肾移植受者自我管理现状及其相关影响因素研究

韦昌韵; 郭雪洁; 赵培玉; 刘佳; 刘红霞

doi:10.16766/j.cnki.issn.1674-4152.002775

肾移植受者自我管理现状及其相关影响因素研究

doi: 10.16766/j.cnki.issn.1674-4152.002775

1.
北京中医药大学护理学院，北京 100029
2.
中日友好医院护理部，北京 100029
3.
中南大学湘雅三医院外科，湖南长沙 410013

基金项目:

国家自然科学基金面上项目 81572235

详细信息

通讯作者:
刘红霞，E-mail：hongxia_t@163.com

中图分类号: R699.2
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- 被引次数: 0
出版历程
- 收稿日期: 2022-03-18
- 网络出版日期: 2023-02-07

Analysis of related factors of self-management in kidney transplant recipients

1.
School of Nursing, Beijing University of Chinese Medicine, Beijing 100029, China

摘要

摘要: 目的分析肾移植受者目前居家自我管理的现状，并探讨自我效能、焦虑、抑郁及自我管理支持对其的影响。方法采用便利抽样法选取2020年10月—2021年2月在北京市两家、长沙市一家三甲医院就诊的270例肾移植受者为研究对象。采用一般资料调查表、慢性病自我效能量表、医院焦虑抑郁量表、肾移植受者自我管理和自我管理支持量表进行问卷调查。结果共回收有效问卷265份，肾移植受者自我管理总分为95(84，103)分，各维度中，问题解决为35(30，40)分，伙伴关系为14(12，16)分，自我照顾行为为45(40，49)分。肾移植受者自我管理与其焦虑(r=-0.259，P＜0.01)、抑郁(r=-0.332，P＜0.01)呈负相关关系；与自我效能(r=0.399，P＜0.01)、自我管理支持(r=0.500，P＜0.01)呈正相关关系。多元线性逐步回归分析结果显示，年龄、居住地、移植术后时间、抑郁、自我效能和自我管理支持是肾移植受者自我管理的独立影响因素(均P＜0.05)。结论肾移植受者自我管理水平较好，但仍有半数患者处于中等水平。护理人员应重视肾移植受者的自我效能、负性情绪及自我管理支持对其自我管理行为的影响，可通过心理疏导、延续护理干预等方式，增加与患者的有益互动，以提高其自我管理水平。
- 肾移植受者 /
- 自我管理 /
- 相关因素 /
- 多元回归
Abstract: Objective To analyze the current status of self-management at home of kidney transplant recipients and explore the effects of self-efficacy, anxiety, depression and self-management support to self-management. Methods Using the convenience sampling method, we selected 270 kidney transplant recipients (KTRs) in three class A tertiary hospitals (two hospitals in Beijing and one in Changsha) from October 2020 to February 2021 and administered the general data questionnaire, chronic disease self-efficacy scale, Hospital Anxiety and Depression Scale questionnaire, kidney transplant recipient self-management scale and self-management support scale. Results We collected 265 valid questionnaires, and the total score of self-management of KTRs was 95 (84, 103) points. For the dimensions, the scores were 35(30, 40) for the problem-solving subscale, 14 (12, 16) points for the partnership subscale and 45 (40, 49) points for the self-care behaviour subscale. Self-management of KTRs and their anxiety (r=-0.259, P < 0.01) and depression (r=-0.332, P < 0.01) were negatively correlated and showed a positive correlation with self-efficacy (r=0.399, P < 0.01) and self-management support (r=0.500, P < 0.01). The results of multiple linear stepwise regression analysis revealed that the age, residence, time after transplantation, depression, self-efficacy and self-management support were independent factors influencing self-management in KTRs (all P < 0.05). Conclusion The self-management level of renal transplant recipients is satisfactory, but half of the patients are still at a medium level. Nursing staff should pay attention to the KTRs' self-efficacy, negative emotions and self-management support on the influence of their self-management behaviour through psychological counselling, continuous nursing intervention and increased beneficial interaction with patients to improve the level of self-management.
- Kidney transplant recipients /
- Self-management /
- Related factors /
- Multiple regression

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表 1 肾移植受者自我管理、焦虑抑郁、自我效能、自我管理支持得分(n=265)

Table 1. Score of self-management, anxiety, depression, self-efficacy, and self-management support of kidney transplant recipients (n=265)

维度	得分[M(P₂₅, P₇₅)，分]	得分指标(%)
自我管理	95(84, 103)	87.96
问题解决	35(30, 40)	87.50
伙伴关系	14(12, 16)	87.50
自我照顾行为	45(40, 49)	86.54
自我管理支持	99(88, 110)	90.00
工具支持	43(36, 45)	95.56
关系支持	20(16, 20)	100.00
心理社会支持	40(34，45)	88.89
焦虑	3(1, 6)	20.00
抑郁	2(0, 5)	11.10
自我效能	49(40, 56)	81.67
注：得分指标=维度得分中位数/该维度可能的最高得分×100%。

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表 2 肾移植受者自我管理影响因素的单因素分析(n=265)

Table 2. Univariate analysis of the factors affecting self-management in kidney transplant recipient(n=265)

项目	例(%)	自我管理[M(P₂₅, P₇₅)，分]	统计量	P值
年龄(岁)			6.497^a	0.039
18~44	123(46.4)	98.00(87.00，103.00)
45~59	115(43.4)	93.00(82.00，103.00)
≥60	27(10.2)	88.00(80.00，99.00)
性别			-0.634^b	0.526
男性	192(72.5)	95.00(84.00，103.00)
女性	73(27.5)	93.00(82.50，103.00)
居住地			-3.914^b	< 0.001
城镇	207(78.1)	96.00(85.00，104.00)
农村	58(21.9)	87.00(78.75，99.00)
BMI			6.940^a	0.031
＜18.5	19(7.2)	87.00(77.00，95.00)
18.5~23.9	148(55.8)	97.00(85.00，103.00)
≥24	98(37.0)	93.00(82.00，103.00)
工作状态			-2.566^b	0.011
在职	142(53.6)	96.50(85.75，103.00)
非在职	123(46.4)	90.00(81.00，103.00)
教育水平			9.603^a	0.008
初中及以下	53(20.0)	89.00(76.00，100.50)
高中/中专	71(26.8)	92.00(82.00，103.00)
大专/本科/研究生	141(53.2)	98.00(86.50，103.00)
婚姻状况			0.075^b	0.941
未婚	28(10.6)	100.00(81.50，104.75)
已婚	237(89.4)	94.00(84.00，103.00)
家庭月收入(元)			1.982^a	0.576
＜3 000	49(18.5)	95.00(78.50，101.50)
3 000~6 000	87(32.8)	91.00(82.00，104.00)
6 001~10 000	58(21.9)	95.00(85.75，103.25)
＞10 000	71(26.8)	96.00(87.00，103.00)
经济负担			8.093^a	0.044
无	38(14.3)	99.00(89.50，105.00)
轻	75(28.3)	95.00(85.00，103.00)
中	81(30.6)	93.00(82.00，103.00)
重	71(26.8)	91.00(82.00，101.00)
是否透析			2.435^a	0.487
否	18(6.8)	93.00(83.50，103.25)
血透	200(75.5)	95.00(84.00，103.00)
腹透	38(14.3)	95.50(83.25，104.00)
腹透+血透	9(3.4)	90.00(69.00，95.00)
移植术后时间(月)			3.372^b	< 0.001
≤12	99(37.4)	100.00(89.00，104.00)
＞12	166(62.6)	91.50(82.00，101.00)
注：^a为H值，^b为Z值。

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表 3 肾移植受者自我管理与焦虑抑郁、自我效能、自我管理支持的相关性(r值)

Table 3. Correlation between self-management and anxiety, depression, self-efficacy, and self-management support in renal transplant recipients (r)

项目	自我管理	自我管理支持	自我效能	焦虑
自我管理支持	0.500^a
自我效能	0.399^a	0.333^a
焦虑	-0.259^a	-0.218^a	-0.516^a
抑郁	-0.332^a	-0.258^a	-0.547^a	0.751^a
注：均P＜0.01。

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表 4 自变量赋值情况

Table 4. Independent variable names and assignments

变量	赋值方法
年龄	以实际值赋值
居住地	城镇=1，农村=0
BMI	BMI＜18.5=1，18.5≤BMI＜24=2，BMI≥24=3
教育水平	初中及以下=1，高中/中专=2，大专/本科/研究生=3
工作状态	在职=1，非在职=0
经济负担	无=0，轻=1，中=2，重=3
移植术后时间	以实际值赋值
自我管理支持	以实际值赋值
自我效能	以实际值赋值
焦虑	以实际值赋值
抑郁	以实际值赋值

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表 5 肾移植受者自我管理的多元线性回归分析

Table 5. Results of multiple stepwise linear regression analysis for self-management of kidney transplant recipients

变量	B	SE	B'	t值	P值
年龄	-0.201	0.068	-0.151	-2.948	0.003
居住地	5.054	1.726	0.146	2.928	0.004
移植术后时间	-0.026	0.009	-0.145	-2.876	0.004
抑郁	-0.606	0.250	-0.141	-2.425	0.016
自我效能	0.177	0.077	0.132	2.292	0.023
自我管理支持	0.401	0.049	0.416	8.243	< 0.001

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