老年血液透析患者自我管理能力对跌倒恐惧的影响研究

吕素玲; 林向东; 陈茹; 陈凌

doi:10.16766/j.cnki.issn.1674-4152.002592

老年血液透析患者自我管理能力对跌倒恐惧的影响研究

doi: 10.16766/j.cnki.issn.1674-4152.002592

温州市中医院血透室，浙江温州 325000

基金项目:

浙江省医药卫生科技计划项目 2017KY633

浙江省温州市科技局项目 Y20190314

详细信息

通讯作者:
吕素玲, E-mail: lusuling55@163.com

中图分类号: R459.5 R473.5
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出版历程
- 收稿日期: 2021-12-05

Effect of self-management ability on fall fear in elderly patients undergoing haemodialysis

Haemodialysis Room of Wenzhou Hospital of Traditional Chinese Medicine, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的了解老年血液透析患者的自我管理能力和跌倒恐惧现状，分析自我管理能力对跌倒恐惧的影响。方法选取2019年10月—2020年12月在温州市中医院治疗的328例血液透析患者为研究对象，采用一般资料调查表、修订版跌倒效能量表、血液透析患者自我管理能力量表进行调查。计数资料采用例数和构成比进行描述。符合正态分布的计量资料采用x±s进行描述，组间比较采用成组t检验和方差分析。老年血液透析患者自我管理能力与跌倒恐惧的相关性采用Pearson相关分析。采用多元线性回归分析老年血液透析患者跌倒恐惧的影响因素。结果老年血液透析患者跌倒恐惧评分为(65.11±18.81)分，自我管理能力评分为(51.64±9.42)分；不同性别、年龄、婚姻状况、是否规律性锻炼、是否发生过跌倒、透析龄的患者跌倒恐惧评分差异有统计学意义(均P < 0.05)；老年血液透析患者自我管理能力与跌倒恐惧总分及各维度评分均呈正相关(均P < 0.01)；多元线性回归分析显示，老年血液透析患者的年龄、自我护理能力、是否发生过跌倒和透析龄是跌倒恐惧的主要影响因素(均P < 0.01)。结论老年血液透析患者跌倒恐惧处于较高的水平，自我管理能力能够影响患者的跌倒恐惧，临床上应加强老年血液透析患者自我管理能力的健康教育，改善患者的跌倒恐惧情况。
- 老年 /
- 血液透析 /
- 自我管理能力 /
- 跌倒恐惧
Abstract: Objective To understand the status quo of elderly haemodialysis patients' self-management ability and fear of falling and analyse the influence of self-management ability on fear of falling. Methods A total of 328 haemodialysis patients treated in Wenzhou Hospital of Traditional Chinese Medicine from October 2019 to December 2020 were selected as the research objects, and the general data questionnaire, the modified fall efficacy scale and the haemodialysis patients' self-management ability scale were used for investigation. The measurement data conforming to normal distribution were described by x±s, and the comparison between groups was performed by t-test of independent samples and ANOVA. Pearson correlation analysis was used to analyse the correlation between self-management ability and fear of fall in elderly haemodialysis patients. Multiple linear regression was used to analyse the influencing factors of fall fear in elderly haemodialysis patients. Results The scores of fall fear and self-management ability of elderly haemodialysis patients were (65.11±18.81) points and (51.64±9.42) points, respectively. Significant differences in fall fear score were found amongst patients of different genders, ages, marital status, whether they exercised regularly, whether they had fallen or not and dialysis age (all P < 0.05). The self-management ability of elderly haemodialysis patients was positively correlated with the total score of fear of falling and the scores of all dimensions (all P < 0.01). Multiple linear regression analysis showed that the age, self-care ability, experience of falling and dialysis duration of elderly haemodialysis patients were the main influencing factors for fear of falling (all P < 0.01). Conclusion Elderly haemodialysis patients' fear of falling is at a high level, and self-management ability can affect patients' fear of falling. Clinically, health education on elderly haemodialysis patients' self-management ability should be strengthened to improve patients' fear of falling.
- The aged /
- Haemodialysis /
- Self-management ability /
- Fear of falling
利益冲突 无

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表 1 老年血液透析患者一般情况

Table 1. General condition of elderly hemodialysis patients

项目	类别	例数	构成比(%)
性别	男性	177	53.96
	女性	151	46.04
年龄(岁)	65~70	128	39.02
	71~80	163	49.70
	＞80	37	11.28
婚姻状况	有配偶	286	87.20
	无配偶	42	12.80
家庭人均收入(元/月)	＜3 000	146	44.51
	3 000~5 000	131	39.94
	＞5 000	51	15.55
主要照顾者	配偶	176	53.66
	子女	83	25.30
	其他	69	21.04
是否规律性锻炼	是	192	58.54
	否	136	41.46
是否发生过跌倒	是	125	38.11
	否	203	61.89
透析龄(年)	＜3	147	44.82
	3~5	119	36.28
	＞5	62	18.90
原发疾病	肾小球肾炎	171	52.13
	糖尿病肾病	84	25.61
	其他	73	22.26

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表 2 老年血液透析患者跌倒恐惧及自我管理能力得分情况(x±s，分)

Table 2. Points of fear of falling and self-management ability in elderly hemodialysis patients, Co-species X times Coefficient(x±s, scores)

项目	条目数	各维度均分	条目均分
跌倒恐惧总分	14	65.11±18.81	4.65±1.34
室内活动	9	43.95±11.03	4.88±1.23
室外活动	5	21.16±7.82	4.23±1.56
自我管理能力总分	20	51.64±9.42	2.58±0.47
伙伴关系	4	11.65±2.73	2.91±0.68
情绪处理	4	10.44±1.83	2.61±0.46
自我护理	7	17.37±3.16	2.48±0.45
问题解决	5	12.18±2.10	2.44±0.42

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表 3 老年血液透析患者一般资料对跌倒恐惧的影响(x±s，分)

Table 3. Influence of general data on fear of falling in elderly hemodialysis patients(x±s, scores)

项目	类别	例数	跌倒恐惧评分	统计量	P值
性别	男性	177	67.14±16.95	2.119^a	0.035
	女性	151	62.74±20.60
年龄(岁)	65~70	128	69.89±18.81	9.305^b	＜0.001
	71~80	163	63.35±18.60
	＞80	37	56.35±15.36
婚姻状况	有配偶	286	66.24±18.65	2.866^a	0.004
	无配偶	42	57.43±18.36
家庭人均收入(元/月)	＜3 000	146	64.42±20.71	0.461^b	0.631
	3 000~5 000	131	65.02±17.57
	＞5 000	51	67.35±16.18
主要照顾者	配偶	176	64.59±20.20	0.149^b	0.861
	子女	83	65.67±16.38
	其他	69	65.78±18.07
是否规律性锻炼	是	192	67.11±19.09	2.299^a	0.022
	否	136	62.29±18.12
是否发生过跌倒	是	125	60.08±19.24	3.883^a	＜0.001
	否	203	68.21±17.90
透析龄(年)	＜3	147	68.80±19.42	6.349^b	0.002
	3~5	119	63.58±17.19
	＞5	62	59.32±18.77
原发疾病	肾小球肾炎	171	64.41±20.53	0.264^b	0.768
	糖尿病肾病	84	65.63±16.48
	其他	73	66.16±17.23
注：^a为t值，^b为F值。

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表 4 老年血液透析患者自我管理能力与跌倒恐惧的相关性分析

Table 4. Correlation analysis between self-management ability and fear of falling in elderly hemodialysis patients

项目	室内活动	室外活动	跌倒恐惧总分
伙伴关系	0.327	0.359	0.388
情绪处理	0.276	0.259	0.380
自我护理	0.320	0.326	0.372
问题解决	0.209	0.203	0.374
自我管理能力总分	0.369	0.362	0.394
注：表中均为r值，均P＜0.01。

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表 5 变量赋值表

Table 5. Table of variable assignments

变量	赋值方法
性别	男性=1；女性=2
年龄	65~70岁=1；71~80岁=2；＞80岁=3
婚姻状况	有配偶=1；无配偶=2
是否规律性锻炼	是=1；否=2
是否发生过跌倒	是=1；否=2
透析龄	＜3年=1；3~5年=2；＞5年=3
自我护理能力	原始数据录入

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表 6 老年血液透析患者跌倒恐惧的多元线性回归分析

Table 6. Fall in the elderly hemodialysis patients fear of multivariate linear regression analysis

变量	B	SE	β	t值	P值
年龄	-19.154	2.198	-0.493	-8.713	＜0.001
自我护理能力	0.423	0.056	0.327	7.559	＜0.001
是否发生过跌倒	-7.888	1.802	-0.276	-4.379	＜0.001
透析龄	-6.228	1.643	-0.250	-3.791	＜0.001

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参考文献(22)

[1]	NAGAI K, IKUTOMO H, TAGOMORI K, et al. Fear of falling restricts activities of daily living after total hip arthroplasty: A one-year longitudinal study[J]. Clin Gerontol, 2018, 41(4): 308-314. doi: 10.1080/07317115.2017.1364682
[2]	周萌, 苏莉, 叶晶, 等. 老年住院患者跌倒预防措施的证据总结[J]. 中华现代护理杂志, 2019, 25(36): 4704-4708. doi: 10.3760/cma.j.issn.1674-2907.2019.36.005 ZHOU M, SU L, YE J, et al. Summary of evidences for fall prevention in elderly inpatients[J]. Chinese Journal of Modern Nursing, 2019, 25(36): 4704-4708. doi: 10.3760/cma.j.issn.1674-2907.2019.36.005
[3]	吕桂兰, 张鸿婵, 孔凌, 等. 老年与中青年维持性血液透析患者跌倒发生率及影响因素比较[J]. 中国护理管理, 2020, 20(9): 1312-1317. doi: 10.3969/j.issn.1672-1756.2020.09.007 LYU G L, ZHANG H C, KONG L, et al. A comparative study on the incidence rate and influencing factors of falls between elderly and middle-young maintenance hemodialysis patients[J]. Chinese Nursing Management, 2020, 20(9): 1312-1317. doi: 10.3969/j.issn.1672-1756.2020.09.007
[4]	庄伟. 维持性血液透析患者自我管理能力与营养状况及生活质量的关系[J]. 中国中西医结合肾病杂志, 2017, 18(10): 906-908. doi: 10.3969/j.issn.1009-587X.2017.10.021 ZHUANG W. Relationship between self-management ability and nutritional status and quality of life in maintenance hemodialysis patients[J]. Chinese Journal of Integrated Traditional and Western Nephrology, 2017, 18(10): 906-908. doi: 10.3969/j.issn.1009-587X.2017.10.021
[5]	HILL K D, SCHWARZ J A, KALOGEROPOULOS A J, et al. Fear of falling revisited[J]. Archives Phys Med Rehabil, 1996, 77: 1025-1029. DOI: 10.1016/s0003-9993(96)90063-5.
[6]	郝艳萍, 刘雪琴. 修订版跌倒效能量表在我国老年人群中的测试研究[J]. 中华护理杂志, 2007, 42(1): 19-21. doi: 10.3321/j.issn:0254-1769.2007.01.005 HAO Y P, LIU X J. Research of application of the Modified Fall Efficacy Scale of Chinese version in the aged in China[J]. Chinese Journal of Nursing, 2007, 42(1): 19-21. doi: 10.3321/j.issn:0254-1769.2007.01.005
[7]	宋艺君. 血液透析病患自我管理量表之构建与测试[D]. 高雄: 高雄医学大学, 2009. SONG Y J. Construction and testing of self-management Scale for hemodialysis patients[D]. Kaohsiung: Kaohsiung Medical University, 2009.
[8]	李慧, 曹迎东, 姜亚芳, 等. 血液透析患者自我管理量表的引进及信效度检测[J]. 中华护理杂志, 2015, 50(11): 1392-1395. doi: 10.3761/j.issn.0254-1769.2015.11.024 LI H, CAO Y D, JIANG Y F, et al. Reliability and validity tests of hemodialysis self-management instrument[J]. Chinese Journal of Nursing, 2015, 50(11): 1392-1395. doi: 10.3761/j.issn.0254-1769.2015.11.024
[9]	蒋婷婷, 单岩, 杜理平, 等. 老年血液透析患者认知衰弱现状及其与跌倒恐惧的相关性研究[J]. 中国护理管理, 2020, 20(7): 1005-1009. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL202007013.htm JIANG P P, SHAN Y, DU L P. Cognitive frailty in elderly patients with hemodialysis and its relationship with fear of falling[J]. Chinese Nursing Management, 2020, 20(7): 1005-1009. https://www.cnki.com.cn/Article/CJFDTOTAL-GLHL202007013.htm
[10]	张丽红, 宋锦平. 老年病人跌倒自我效能现状及危险因素分析[J]. 护理研究, 2016, 30(11): 4142-4144. ZHANG L H, SONG J P. Analysis of status quo and risk factors of self efficacy in elderly patients' fall[J]. 护理研究, 2016, 30(11): 4142-4144. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201633015.htm
[11]	徐蕾. 血液透析患者跌倒原因的分析及护理[J]. 心理月刊, 2020, 15(12): 134. https://www.cnki.com.cn/Article/CJFDTOTAL-XLYK202012107.htm XU L. Analysis and nursing of fall causes in hemodialysis patients[J]. Psychologies Magazine, 2020, 15(12): 134. https://www.cnki.com.cn/Article/CJFDTOTAL-XLYK202012107.htm
[12]	李晓霞, 贾林沛, 李兵. 维持性血液透析患者跌倒事件的影响因素探究[J]. 中国血液净化, 2020, 19(4): 234-237. doi: 10.3969/j.issn.1671-4091.2020.04.005 LI X X, JIA L P, LI B. The influencing factors of fall accident in maintenance hemodialysis patients[J]. Chinese Journal of Blood Purification, 2020, 19(4): 234-237. doi: 10.3969/j.issn.1671-4091.2020.04.005
[13]	宋倩, 张文杰, 陈梅香. 居家老年高血压人群跌倒恐惧现状及影响因素分析[J]. 中华现代护理杂志, 2020, 26(27): 3777-3782. doi: 10.3760/cma.j.cn115682-20200519-03414 SONG Q, ZHANG W J, CHEN M X. Current status and influencing factors of fear of falling in community-dwelling elderly people with hypertension[J]. Chinese Journal of Modern Nursing, 2020, 26(27): 3777-3782. doi: 10.3760/cma.j.cn115682-20200519-03414
[14]	周美玲, 许秀君, 沈华娟, 等. 动机性访谈对维持性血液透析患者自我管理能力及生活质量的影响[J]. 中国血液净化, 2020, 19(1): 25-28. doi: 10.3969/j.issn.1671-4091.2020.01.007 ZHOU M L, XU X J, SHEN H J, et al. The impact of motivational interview on self-management ability and quality of life in maintenance hemodialysis patients[J]. Chinese Journal of Blood Purification, 2020, 19(1): 25-28. doi: 10.3969/j.issn.1671-4091.2020.01.007
[15]	巴珍妮, 彭山玲, 陈玲. 维持性血液透析患者自我管理能力的潜在剖面分析[J]. 护理学杂志, 2020, 35(7): 27-30. doi: 10.3870/j.issn.1001-4152.2020.07.027 BA Z N, PENG S L, CHEN L. Identifying typologies of self-management ability among maintenance hemodialysis patients: a latent profile analysis[J]. Journal of Nursing Science, 2020, 35(7): 27-30. doi: 10.3870/j.issn.1001-4152.2020.07.027
[16]	罗怡欣, 黄燕林. 腹膜透析患者自我管理能力现状及其影响因素分析[J]. 护理管理杂志, 2019, 19(1): 11-15. https://www.cnki.com.cn/Article/CJFDTOTAL-HLGL201901005.htm LUO Y X, HUANG Y L. Analysis of self-management ability and its influencing factors in peritoneal dialysis patients[J]. Journal of Nursing Administration, 2019, 19(1): 11-15. https://www.cnki.com.cn/Article/CJFDTOTAL-HLGL201901005.htm
[17]	任清丽, 连敏玲, 罗连华, 等. 基于行为转变理论微信健康教育对维持性血液透析患者自我管理效果的研究[J]. 护理管理杂志, 2017, 17(7): 524-526. doi: 10.3969/j.issn.1671-315X.2017.07.024 REN Q L, LIAN M L, LUO L H, et al. Effect of the trans-theoretical model of behavior based WeChat health education on self-management among patients with maintenance hemodialysis[J]. Journal of Nursing Administration, 2017, 17(7): 524-526. doi: 10.3969/j.issn.1671-315X.2017.07.024
[18]	梁兰, 宋静, 陈灿灿. 血液透析患者心理控制源与自我管理行为的相关性研究[J]. 心理月刊, 2021, 16(6): 126-127. https://www.cnki.com.cn/Article/CJFDTOTAL-XLYK202106061.htm LIANG L, SONG J, CHEN C C. Study on the correlation between the locus of control and self-management behavior in hemodialysis[J]. Psychologies Magazine, 2021, 16(6): 126-127. https://www.cnki.com.cn/Article/CJFDTOTAL-XLYK202106061.htm
[19]	候瑞, 宋明芬, 亢俊俊, 等. 维持性血液透析患者疲乏影响因素及其与心理弹性、希望之间的相关性分析[J]. 中华全科医学, 2021, 19(2): 266-269. doi: 10.16766/j.cnki.issn.1674-4152.001784 HOU R, SONG M F, HANG J J, et al. Influencing factors of fatigue in in maintenance hemodialysis patients and their correlation with psychological resilience and hope[J]. Chinese Journal of General Practice, 2021, 19(2): 266-269. doi: 10.16766/j.cnki.issn.1674-4152.001784
[20]	周美玲, 许秀君, 陈燕芳, 等. 动机性访谈对维持性血液透析患者自我管理能力的影响[J]. 浙江医学教育, 2019, 18(6): 44-47. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJT201906015.htm ZHOU M L, XU X J, CHEN Y F, et al. The impact of motivational interviewing on self-management ability of maintenance hemodialysis patients[J]. Zhejiang Medical Education, 2019, 18(6): 44-47. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJT201906015.htm
[21]	陶涛. 维持血液透析患者自我管理与营养状况及生活质量的关系[J]. 当代护士, 2018, 25(10): 117-119. https://www.cnki.com.cn/Article/CJFDTOTAL-DDZT201804057.htm TAO T. To maintain the relationship between self-management and nutritional status and quality of life in hemodialysis patients[J]. Modern Nurse, 2018, 25(10): 117-119. https://www.cnki.com.cn/Article/CJFDTOTAL-DDZT201804057.htm
[22]	付俊香, 王爱敏, 周云平, 等. 八段锦对维持性血液透析患者睡眠质量及负性情绪的影响[J]. 护理管理杂志, 2021, 21(4): 285-290. https://www.cnki.com.cn/Article/CJFDTOTAL-HLGL202104014.htm FU J X, WANG A M, ZHOU Y P, et al. Effect of Baduanjin exercise on sleep quality and negative emotion in maintenance hemodialysis patients[J]. Journal of Nursing Administration, 2021, 21(4): 285-290. https://www.cnki.com.cn/Article/CJFDTOTAL-HLGL202104014.htm