终末期肾病透析患者疾病经济负担和生活质量研究.docVIP

摘要 目的：调查维持中心血液透析、腹膜透析（CAPD）两种肾脏替代治疗患者的疾病经济负担和生活质量，为临床合理选择治疗方案提供参考。 方法：对我院维持目前透析方式6月以上的中心血液透析、腹膜透析（CAPD）患者，通过查阅病历资料、门诊随诊采访等方式，回顾性调查入选病人平均每年的经济负担（直接经济负担和间接经济负担）以及现阶段的生活质量（KDQOL－SF）。 结果：完成病例调查86人，其中血液透析36人，腹膜透析50人。两组患者在性别、年龄、文化程度、付费方式、收入、原发病、透析时间等背景上没有显著性差异。血液透析组和腹膜透析组平均每年透析费用分别为75619±42008元和53408±6667元（P＝0.003），总的疾病经济负担分别为100403±44419元和79859±22209元（P＝0.014）。腹膜透析组在生活质量的有些方面（总体健康、精神健康、情感职能、躯体疼痛以及肾病负担、社交质量、症状与不适、肾病影响、患者满意度）得分高于血液透析组，其他方面没有显著性差异。 结论：血液透析组患者疾病经济负担高于腹膜透析患者。腹膜透析患者在生活质量的某些维度上优于血液透析患者。在目前血液透析应用远远多于腹膜透析的情况下，应进一步推广使用腹膜透析。 关键词：终末期肾病 血液透析 腹膜透析 疾病经济负担 生活质量 ABSTRACT Objective：To investigate the economic burden and the quality of life (QoL) of patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis（CAPD） and provide information for the reasonable selection of the renal replacement therapies. Method：Patients staying on CAPD or HD for at least 6 months were reviewed about QoL and the average economic burden yearly by refering the medical records and answering questionnaire. The economic burden was divided into direct economic burden which means medical expense and nonmedical expense and indirect economic burden which means economic loss because of loss of job opportunity. QoL was evaluated by using KDQOL-SF questionnaire. Results：36 HD patients and 50 CAPD patients were included. There was no significant difference between two groups in gender, age, educational level, income level, mode of medical payment, ESRD causes and dialysis time. The average expense of HD patient and CAPD patient was 75619±42008RMB/year and 53408±6667RMB/year（P＝0.003）respectively. The total economic burden was 100403±44419RMB/year and 79859±22209RMB/year（P＝0.014）respectively. In some dimensions (General Health, Mental Health, Role Emotional, Bodily Pain, burden of kidney disease, quality of social interaction, symptom/problem list , effects of kidney disease , and patient satisfaction ), CAPD patients’ score was higher than tha