规律血液透析患者用药依从性的自身因素分析

Self-Factors Analysis of Medication Adherence in Patients with Regular Hemodialysis

摘要: 目的：深入分析规律血液透析患者自身因素对用药依从性的影响，为有限医疗资源下优选干预措施提供参考。方法：对纳入研究的83名透析患者，由2名经验丰富的临床药师采用Morisky-8量表对每位患者进行独立的标准化问卷调查，对问卷中条目相关的因素及依从性结果进行统计分析。应用SPSS 26.0和R 4.4.0软件，对所有问卷条目所涉及的潜在影响因素与最终依从性结果之间的关系进行卡方检验和二元Logistic回归等统计分析。结果：血液透析患者自行停药及不遵守药物治疗方案的发生率较高，分别为48.2% (40/83)和43.4% (36/83)；进一步分析发现，患者对治疗方案的理解和记忆程度是影响其遵守情况的关键因素，具有极高的统计显著性(P = 0.000, OR = 60.762)，显示出极强的相关性。这表明，对治疗方案的认知障碍直接导致了执行行为的偏差。结论：对于规律血液透析患者，尤其是医疗资源欠发达地区的患者，在制定和执行干预措施时，应将其对药物治疗方案的理解、认知和记忆能力作为重点评估和改善的环节。同时，医务人员需要反复、具体地向患者阐明自行中断药物治疗的潜在风险和严重后果，进行充分的用药安全教育，并明确要求患者必须在专业医疗指导下调整用药，严禁自行停药。

Abstract: Objective: To analysis the influence of personal factors of regular hemodialysis patients on medication adherence, and to provide a reference for optimizing intervention measures under limited medical resources. Methods: Among the 83 dialysis patients included in the study, two experienced clinical pharmacists conducted an independent standardized questionnaire survey for each patient using the Morisky-8 scale. Statistical analysis was performed on the factors related to the items in the questionnaire and the results of compliance. SPSS 26.0 and R 4.4.0 Software were used to conduct chi-square tests and binary Logistic regression and other statistical analyses on the relationship between the potential influencing factors involved in all questionnaire items and the final compliance results. Results: The incidences of self-discontinuation of medication and non-compliance with the drug treatment plan among hemodialysis patients were relatively high, which were 48.2% (40/83) and 43.4% (36/83) respectively. Further analysis revealed that the patients’ understanding and memory of the treatment plan were the key factors influencing their compliance, with extremely high statistical significance (P = 0.000, OR = 60.762), showing a very strong correlation. This indicates that cognitive impairment of the treatment plan directly led to deviations in execution behavior. Conclusion: For patients undergoing regular hemodialysis, especially those in areas with underdeveloped medical resources, when formulating and implementing intervention measures, their understanding, cognition and memory ability of drug treatment plans should be regarded as key assessment and improvement links. At the same time, medical staff need to be repeated specifically explain to patients the potential risks and serious consequences of interrupting drug treatment on their own, conduct adequate medication safety education, and clearly require patients to adjust their medication under professional medical guidance and strictly prohibit stopping medication on their own.