【作者】 林琳；

【导师】 王宁莉；

【作者基本信息】 右江民族医学院 ， 护理（专业学位）， 2025， 硕士

【摘要】 目的:(1)调查腹膜透析患者自我管理现状;(2)分析腹膜透析患者自我管理的影响因素;(3)探索腹膜透析患者的自我效能、疾病感知、社会支持和焦虑、抑郁对自我管理的作用路径,为临床开展本土化及精准干预研究提供理论依据。方法:采取横断面调查方法,采用便利抽样法,选取2023年12月至2024年10月在广西百色市某三甲医院腹膜透析门诊随访及在肾内科住院复诊并符合纳排标准的300例腹膜透析患者为研究对象。研究工具包括一般资料调查表、腹膜透析患者自我管理量表、慢性疾病自我效能感6项目量表、简易疾病感知问卷、社会支持评定量表及医院焦虑抑郁量表,采用SPSS 27.0软件进行数据统计分析,使用频数、构成比、均数±标准差对社会人口学、疾病相关资料,自我管理水平、自我效能感水平、疾病感知水平、焦虑抑郁情况和社会支持水平进行描述性分析;采用两独立样本t检验、单因素方差分析不同人口学和不同疾病特征腹膜透析患者自我管理水平的差异;采用Pearson相关分析法分析自我效能、疾病感知、社会支持和焦虑抑郁与自我管理的相关性;采用多元线性回归分析自我管理的影响因素;利用AMOS 28.0软件构建结构方程模型探究腹膜透析患者自我管理的影响因素作用路径及强度。将所有统计学检验均设定显著性水平为α=0.05。结果:共发放310份问卷,回收有效问卷300份,有效回收率为96.77%。结果显示:(1)腹膜透析患者自我管理总分为(51.88±16.45)分、自我效能感总分为(46.58±6.01)分、疾病感知总分为(46.39±5.51)分、社会支持总分为(34.52±4.39)分、焦虑、抑郁得分分别为(8.26±4.61)分、(7.87±4.90)分。(2)不同年龄、医疗费用支付方式、职业状态、家庭居住地、文化程度及并发腹膜炎的腹膜透析患者的自我管理总分存在统计学差异(P<0.05)。(3)相关性分析结果显示:腹膜透析患者的自我效能、疾病感知、社会支持与自我管理之间存在正相关关系(r=0.514、r=0.497、r=0.490,P<0.001),焦虑、抑郁与自我管理呈负相关关系(r=-0.513,P<0.001)。(4)多元线性回归分析结果显示:年龄、医疗费用支付方式、职业状态、家庭居住地、文化程度、并发腹膜炎、自我效能感、疾病感知、社会支持及焦虑、抑郁均是腹膜透析患者自我管理的影响因素。(5)结构方程模型拟合较好(χ2/df=1.860,RMSEA=0.054,CFI=0.946,TLI=0.947,GFI=0.898)。自我效能、疾病感知、社会支持对自我管理均显示出显著的正向预测作用(β=0.344,β=0.272,β=0.302,P<0.001),焦虑、抑郁对自我管理有负向预测作用(β=-0.389,P<0.001);社会支持通过自我效能对自我管理的间接效应值为0.135(95%CI[0.071,0.232]),效应值占比为25.9%;社会支持通过缓解焦虑抑郁对自我管理的间接效应值为0.124(95%CI[0.057,0.229]),效应值占比为23.8%;疾病感知通过自我效能对自我管理的中介路径效应值为0.106(95%CI[0.050,0.187]),效应值占比为20.3%;疾病感知通过焦虑抑郁对自我管理的中介路径效应值为0.157(95%CI[0.076,0.266]),效应值占比为30.0%;表明,自我效能感和焦虑抑郁均在社会支持与自我管理间具有中介作用,两者在疾病感知与自我管理之间也起到中介作用。结论:(1)腹膜透析患者自我管理水平处于中等水平。(2)青年腹膜透析患者自我管理水平相对较高;医疗费用支付方式为职工医保、在职人员、家庭居住地为市区或者乡镇及文化程度高的患者自我管理水平较高。(3)社会支持、自我效能感、疾病感知对腹膜透析患者自我管理水平有积极影响,焦虑、抑郁能够直接对自我管理水平产生负面影响。(4)腹膜透析患者的自我效能感、焦虑、抑郁在社会支持与自我管理之间发挥中介作用,社会支持通过提升自我效能感、缓解焦虑、抑郁提高自我管理水平。自我效能、焦虑抑郁在疾病感知和自我管理中发挥中介作用。因此,可针对不同年龄、文化程度和居住地的腹膜透析患者,制定个性化的健康教育方案,提升疾病认知、增强自我效能感、优化社会支持、关注心理健康等提升腹膜透析患者的自我管理水平,进而改善其生活质量。更多还原

【Abstract】 Objective:(1)Investigate the current situation of self-management of peritoneal dialysis patients;(2)Analyze the influencing factors of self-management of peritoneal dialysis patients;and(3)Explore the self-efficacy of patients,disease perception,social support and anxiety and depression on self-management of peritoneal dialysis patients,so as to provide theoretical basis for clinical localization and precision intervention research.Methods:Using cross-sectional survey method and convenience sampling method,300peritoneal dialysis patients who were follow-up in the peritoneal dialysis clinic of a third grade A hospital in Baise,Guangxi from December 2023 to October 2024 and hospitalized in the renal department and met the discharge criteria were selected as the study objects.Research tools included the general data questionnaire,self-management scale for peritoneal dialysis patients,Chronic Disease Self-efficacy 6 item scale,Simple Disease Perceptual Questionnaire,Social Support Rating Scale and Hospital Anxiety and Depression Scale,Statistical analysis of the data was performed using the SPSS 27.0 software,Using frequency,composition ratio,mean±standard deviation for socio-demographic and disease-related data,Descriptive analysis of self-management,self-efficacy,disease perception,anxiety,depression,and social support;Differences in self-management level of peritoneal dialysis patients with different demographic and different disease characteristics using two independent sample t-test and one-way ANOVA;The correlation of self-efficacy,self-perception,social support,depression and self-management;Multiple linear regression was used to analyze the factors affecting self-management;The AMOS 28.0 software was used to construct the structural equation model to explore the action path and strength of the influencing factors of self-management in peritoneal dialysis patients.The significance level was set toα=0.05 for all statistical tests.Results:A total of 310 questionnaires were distributed and 300 valid questionnaires were recovered,with an effective recovery rate of 96.77%.The results showed that:(1)The total score of self-management of peritoneal dialysis patients(51.88±16.45),total score of self-efficacy(46.58±6.01),total score of disease perception(46.39±5.51),total score of social support(34.52±4.39),anxiety and depression(8.26±4.61)and(7.87±4.90),respectively.(2)There were statistical differences in the total self-management scores of peritoneal dialysis patients of different ages,medical expenses payment methods,occupational status,family residence,educational level and concurrent peritonitis(P<0.05).(3)The correlation analysis showed a positive relationship between self-efficacy,disease perception,social support and self-management in peritoneal dialysis patients(r=0.514,r=0.497,r=0.490,P<0.001),and a negative correlation between anxiety and depression and self-management(r=-0.513,P<0.001).(4)The results of multiple linear regression analysis showed that:age,payment method of medical expenses,occupational status,family residence,educational level,concurrent peritonitis,self-efficacy,disease perception,social support and anxiety,and depression were all influencing factors of self-management of peritoneal dialysis patients.(5)The structural equation model fits well(χ~2/df=1.860,RMSEA=0.054,CFI=0.946,TLI=0.947,GFI=0.898).Self-efficacy,disease perception,and social support all showed significant positive predictive effects on self-management(β=0.344,β=0.272,β=0.302,P<0.001),Anxiety and depression had negative predictive effects on self-management(β=-0.389,P<0.001);The indirect effect value of social support on self-management through self-efficacy was 0.135(95%CI[0.071,0.232]),The effect value accounted for 25.9%;The indirect effect of social support on self-management by relieving anxiety and depression was 0.124(95%CI[0.057,0.229]),The effect value accounted for 23.8%;The mediating pathway effect value of disease perception on self-management through self-efficacy was 0.106(95%CI[0.050,0.187]),The effect value accounted for 20.3%;The mediating pathway effect of disease perception through anxiety-depression was 0.157(95%CI[0.076,0.266]),The effect value accounted for 30.0%;make known,Both self-efficacy and anxiety and depression have a mediating role between social support and self-management,Both also play a mediating role between disease perception and self-management.Conclusion:(1)The level of self-management of peritoneal dialysis patients is moderate.(2)Young peritoneal dialysis patients have relatively high self-management level;the medical expenses are employee medical insurance,in-service personnel,urban or township family residence and patients with high education level have high self-management level.(3)Social support,self-efficacy and disease perception have a positive impact on the self-management level of peritoneal dialysis patients,while anxiety and depression can directly have a negative impact on the level of self-management.(4)The self-efficacy,anxiety and depression of peritoneal dialysis patients play an intermediary role between social support and self-management,and social support improves the level of self-management by improving self-efficacy,alleviating anxiety and depression.Self-efficacy,anxiety and depression play a mediating role in disease perception and self-management.Therefore,personalized health education programs can be formulated for peritoneal dialysis patients of different ages,education levels and residence,so as to improve disease awareness,enhance self-efficacy,optimize social support,pay attention to mental health and improve the self-management level of peritoneal dialysis patients,so as to improve their quality of life.更多还原