD对全部8项生活质量指标均有显著改善（P<0.01）。治疗6个月后，除生理功能外，PD在其他生活质量指标均好于HD（P<0.05）。Logistic回归显示PD与患者更好的生理职能和情感职能相关（P<0.01）。结论 PD与HD一样可改善RCHF患者近期的临床症状和睡眠质量，但PD生活质量改善上优于HD。

       

      Abstract: Objective To investigate the effect of peritoneal dialysis(PD)and hemodialysis(HD)on sleep and life quality in patients with refractory congestive heart failure(RCHF).Methods The clinical data and follow-up material of PD patients(31)or HD ones(17)in Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School from January 1,2010 to December 31,2017,were analyzed retrospectively.Clinical and laboratory examination data before and 6 months after dialysis,the MOS item short from health survey(SF-36)results,and Pittsburgh sleep quality index( PSQI)were collected for analysis.Through self-contrast of the indices before and after treatment,effects of the two treatment ways on life quality in these patients were compared.Results After six months treatment,both PD and HD effectively improved NYHA classification and B-type natriuretic peptide levels(both P<0.01)with no significant difference between the two treatment ways(P>0.05).Neither PD nor HD significantly improved left ventricular ejection fraction after 6-month dialysis(P>0.05).Except hypnotic drugs and daytime dysfunction,other sleep quality indices were improved significantly the HD patients(P<0.05).In the PD patients,except hypnotic drugs,other 6 sleep quality indices were improved significantly(P<0.05).Total PSQI scores were increased for both HD and PD ways(P<0.05)with no difference between HD and PD(P>0.05).Other 7 life quality indices except emotional function were significantly improved in the HD patients(P<0.01),while all the eight life quality indices were improved in the PD patients(P<0.01).After treatment of 6 months,except physical function other life quality indices for the PD patients were better than those for the HD patients(all P<0.05).Logistic regression analysis showed that PD was associated with better emotional function and physical function than HD(P<0.05).Conclusions Both PD and HD can both improve clinical symptoms and sleep quality in RCHF patients as assessed by NYHA classification and B-type natriuretic peptide levels.However,improvement of life quality for PD was better than that for HD.

       

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