血液透析病人的护理特点及护理探讨

论文编号:HL196  论文字数:13597.页数:23

论文题目：血液透析病人的心理特点及护理探讨
摘 要
 目的：l.了解维持性血液透析患者抑郁的发生状况。2.描述维持性血液透析抑郁患者的社会支持、应对方式及心理防御方式。3.讨维持性血液透析患者抑郁发生的原因，抑郁与社会支持、应对方式及心理防御方式之间的相互关系。
 方法：应用描述性及相关性的研究方法，选择于2009年10月～2010年6月在我院肾病科血液透析室行血液透析治疗的84例患者作为调查对象进行问卷调查。应用抑郁自评量表(sDS)调查维持性血液透析患者抑郁的发生状况：应用社会支持评定量表(SSRs)调查维持性血液透析患者的社会支持水平；应用应对方式问卷调查维持性血液透析患者的应对方式；应用心理防御问卷(DSQ)调查维持性血液透析患者的心理防御方式。选用SPSSll.0软件进行统计分析，抑郁、社会支持、应对方式、心理防御机制采用样本均数及总体均数来描述，用Pearson相关多元逐步回归的方法分析抑郁与社会支持、应对方式及心理防御方式的相关性；用多元逐步回归的方法分析抑郁与各因素之间的相关性。
 结果：共调查完整有效病例84例。1.维持性血液透析患者抑郁的发生率为69％。 2.维持性血液透析患者抑郁组与非抑郁组两组间一般资料构成比比较，家庭人均月收入有统计学差异(P<0.05)；3.维持性血液透析患者抑郁组与非抑郁组两组间社会支持各因子均分的比较均无统计学差异(P>0.05)。4.两组间应对方式各因子均分比较有部分因子均分达到了统计学差异(P<O.05)；抑郁组的解决问题的倾向性、解决问题的有效性、求助的有效性等成熟因子均分明显低于非抑郁组，有显著性差异(P<0.05)；抑郁组的自责的倾向性、幻想的倾向性、退避的倾向性等不成熟因子均分明显高于非抑郁组，有显著性差异(p<0．05)。
 结论：1.维持性血液透析患者抑郁的发生率较其它疾病伴发抑郁为高。2.经济状况对维持性血液透析患者抑郁的产生有着重要的影响。3.家庭与社会给予了维持性血液透析患者一定的社会支持。4.维持性血液透析抑郁患者在日常生活中面对困难和处理问题时，多采用“自责、退避”消极的应对方式，较少采用积极的应对方式。

关键词：维持性血液透析：抑郁；社会支持；应对方式
Title:  The psychoanalysis and nursing of patients with Maintenance hemodialysis
ABSTRACT
 Objective:The purpose of this study was to understand the depression incidence rate in patiens with maintenance hemodialysis，to determine social support,coping style and mental defense style of the patients，to explore the relatiomhip between the depression and social support，coping style and defense style of the patients．
 Methods:A descriptive，correlative design Was employed in this study．From October 2009 to June 2010，84 patients who received maintenance hemodialysis treatment in the Department of Nephrology from our hospatiol were recruited to complete a series of questionnaires，including Self-Rating Depression Scale Social(SDS)，Support Rating Scale(SSRS)，Coping Style Questionnaire and Defensive Style Questionnaire(DSQ)．The survey scheme accorded with the medical ethics demands．The SPSS 1 1．0 was used for data analysis．Describing the depression incidence rate，the social support，coping style，and mental defense style with the sample avemge and the total average．The relationship ofthem is analyzed by Pearson relative analysis．
 Results:In this survey,84 complete and effective questionnaires were taken back．1.Depression state to extend occurred in 69％ of the maintenance hemodialysis patients.2.he cases were divided into two groups(depression group and non-depression)．There were ignificant difference in earnings(P<0．05)，but nO significant difference in social support between twogroups(P>O.5)．3.n coping style，there were significant difference in the averages scores of the factors of the endency of solving problem,self-reproach appealing llusion,,wince and the effectiveness of roblem-solving appealing((P<0.5).4.There were significant difference in the averages scores of immature defense styles such as projection，passive-aggression，acting out，fantasy,withdrawl between two groups(P<O．05)．There were remarkable difference in the averages scores of mature defense styles such as humor,sublimation and bintermediate between two groups(P<0.05).
 Conclusion:There Was higher depression incidence rate in hemodialysis atients．The economic condition may be one of the main caBses in influencing the incidence of depression for patients with emodialysis．The maintenance hemodialysis patients were given a certain social support from the family and the socity．The chronic hemodialysis patients tended to negative coping style in life，and negative coping style Can burden their depression．The 900d social supporting could improve the coping style and relieve the depression symptoms of hemodialysis patients remarkably．The chronic hemoclialysis patients tended to use immature mechanism and intermediate mechanism instead of mature mechanism．The production of depression Was correlated positively with negative coping style and unmature defensive style，and negatively with positive coping style and mature defensive style significantly．

Keywords:Maintenance hemodialysis，Depression，Coping style，Social support.

 目  录
摘 要 IV
ABSTRACT VI
1 绪论 1
1.1背景及意义 1
1.2目的和目标 2
1.3关键词及定义 2
1.4文献回顾 3
2 研究设计 4
2.1研究设计 4
2.2研究对象 4
2.3研究工具 4
2.4研究步骤 4
2.5统计分析 5
3.结果 6
3.1维持性血液透析患者抑郁发生状况每个表格前要有简短的文字叙述表格数据所表达的主要意思 6
3.2维持性血液透析患者抑郁与社会支持的关系 6
3.3维持性血液透析患者抑郁与应对方式的相关分析 6
3.4维持性血液透析患者抑郁与社会支持、应对方式及防御方式多元逐步回归分析 7
4.讨论 8
4.1维持性血液透析患者抑郁与社会支持的关系 8
4.2维持性血液透析患者抑郁与应对方式的关系 9
4.3维持性血液透析患者抑郁与心理防御方式的关系 10
4.4维持性血液透析患者的护理 11
5.推论与建议 13
5.1结论 13
5.2研究局限性及展望 13
参考文献 14
致谢 18