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1、（八）提高透析患者的生活质量（,000）110,617RenjiHospital,2000上海地区腹透人群增长情况(图)RenjiHospital,2000RenjiHospital,2000如何提高透析患者的生活质量？RenjiHospital,2000HealthAstateofcompletephysical,psychologicalandsocialwell-beingandnotmerelytheabsenceofdiseaseorinfirmity.WorldHealthOrganization,1958RenjiHospital,2000生
2、活质量的评定（1）36-ItemMOS-ShortFormHealthSurvey(SF-36)KidneyDiseaseQualityoflife(KDQOLTM)EuroQol(EQ-5D)RenjiHospital,2000生活质量评定（2）BeckDepressionInventory(BDI)DepressivesymptomsIllnessEffectsQuestionaire(IEQ)PerceptionofillnesseffectsMultidimensionalScaleofPerceivedSocialSupport(MSP)Soci
3、alsupportSatisfactionWithLifeScale(SWLS)SatisfactionwithlifeKarnofskyScaleObjectivefuctioningRenjiHospital,2000在CRI和HD患者中生活质量的比较变量CRI(50)HD(99)BDI8.0±7.010.1±8.3*CDI4.1±4.15.6±5.3MSP16.3±4.122.4±4.2*IEQ37.9±24.760.6±2.9*Karnofsky86.9±14.772.3±16.1*SWLS22.8±8.423.2±7.6*P<0.01Shidle
4、rNR.AmJKidneyDis98RenjiHospital,2000透析前的尿毒症患者与普通人群的生活质量的比较表现正常的百分比普通人群血透前腹透前(n=750)(n=152)(n=149)Mobility(%)95.128.3a50.3abSelfcare(%)96.773.8a85.7abUsualactivities(%)85.823.1a29.9aPain/discomfort(%)68.037.0a48.3aAnxiety/Depression(%)83.655.9a67.3aValuationofwonhealth85.355.7a58.6
5、a(0-100)a与普通人群相比P<0.05b与血透前人群比较P<0.05KorevaarJC.PDI,2000RenjiHospital,2000MerkusMP.AmJKidneyDis,1997MerkusMP.KI,1999MerkusMP.KI,1999我国与加拿大血透患者生活质量的比较我国HD加拿大HDAffectScore50.39±6.8651.9±7.27Lifesatisfaction5.12±1.614.90±1.21Generalaffect4.81±1.885.10±1.21Well-being10.4±3.1110.6±4.84
6、karnofskyactivityscore2.19±0.642.30±1.21Objectivequalityoflife7.35±1.648.10±1.21**P<0.01WangM.HongkongJNeph,2000RenjiHospital,2000与透析患者生活质量相关的因素适时透析充分透析与残肾功能的保护减少并发症心理健康患者选择与教育RenjiHospital,20001997年DOQI准则Krt/V<2.0应开始透析除非:1.NPNA>0.8g/kg/d,SGA示营养良好2.无尿毒症症状和体征RenjiHospital,2000透析开始的
7、临床准则慢性肾衰的早期转诊Scr>200µmol/L肾功能的准确测定Ccr<30ml/min的处理每三月进行肾功能评估以SGA或NPNA评估患者营养状态透析开始GFR<6ml/min,应透析GFR<12ml/min伴尿毒症症状或营养不良,应透析GFR<12ml/min不伴尿毒症症状或营养不良,加强随访ChurchillDN.JASN99RenjiHospital,2000透前随访对ESRD患者 住院率、费用、死亡率的影响随访时间住院时间费用死亡（天）ER(>4月)9$449816%LR(<1月)30$2363319%CampbellJD.DialTrans
8、plant.1989RenjiHospital,2000透析初始月
