维持性血液透析患者失志综合征研究的范围综述

A Scoping Review of Demoralization Syndrome in Patients Undergoing Maintenance Hemodialysis

摘要: 目的：系统梳理维持性血液透析患者失志综合征的研究现状，包括发生率、影响因素、测评工具及干预方法，为临床识别与干预提供依据。方法：以范围综述方法为指导，检索中国知网、维普、万方、PubMed、Web of Science等数据库，时间范围为建库至2025年6月19日。根据纳排标准进行文献筛选和整理，并提取研究主题进行归纳分析。结果：共纳入22篇文献。研究显示MHD患者失志综合征负担普遍较重，存在不同分级标准与测量工具，影响结果可比性。失志的影响因素呈现多维交，涵盖社会人口学特征、疾病负担、心理共病、社会支持及个体资源等。干预研究数量有限，多集中于住院期间的短期心理支持，策略体系化与延续性尚不足。结论：维持性血液透析患者失志综合征具有普遍性与高负担性，需加强本土化评估工具建设，推动失志风险筛查、标准化评估及多维干预体系协同发展，以提升透析患者的心理健康与生活质量。

Abstract: Objective: To systematically review the current research status of demoralization syndrome in Maintenance Hemodialysis (MHD) patients, including its incidence, influencing factors, assessment tools, and intervention strategies, in order to provide a basis for clinical identification and intervention. Methods: Guided by the scoping review methodology, databases including China National Knowledge Infrastructure (CNKI), VIP, Wanfang, PubMed, and Web of Science were searched for relevant literature published from the inception of each database to June 19, 2025. Studies were screened and selected according to predefined inclusion and exclusion criteria, and key research topics were extracted for summary and analysis. Results: A total of 22 studies were included. Findings indicate that demoralization syndrome is prevalent and imposes a substantial psychological burden on MHD patients. However, inconsistencies in classification criteria and assessment tools hinder comparability across studies. The influencing factors are multidimensional, encompassing sociodemographic characteristics, disease-related factors, psychological comorbidities, social support, and individual psychological resources. Intervention studies remain limited, with most focusing on short-term psychological support during hospitalization. Systematic and sustained intervention strategies are still lacking. Conclusion: Demoralization syndrome is a common and burdensome psychological issue among maintenance hemodialysis patients. There is an urgent need to develop localized and standardized assessment tools and to promote integrated systems for risk screening, comprehensive evaluation, and multidimensional interventions, in order to improve patients’ mental health and quality of life.