Analysis of current situation and influencing factors of postoperative quality of life and psychological status of pediatric recipients after kidney transplantation
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摘要:
目的 探讨儿童肾移植受者术后生存质量和心理状况现状并分析其影响因素。 方法 选取96例儿童肾移植受者为研究对象,收集受者的一般资料,采用儿童生存质量量表(PedsQLTM3.0)评估其生存质量,采用长处和困难问卷(SDQ)评估其心理状况,对儿童肾移植受者术后生存质量和心理状况的影响因素进行单因素和多因素分析。 结果 儿童肾移植受者术后生存质量总分为(71±14)分,困难总分为(12.4±5.8)分。单因素分析结果显示,性别、术后体质量指数(BMI)和肾移植术后并发症是儿童肾移植受者术后生存质量总分的影响因素(均为P < 0.05);性别、肾移植术后并发症和肾移植术后随访时间是儿童肾移植受者困难总分的影响因素(均为P < 0.05)。多因素分析结果显示,性别、术后BMI、肾移植术后并发症、肾移植前透析种类是儿童肾移植受者术后生存质量的影响因素,性别、肾移植术后并发症、肾移植术后随访时间是儿童移植受者术后心理状况的影响因素(均为P < 0.05)。 结论 儿童肾移植受者术后生存质量和心理状况较好,临床中应重点关注女性、术后BMI偏低、肾移植术后出现并发症及肾移植术后随访时间较短的患儿,预防性给予干预措施,进一步提高生存质量。 Abstract:Objective To evaluate the current situation of quality of life and psychological status of pediatric recipients after kidney transplantation and analyze the influencing factors. Methods Ninety-six pediatric recipients undergoing kidney transplantation were enrolled in this study. Baseline data of the recipients were collected. The quality of life was assessed by Pediatric Quality of Life Inventory 3.0 (PedsQLTM3.0). The psychological status was evaluated by Strengths and Difficulties Questionnaire (SDQ). The influencing factors of postoperative quality of life and psychological status of pediatric kidney transplant recipients were subject to univariate and multivariate analyses. Results The total score of quality of life of pediatric kidney transplant recipients was (71±14) and (12.4±5.8) for the total difficulty score. Univariate analysis showed that gender, postoperative body mass index (BMI) and postoperative complications were the influencing factors of the total score of quality of life of pediatric kidney transplant recipients (all P < 0.05). Gender, postoperative complications and follow-up time were the influencing factors of the total difficulty score of pediatric kidney transplant recipients (all P < 0.05). Multivariate analysis demonstrated that gender, postoperative BMI, postoperative complications, dialysis type before kidney transplantation were the influencing factors of postoperative quality of life of pediatric kidney transplant recipients, whereas gender, postoperative complications and follow-up time were the influencing factors of postoperative psychological status (all P < 0.05). Conclusions The quality of life and psychological status of pediatric kidney transplant recipients are good. In clinical practice, special attention should be paid to those children who are female, with low BMI after kidney transplantation, postoperative complications and short follow-up time. Preventive interventions are recommended to further improve the quality of life of the children. -
表 1 儿童肾移植受者术后生存质量及心理状况影响因素的单因素分析
Table 1. Univariate analysis of influencing factors on the postoperative lifequality and psychological status of pediatric kidney transplant recipients(x±s, score)
变量 n 生存质量总分 P值 困难总分 P值 性别 0.002 0.003 男 48 76±12 10.6±5.2 女 48 67±15 14.1±5.9 移植时年龄 0.971 0.851 < 10岁 36 71±12 12.5±5.4 ≥10岁 60 71±16 12.3±6.2 术后BMI 0.016 0.588 < 18.5 kg/m2 52 68±15 12.7±5.8 ≥18.5 kg/m2 44 75±12 12.0±5.9 医疗费用支付方式 0.843 0.292 自费 46 71±16 11.7±6.1 医保 50 72±12 13.0±5.6 原发病 0.606 0.991 慢性肾小球肾炎 59 71±14 12.4±5.7 IgA肾病 9 75±15 12.3±6.4 其他疾病 28 70±16 12.4±6.2 肾移植前透析时间 0.930 0.221 < 18个月 42 72±15 11.5±5.4 ≥18个月 54 71±14 13.0±6.2 肾移植前透析种类 0.094 0.153 血液透析 4 74±11 16.5±1.7 腹膜透析 66 71±14 12.6±6.4 血液透析联合腹膜透析 22 68±14 11.6±4.3 未做 4 87±10 7.5±0.6 原发病确诊至肾移植时间 0.414 0.077 < 40个月 68 72±16 11.7±6.1 ≥40个月 28 69±9 14.0±5.0 肾移植术后并发症 0.021 0.005 无 56 74±13 11.0±5.8 有 40 67±15 14.3±5.4 肾移植术后随访时间 0.488 0.002 < 30个月 50 72±15 14.1±6.0 ≥30个月 46 70±13 10.5±5.1 表 2 儿童肾移植受者术后生存质量影响因素的多因素分析
Table 2. Multivariate analysis of influencing factors on the postoperative life quality of pediatric kidney transplant recipients
变量 B值 标准误 β值 t值 容差 P值 常数项 90.701 6.517 -① 13.917 - < 0.001 性别 -6.326 2.777 -0.223 -2.278 0.880 0.025 术后BMI 7.131 2.842 0.251 2.509 0.846 0.014 肾移植术后并发症 -6.945 2.650 -0.242 -2.620 0.994 0.010 肾移植前透析种类 血液透析 -20.718 9.461 -0.292 -2.190 0.475 0.031 腹膜透析 -16.650 6.961 -0.545 -2.392 0.163 0.019 血液透析联合腹膜透析 -18.735 7.181 -0.556 -2.609 0.186 0.011 注:①-为无数据。肾移植前透析种类虚拟变量以未做透析组为参照组。该回归模型的决定系数R2为0.248,校正R2为0.197。 表 3 儿童肾移植受者术后心理状况影响因素的多因素分析
Table 3. Multivariate analysis of influencing factors on the psychological status of pediatric kidney transplant recipients
变量 B值 标准误 β值 t值 容差 P值 常数项 10.844 1.128 -① 9.617 - < 0.001 性别 3.216 1.080 0.277 2.978 0.984 0.004 肾移植术后并发症 2.759 1.114 0.234 2.478 0.951 0.015 肾移植术后随访时间 -2.604 1.108 -0.224 -2.351 0.937 0.021 注:①-为无数据。该回归模型的决定系数R2为0.220,校正R2为0.194。 -
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