Sib tham txog kev sib deev tsis zoo nrog cov neeg mob raum mob
Mar 30, 2022
Hu rau:joanna.jia@wecistanche.com/ WhatsApp: 008618081934791
Gaby F. van Ek, et al
Abstract
Taw qhia. Kev sib deevkev ua haujlwm tsis zoo(SD) yog ib qho teeb meem tshwm sim hauv cov neeg mob uas raug mobmob ntev raumkab mob(CKD). Kev noj qab haus huv ntawm kev sib deev tseem yog ib qho nyuaj rau kev txheeb xyuas thiab sib tham. Txawm hais tias muaj ntau qhov kev tshawb fawb tau ua tiav ntawm qhov tshwm sim ntawm SD, me ntsis paub txog cov qauv kev coj ua thaum nws txhawj xeeb txog kev ua neej zoo (QoL) cov lus nug xws li SD hauv nephrologists 'kev coj ua.
Hom phiaj.Lub hom phiaj ntawm txoj kev tshawb no yog los txiav txim seb qhov twg nephrologists, cov kws kho mob raum tseem ceeb, sib tham txog SD nrog lawv cov neeg mob thiab lawv cov teeb meem tuaj yeem sib tham txog cov ncauj lus no.
Cov txheej txheem.Ib daim ntawv nug 50- yam khoom tau xa mus rau tag nrho Dutch nephrologists (n=312).
Cov txiaj ntsig tseem ceeb.Qhov kev tshawb fawb tau tshwm sim.
Cov txiaj ntsig.Cov lus teb ntawm qhov kev soj ntsuam yog 34.5 feem pua. Yuav luag txhua tus neeg teb (96.4 feem pua) tau hais los hais txog SD hauv tsawg dua ib nrab ntawm lawv cov neeg mob tshiab. Qhov teeb meem tseem ceeb tshaj plaws tsis txhob tham txog SD yog cov neeg mob tsis qhia lawv qhov kev txhawj xeeb txog SD tus kheej (70.8 feem pua). Lwm qhov teeb meem tseem ceeb yog: "tsis muaj lub sijhawm tsim nyog los tham" (61.9 feem pua) thiab "lub sijhawm tsis txaus" (46.9 feem pua). Yim caum-tsib feem pua ntawm cov kws kho mob nephrologist tau hais tias tsis txaus siab tau them rau SD thiab kev xaiv kho mob thaum lawv kawm. Rau caum-tsib feem pua ntawm cov neeg teb tau hais tias yuav tsum tau txuas ntxiv lawv txoj kev paub txog kev sib tham ntawm SD.
Cov lus xaus.Dutch nephrologists tsis tham txog teeb meem nrog kev sib deev ua haujlwm ib txwm muaj. Qhov tsis muaj kev paub, kev kawm tsim nyog, thiab lub sijhawm tsis txaus yog qhov ua rau muaj qhov tsis zoo ntawm SD hauv cov neeg mob CKD. Kev ua kom muaj peev xwm ntawm kev sib deev kev kawm thiab txhawb kev paub ntawm nephrologists txog qhov tseem ceeb ntawm kev saib xyuas SD tuaj yeem txhim kho kev saib xyuas thiab QoL rau cov neeg mob CKD. Kev tshawb fawb ntxiv yuav tsum tau ua ntawm cov neeg mob thiab lwm tus kws kho mob raum kom tsim tau ib txoj hauv kev los txhim kho peb cov kab ke tam sim no. van Ek GF, Krouwel EM, Nicolai MP, Bouwsma H, Ringers J, Putter H, Pelger RCM, thiab Elzevier HW. Sib tham txog kev sib deev tsis zoo nrog cov neeg mob raum mob ntev: Kev coj ua qauv hauv chaw ua haujlwm ntawm nephrologist. J Sex Med 2015; 12:2350–2363.
Cov lus tseem ceeb.Cov kab mob raum mob ntev;Nephrology; Kev xyaum ua qauv; Cov lus nug;Kev sib deev tsis zoo
Taw qhia
Ntev raumkab mob(CKD) yog qhov teeb meem kev noj qab haus huv zoo thoob ntiaj teb. Qhov kwv yees cov pejxeem muaj ntau tshaj li 10 feem pua thiab tseem nce ntxiv [1]. Kev sib deev dysfunction (SD) yog ib qho teeb meem loj thiab tshwm sim hauv cov txiv neej thiab cov poj niam uas raug kev txom nyem los ntawm CKD [2]. Erectile kawg (ED) muaj nyob rau hauv 70 feem pua ntawm cov txiv neej cov neeg mob, nrog rau txo libido thiab nyuaj rau kev mus txog qhov orgasm [3,4]. Cov poj niam cov neeg mob raug kev txom nyem los ntawm qhov chaw mos lubrication, poob ntawm arousal thiab muaj siab, dysmenorrhea, thiab nyuaj mus cuag ib tug orgasm [4]. Kev tsis txaus siab ntawm kev sib deev hauv cov poj niam cov neeg mob yog ob zaug ntau zaus piv rau cov neeg noj qab haus huv [3,5]. Cov neeg mob uas lub raum lim ntshav qhia txog qhov txo qis duakev sib deev kev ntshawthiabmuaj peev xwm. Hauv ob hom kev lim ntshav, qhov ntau ntawm SD ntsuas yog nyob ib ncig ntawm 65 feem pua ntawm cov txiv neej thiab 70 feem pua rau cov poj niam [6]. Nyob rau hauv cov ntaub ntawv ntawm hemodialysis, qhov tshwm sim ntau dua rau cov poj niam thiab nce mus txog 84 feem pua [7].Lub raum kev hloov pauvpaub tias yuav ua rau muaj kev txhim kho hauv kev tsis txaus siab ntawm kev sib deev; Txawm li cas los xij, qhov nthuav dav ntawm SD tom qabraumkev hloov pauvtseem nyob ntawm 46 feem pua ntawm cov txiv neej thiab poj niam [6]. Immunosuppressive therapy xav tau tom qab hloov pauv tuaj yeem ua rau cov txiv neej tsis muaj zog thiab tsis nyiam kev sib deev ntawm cov txiv neej thiab poj niam [8]. Lub etiology ntawm SD nyob rau hauv cov neeg mob nrog CKD yog tshwm sim los ntawm ntau yam kab mob xws li uremic milieu, anemia, kab mob plawv, CKD ntxhia thiab pob txha mob, kev sib deev hormone cuam tshuam, autonomic neuropathy, hyperparathyroidism, thiab hyperprolactinemia. Tsis tas li ntawd, qhov muaj SD yog tshwm sim los ntawm kev phiv los ntawm kev siv tshuaj, kev mob comorbid (kab mob plawv, ntshav qab zib mellitus, thiab kev noj zaub mov tsis txaus), thiab kev puas siab puas ntsws. Psychosocial yam muaj xws li kev nyuaj siab, kev ntxhov siab, kev ntseeg tus kheej tsis zoo, kev sib yuav tsis sib haum xeeb, kev tshem tawm hauv lub cev, teeb meem ntawm lub cev, thiab kev ntshai ntawm kev tsis taus thiab kev tuag [2,4,5,9–11]. Ob peb txoj kev kho mob tau siv los kho SD hauv CKD: phosphodiesterase type 5 inhibitors (PDE5), kev txhaj tshuaj intracavernosal, intraurethral suppositories, hormonal therapy, thiab psychotherapy. Txawm li cas los xij, kev nyab xeeb thiab kev ua tau zoo ntawm cov kev cuam tshuam no tau kawm tsis zoo [4].
Kev noj qab haus huv ntawm kev sib deev yog ib qho tseem ceeb hais txog lub neej zoo (QoL), yog li ntawd qhov muaj SD pab ua rau QoL tsis zoo [12]. Qhov teeb meem no tau tshaj tawm rau cov txiv neej thiab poj niam cov neeg mob uas muaj CKD [13,14]. Cov neeg mob SD tuaj yeem muaj kev ntxhov siab ntau dua, kev ntxhov siab, thiab kev nyuaj siab. Ib feem peb ntawm cov neeg mob nrog CKD ua tiav cov txheej txheem kuaj mob rau kev nyuaj siab [15]. Tshwj xeeb tshaj yog nyob rau hauv cov poj niam cov neeg mob, muaj kev sib koom siab ntawm SD thiab kev nyuaj siab, qhov tshwm sim yog nce tsib npaug thaum SD muaj [16,17]. Tsis tas li ntawd, kev tsis txaus siab ntawm kev sib deev kuj muaj qhov cuam tshuam rau kev sib raug zoo thiab kev sib yuav hauv lub neej. SD tsis tsuas yog cuam tshuam rau cov neeg mob nrog CKD tab sis lawv cov neeg koom tes thiab. Tsawg tus khub txaus siab yog ib qho teeb meem tshwm sim [18].
Txawm hais tias lub cev loj hlob ntawm cov pov thawj tias SD txo qis cov neeg mob kev noj qab haus huv ntawm ob peb theem, tsuas yog qee qhov kev tshawb fawb tau ua los txhawm rau tshuaj xyuas seb tus kws kho mob lub raum puas tham txog cov teeb meem no. Cov kev tshawb fawb yav dhau los tau pom tias kev saib xyuas thiab kev paub txog SD los ntawm cov kws kho mob lub raum yog txwv. Xya caum-tsib feem pua ntawm cov kws kho mob raum tsis paub meej tias qhov kev tsis txaus siab ntawm SD cuam tshuam rau lawv cov neeg mob li cas. Feem ntau ntawm cov kws kho mob tsis tshua paub txog cov teeb meem ntawm lub cev thiab lub siab lub ntsws cov neeg mob yuav tsum tau nyiaj dhau [19]. Txawm hais tias qhov no yog vim tsis muaj kev paub txog qhov muaj feem ntau thiab cuam tshuam ntawm SD rau cov neeg mob lossis los ntawm kev cuam tshuam los ntawm kev sib tham txog kev sib deev nrog tus neeg mob tseem tsis paub meej.
Vim muaj kev cuam tshuam loj ntawm SD rau cov neeg mob kev noj qab haus huv, kev kuaj pom ntxov yog qhov tseem ceeb. Tus kws kho mob nephrologist tuaj yeem ua lub luag haujlwm tseem ceeb hauv kev tshawb nrhiav thiab kev tawm tswv yim ntawm SD vim lawv txoj kev koom tes ua ke thaum tag nrho cov txheej txheem ntawm tus kab mob. Lub hom phiaj ntawm peb txoj kev tshawb fawb yog los txiav txim seb qhov twg nephrologists tham txog qhov teeb meem ntawm SD nrog lawv cov neeg mob uas raug kev txom nyem los ntawm CKD thiab cov teeb meem los tham txog cov ncauj lus no.
Cov txheej txheem
Kawm Tsim
Cov ntaub ntawv rau qhov kev tshawb fawb hla ntu no tau sau los ntawm daim ntawv nug. Cov qauv no muaj tag nrho cov kws kho mob Dutch nephrologist (N=318) uas yog cov tswv cuab ntawm Nefrovisie. Qhov no yog lub koomhaum hauv tebchaws ntawm Dutch Federation of Nephrology lub luag haujlwm rau kev saib xyuas thiab saib xyuas kev noj qab haus huv zoo los ntawm cov chaw haujlwm nephrology. Raws li rau qhov chaw nyob tau txais los ntawm lub koom haum tsis dhau hnub, tag nrho ntawm 312 daim ntawv nug ntawm 318 tuaj yeem xa tuaj.
Tswv Yim Tsim thiab Txhim Kho
Cov lus nug uas siv rau qhov kev soj ntsuam no yog tsim los ntawm tus sau (GFvE), tus kws tshawb fawb (EMK), kws kho mob urologist-sexologist (HWE), thiab nephrologist (HB). Cov qauv thiab tsim qauv ntawm daim ntawv nug tau muab los ntawm cov lus nug uas tau siv hauv cov kev tshawb fawb yav dhau los hais txog kev sib deev thiab cov kws kho mob [20–24], nrog rau cov khoom raws li cov teeb meem txheeb xyuas los ntawm cov kws sau ntawv thiab hauv cov ntaub ntawv. Qhov kev tshawb fawb tau sim los ntawm nephrologists thiab cov neeg nyob hauv Leiden University Medical Center Department of Nephrology (n=7). Cov neeg sawv cev tuaj ze tau nug kom tawm tswv yim txog cov ntsiab lus ntawm daim ntawv ntsuam xyuas. Tsis muaj lus hais txog cov ntsiab lus ntawm daim ntawv nug, yog li tsis muaj kev hloov kho hauv daim ntawv nug zaum kawg.
Kev Tshawb Fawb thiab Txheej Txheem
Daim ntawv nug muaj 50 yam khoom uas muaj ntau yam kev xaiv thiab qhib cov lus nug. Lub hom phiaj tseem ceeb yog qhia txog kev coj ua tam sim no thiab cov teeb meem cuam tshuam txog kev sib tham txog kev sib deev thiab teeb meem fertility. Tsis tas li ntawd, tau txais cov ntaub ntawv hais txog qib kev paub tam sim no, xav tau kev cob qhia, thiab kev lav phib xaub rau kev nqa SD. Cov lus nug txog cov teeb meem fertility tau ua tiav nyias. Thawj daim ntawv ntsuam xyuas muaj cov lus nug txog pej xeem thiab muaj kev xaiv tawm. Ib lo lus nug tuaj yeem teb tau txog qhov laj thawj ntawm kev tshem tawm. Cov neeg tsis teb tau txais tsab ntawv ceeb toom 2 thiab 4 lub hlis, feem, tom qab kev xa ntawv thawj zaug. Txhua daim ntawv nug tau ua tiav tsis qhia npe. Tsis xav tau kev pom zoo rau kev ncaj ncees.
Cov txheej txheem txheeb cais
Cov ntaub ntawv tau txais raug txheeb xyuas siv SPSS tso tawm 20 (SPSS Inc., Chicago, IL, USA). Cov ntaub ntawv pej xeem, nrog rau cov lus teb rau daim ntawv ntsuam xyuas, tau txheeb xyuas los ntawm kev faib cov zaus. Cov tsev kho mob ntawm cov neeg teb thiab cov neeg tsis teb tau raug cais los ntawm cov pej xeem ntom ntom ntawm thaj chaw thiab hom tsev kho mob. Hais txog cov pej xeem ceev, chav kawm I suav nrog cov cheeb tsam uas muaj pej xeem tsawg dua 283 tus pej xeem ib km2, chav II suav nrog thaj chaw nrog 283-907 pej xeem ib km2 thiab chav kawm III muaj cov pej xeem ntau dua 907 pej xeem ib km2. Cov tsev kho mob tau muab faib ua tej yam: tertiary referral centers thiab university hospitals vs district hospitals.
Cov txheej txheem Pearson chi-square thiab Cochrane Armitage trend test tau siv los sib piv cov ntaub ntawv categorical hais txog cov ntaub ntawv pej xeem.
Rau kev sib raug zoo ntawm cov ntaub ntawv tus lej thiab cov ntaub ntawv pej xeem, kev sim Mann-Whitney tau siv. Cov txiaj ntsig tau raug suav hais tias yog qhov tseem ceeb yog tias muaj ob sab P qhov tseem ceeb<>
Rau kev txheeb xyuas cov lus nug 5 thiab 6, cov lus teb "tsawg dua ib nrab ntawm cov xwm txheej" muaj cov lus teb "tsis tau" thiab "tsawg dua ib nrab ntawm cov xwm txheej;" cov lus teb "Ntau tshaj ib nrab ntawm cov ntaub ntawv" muaj cov lus teb "ntau tshaj ib nrab ntawm cov ntaub ntawv" thiab "ib txwm." Rau kev txheeb xyuas cov lus nug 9 thiab 10, cov lus teb "Nyob rau hauv tsawg dua ib nrab ntawm cov neeg mob" muaj cov lus teb "tsis tau" thiab "tsawg dua ib nrab ntawm cov neeg mob," cov lus teb "Nyob rau ib nrab lossis ntau dua ntawm cov ntaub ntawv" muaj cov lus teb " ib nrab" "ntau tshaj ib nrab ntawm cov ntaub ntawv" thiab "ib txwm." Rau kev txheeb xyuas lo lus nug 11, cov lus teb "Abree" muaj cov lus teb "Pom" thiab "tag nrho pom zoo;" cov lus teb "Tsis pom zoo" muaj cov lus teb "tsis pom zoo" thiab "tsis pom zoo tag nrho."
Cov txiaj ntsig
Kev Tshawb Fawb Teb
Nyob rau hauv tag nrho, 51 feem pua (n=159) ntawm 312 daim ntawv nug raug xa rov qab. Tawm ntawm cov lus teb, 106 qhov kev tshawb fawb tau ua tiav (33.9 feem pua), thiab 38 ntawm cov neeg teb tsis kam koom nrog. Qhov laj thawj tseem ceeb tsis koom nrog yog tsis muaj sijhawm (n=28); Lwm cov laj thawj suav nrog: tsis xyaum tam sim no (n=5), tsis txaus siab (n=2), so haujlwm (n=2), tsis ntseeg txog kev ntxub ntxaug ntawm cov neeg koom (n {{11}) }}), thiab tsis xyaum ua tus kws kho mob (n=1). Yuav luag 10 feem pua (n=15) ntawm cov kws kho mob nephrologists tau tshwj xeeb hauv cov menyuam yaus nephrology. Vim tias cov ntsiab lus ntawm daim ntawv nug nyob deb ntawm lawv cov neeg mob, lawv cov lus teb tau raug cais tawm. Vim qhov tseeb tsis muaj kev hloov pauv tom qab kev sim ntsuas ntawm cov kws kho mob nephrologist los ntawm Leiden University Medical Center, cov lus teb rau daim ntawv nug tus tsav tau suav nrog (n=7). Thaum kawg, 113 ntawm 328 (34.5 feem pua) tau xa cov ntawv tshawb fawb tau txheeb xyuas.
Cov pej xeem
Kev sib piv tau tsim los ntawm cov ntaub ntawv pej xeem ntawm cov neeg teb thiab cov neeg tsis teb.
Cov poj niam txiv neej ntawm ob tus neeg tsis teb tsis paub, 310 nephrologists tau siv los sib piv. Ntau tshaj 50 feem pua ntawm 310 nephrologists (53.5 feem pua, n=166) yog txiv neej, 46.5 feem pua (n=144) yog poj niam. Ntawm cov tsis teb, 106 nephrologists (53.8 feem pua) yog txiv neej thiab 91 (46.2 feem pua) yog poj niam. Hauv pawg neeg teb, 61.9 feem pua (n=70) yog txiv neej thiab 38.1 feem pua (n=43) yog poj niam. Tsis muaj qhov sib txawv tseem ceeb ntawm kev sib faib ntawm poj niam txiv neej ntawm cov neeg teb thiab cov neeg tsis teb (P=0.16).
Cov neeg teb cov hnub nyoog nruab nrab yog 47.2 xyoo (± 8.3 SD), txij li 33 txog 62 xyoo. Lub hnub nyoog ntawm cov neeg tsis teb tsis paub. Cov neeg teb cov txiv neej muaj qhov tseem ceeb tshaj li cov poj niam teb (txhais tau tias 50.2 vs. 42.2; P <>
Qhov chaw ua haujlwm ntawm 10 tus neeg tsis paub lus teb tsis paub, ua rau 302 tus kws kho mob nephrologist siv rau kev sib piv cov pej xeem. Feem ntau ntawm 302 Dutch nephrologists (60.3 feem pua , n=182) tau ua haujlwm nyob rau hauv ib cheeb tsam nrog cov pej xeem ceev ntawm ntau dua 907 tus pej xeem ib km2. Yim caum tsib (28.1 feem pua) nephrologists tau ua haujlwm nyob rau hauv ib cheeb tsam nrog cov pej xeem ceev ntawm 283 thiab 907 pej xeem ib km2 thiab 11.6 feem pua (n=35) nyob rau hauv ib cheeb tsam nrog tsawg dua 283 pej xeem ib km2. Tsis muaj qhov sib txawv tseem ceeb ntawm kev faib tawm hauv tsev kho mob qhov chaw ntawm tus neeg teb thiab tus neeg tsis teb (P=0.46).
Rau caum-yim feem pua (n=205) ntawm Dutch nephrologists tau ua haujlwm hauv ib cheeb tsam tsev kho mob, 85 ntawm 205 tus kws kho mob nephrologist tau koom nrog hauv kev tshawb fawb. Qhov no yog cov lus teb ntawm 41.5 feem pua. Tag nrho ntawm 97 tus kws kho mob nephrologist (32.1 feem pua) tau ua haujlwm hauv tsev kho mob tertiary referral/university. Cov lus teb ntawm pab pawg no yog 24.7 feem pua (n=24). Muaj cov lus teb ntau dua hauv cov tsev kho mob hauv nroog piv nrog cov tsev kho mob tertiary/university (41.5 feem pua vs. 24.7 feem pua ; P=0.05).
Table 1 qhia txog tus kheej thiab kev coj cwj pwm ntawm cov neeg teb.
Sib tham SD
Feem coob ntawm cov neeg teb tau hais tias lawv "yeej tsis / yuav luag tsis tau" (57.7 feem pua , n=64) lossis "tsawg dua ib nrab ntawm cov xwm txheej" (38.7 feem pua, n=43) tau tham txog SD nrog lawv cov tshiab cov neeg mob. Tsuas yog 1.8 feem pua ntawm cov kws kho mob nephrologists (n=2) tau teb tias lawv tau tham txog SD "hauv ib nrab" ntawm lawv cov neeg mob tshiab, lwm 1.8 feem pua (n=2) tau teb rau kev sib tham SD hauv "ntau tshaj ib nrab" ntawm lawv cov neeg mob tshiab.
Nephrologists 'cov lus teb hais txog qhov zaus ntawm kev sib tham SD hauv ntau theem ntawm CKD thiab nrog cov neeg mob sib txawv tau teev tseg hauv Table 2.
Cov neeg teb raug nug kom nco ntsoov tias yog vim li cas thiaj khaws lawv los ntawm kev sib tham txog qhov teeb meem ntawm SD. Cov txiaj ntsig tau qhia hauv Table 3.
Qhov laj thawj tseem ceeb tshaj plaws (70.8 feem pua) yog tias cov neeg mob tsis qhia lawv cov kev txhawj xeeb txog SD tus kheej. Tag nrho ntawm 92.8 feem pua ntawm cov neeg teb (n=103) tau hais tias tsawg dua ib nrab ntawm cov neeg mob, cov neeg mob qhia lawv cov kev txhawj xeeb ntawm kev sib deev, 7.2 feem pua (n=8) teb tias ntau tshaj ib nrab ntawm lawv cov neeg mob qhia lawv cov kev txhawj xeeb spontaneously.
Thaum SD tau tham, cov ntsiab lus feem ntau ntawm cov txiv neej cov neeg mob yog ED (92.9 feem pua), txo libido (80.5 feem pua), thiab cov kev mob tshwm sim ntawm cov tshuaj (59.3 feem pua). Hauv cov poj niam cov neeg mob, txo libido (77.0 feem pua), mob thaum muaj kev sib deev (52.2 feem pua), thiab cov kev mob tshwm sim ntawm cov tshuaj (44.2 feem pua) yog cov kev sib tham tshaj plaws. 82.4 feem pua ntawm cov kws kho mob nephrologist (n=89) tau hais tias tus khub yuav tsum muaj nyob hauv "tsawg dua ib nrab ntawm cov xwm txheej" yog tias SD tau tham txog. Yuav luag 18 feem pua (n=19) tau hais tias tus khub tau nyob hauv "ntau tshaj ib nrab ntawm cov xwm txheej."
Txhua tus kws kho mob nephrologist tau hais kom nco ntsoov qhov tseem ceeb ntawm kev tshuaj xyuas rau SD hauv cov neeg mob uas muaj CKD. Hauv 65.2 feem pua ntawm cov neeg mob (n=73), nephrologists teb lawv xav tias kev tshuaj ntsuam xyuas yog "me ntsis tseem ceeb," 24.1 feem pua (n=27) tau hais tias "tseem ceeb" thiab 0.9 feem pua ( n=1) "tseem ceeb heev." Tag nrho ntawm 9.8 feem pua (n=11) tau teb lawv xav txog kev tshuaj ntsuam rau SD "tsis tseem ceeb" hauv cov neeg mob raug kev txom nyem los ntawm CKD.
Kev paub txog SD
Ntau tshaj li ib nrab ntawm cov neeg teb (58.0 feem pua , n=65) tau hais tias muaj "qee" kev paub uas tsim nyog los tham txog cov teeb meem txog kev sib deev nrog cov neeg mob, tsuas yog 2.7 feem pua (n=3 ) hais tias muaj "ntau heev." Tshaj ib lub hlis twg (34.8 feem pua , n=39) tau tshaj tawm tias muaj "tsis ntau" kev paub thiab 4.5 feem pua (n=5) tsis muaj kev paub txhua yam los tham txog kev sib deev.
Feem ntau ntawm cov kws kho mob nephrologists (86.2 feem pua , n=94) tau hais tias tsis txaus siab tau them rau SD thiab cov kev xaiv kho mob thaum lawv nyob hauv kev cob qhia. Rau caum-tsib feem pua ntawm cov neeg teb (n=73) tau hais tias yuav tsum tau nthuav lawv cov kev paub txog kev sib tham ntawm SD.
Qhia thiab Counseling
Cov ntaub ntawv tau txais txog kev tswj hwm cov neeg mob uas muaj teeb meem SD. Nephrologists cov lus teb hais txog kev qhia thiab kev sab laj cov neeg mob nrog SD tau sau tseg hauv Table 4.
Tsis tas li ntawd, cov neeg teb tau nug txog kev qhia thiab sab laj cov neeg mob SD txog kev hloov lub raum. Cov txiaj ntsig tau teev tseg hauv Table 5.
Kev lav ris
Yim caum feem pua ntawm cov kws kho mob nephrologist (n=90) tau sau tseg tsis muaj kev pom zoo meej hauv lawv lub tuam tsev hais txog tus kws kho mob twg los tham txog cov neeg mob kev sib deev. Kev pom zoo meej tau ua hauv 14.3 feem pua (n=16), thiab 5.4 feem pua ntawm cov neeg teb (n=6) tau sau tseg tias lawv tsis paub txog qhov kev pom zoo.
Cov ntaub ntawv tau txais los ntawm cov kws kho mob nephrologists qhov kev pom tias tus kws kho mob lub raum yog tus lav ris rau kev sib tham txog SD. Cov txiaj ntsig tau piav qhia hauv daim duab 1.
Raws li nephrologists, kwv yees li 4.6 feem pua ntawm cov neeg mob (± 5.6 SD) raug xa mus rau lwm tus kws kho mob rau kev tawm tswv yim txog lawv cov teeb meem kev sib deev hauv xyoo dhau los.
Kev sib tham
Lub hom phiaj ntawm txoj kev tshawb no yog los txiav txim seb qhov twg nephrologists tham txog qhov teeb meem ntawm SD nrog lawv cov neeg mob uas raug kev txom nyem los ntawm CKD thiab kev txwv rau kev sib tham txog cov ncauj lus no. SD yog ib qho teeb meem loj thiab tshwm sim hauv cov neeg mob uas muaj CKD. Tsis muaj kev tshawb fawb yav dhau los tau ua los ntawm cov kws kho mob nephrologists ntsuas lawv qhov kev pab cuam rau kev tshawb nrhiav thiab kev tawm tswv yim ntawm SD. Peb tau txais kev pom zoo rau cov kws kho mob nephrologists qhov kev xav dav dav, txwv tsis pub tham txog SD, kev paub dav dav ntawm cov ncauj lus no, thiab xav tau kev cob qhia.
Txoj kev tshawb no qhia tias Dutch nephrologists tsis tshua tham txog SD. Qhov laj thawj tseem ceeb tsis tham txog SD yog tias cov neeg mob tsis qhia SD tus kheej. Qhov kev xav no yuav ua rau muaj kev zam tsis tu ncua. Raws li Asmeskas kev tshawb fawb ntawm 500 tus neeg laus hauv pab pawg hnub nyoog 25 xyoo thiab laus dua, 71 feem pua ntawm cov neeg xam phaj tau txhawj xeeb txog qhov tseeb tias lawv tus kws kho mob yuav tso tseg kev txhawj xeeb txog lawv cov teeb meem kev sib deev [26]. Kev kwv yees txog qhov teeb meem no, qhov tsis txaus siab ntawm ob tog yuav yog vim li cas tham txog SD tseem muaj teeb meem ntawm cov neeg mob thiab nephrologists. Kev tshuaj xyuas tej zaum yuav yog ib qho kev daws teeb meem los rhuav tshem lub voj voog txuas ntxiv ntawm kev zam thiab kuaj pom SD nyob rau theem pib. Muab hais tias tsuas yog 24.1 feem pua ntawm cov kws kho mob nephrologist tau hais los nrhiav kev tshuaj ntsuam rau SD "tseem ceeb," ua kom paub txog qhov tseem ceeb ntawm kev tshuaj ntsuam xyuas yog qhov tseem ceeb. Qhov tseem ceeb ntawm kev tshuaj ntsuam rau SD hauv CKD tseem tsis tau kawm.
Kev tswj lub sijhawm tseem cuam tshuam rau qhov kev sib tham ntau zaus, vim tias "lub sijhawm tsis txaus" thiab "tsis nrhiav lub sijhawm zoo los tham" yog qhov laj thawj tseem ceeb rau khaws cov kws kho mob nephrologist los ntawm kev sib tham txog SD. Tsis tas li ntawd, "lub sijhawm tsis txaus" feem ntau yog vim li cas rau cov kws kho mob nephrologist tsis koom nrog hauv daim ntawv ntsuam xyuas. Nws txhais tau hais tias lub sijhawm yog qhov kev txwv loj rau nephrologists hauv kev tswj hwm SD.
Txhawm rau tswj cov teeb meem kev sib deev, kev cob qhia txaus yog qhov yuav tsum tau ua. Hauv daim ntawv ntsuam xyuas no, {{0}} feem pua ntawm cov neeg teb tau hais tias tsis txaus siab tau them rau SD nrog rau cov kev xaiv kho mob thaum lawv kawm nyob hauv. Qhov tsis muaj kev kawm txog SD yog qhov teeb meem thoob plaws hauv txhua lub chaw kho mob. Tsis muaj kev cob qhia tus qauv rau cov tub ntxhais kawm kho mob txog kev noj qab haus huv ntawm kev sib deev thiab feem ntau cov tub ntxhais kawm tau txais ntau yam thiab qee zaum txawm tias kev cob qhia tsis txaus [27,28]. Qhov tsis muaj kev cob qhia ua rau muaj teeb meem uas twb muaj lawm, xws li kev paub tsis txaus thiab kev sib txuas lus tsis txaus, thaum tham txog SD [29]. Kev ua raws li kev qhia txog kev sib deev rau hauv kev cob qhia nyob hauv yuav ua rau muaj kev cuam tshuam tsis zoo txog kev sib tham thiab kev tawm tswv yim ntawm SD. Rosen et al. 2005 [30] pilot-tested a Rhiav raws li "Robert Wood Johnson Model." Txoj kev tshawb no suav nrog cov neeg nyob hauv cov chaw kho mob tshwj xeeb. Ob feem peb (67.4 feem pua) ntawm cov neeg koom tau sau tseg tias lawv tau txais kev paub ntau dua ntawm cov teeb meem kev sib deev vim yog kev cob qhia. Ntau tshaj li ib nrab ntawm cov neeg koom (52.0 feem pua) tau hais tias qhov kev cob qhia ua rau lawv xis nyob thiab txawj sib txuas lus txog kev sib deev nrog lawv cov neeg mob [30]. Rau cov kws kho mob tam sim no, kev xyaum, kev cob qhia ntxiv yuav tsum tau muab los ntawm National Federation of Nephrology txhawm rau txhim kho lawv txoj kev paub.
Rau caum feem pua ntawm cov kws kho mob nephrologist tau hais tias kev lav phib xaub ntawm kev sib tham txog SD nyob hauv lawv cov pab pawg kws tshaj lij. Cov kev tshawb pom no cuam tshuam qhov kev tshawb pom yav dhau los hauv kev tshawb fawb los ntawm 2011 ua los ntawm Green et al. Nyob rau hauv txoj kev tshawb no, 60 feem pua ntawm ib pab pawg sib xyaw ntawm cov kws kho mob lub raum tau hais txog lub luag haujlwm tseem ceeb ntawm kev tswj hwm SD lus dag nrog tus kws kho mob thawj zaug; tsuas yog 35 feem pua hais tias nws yog lub luag haujlwm ntawm nephrologists [31].
Txawm hais tias cov neeg teb nyob rau hauv daim ntawv ntsuam xyuas no tau hais kom lav ris rau kev sib tham txog SD, feem coob (80 feem pua) tau hais tias tsis muaj kev pom zoo meej hauv lawv lub tuam tsev hais txog tus kws kho mob twg muaj lub luag haujlwm. Yuav kom ua tiav qhov kev txhim kho tiag tiag, kev pom zoo meej yuav tsum tau ua nrog kev koom tes nrog txhua tus kws kho mob ua haujlwm hauv nephrology department.
Cov txiaj ntsig ntawm txoj kev tshawb fawb no qhia tias tej zaum yuav muaj lub luag haujlwm rau lwm tus kws kho mob raum (xws li, kws saib xyuas neeg mob lim ntshav thiab cov neeg ua haujlwm sib raug zoo) hauv kev sib tham thiab nrhiav pom SD. Cov neeg mob nrog CKD yuav raug soj ntsuam mus sij hawm ntev nrog ntau tus kws kho mob raum; yog li ntawd, yuav tsum tau tsim ib lub cib fim los kuaj xyuas kev sib deev ntawm tus neeg mob. Yog tias muaj lub sijhawm teem sijhawm nrog tus kws kho mob lub raum tshwj xeeb uas tau kawm tshwj xeeb hauv kev sib tham txog kev noj qab haus huv ntawm kev sib deev, qhov teeb meem ntawm qhov tsis zoo ntawm SD yuav raug daws. Hais txog kev tswj hwm thiab kev tawm tswv yim ntawm SD, kev xa mus rau theem pib mus rau tus kws kho mob urologist, andrologist, lossis kws kho mob poj niam txiv neej yuav yog qhov zoo tshaj plaws rau cov neeg mob noj qab haus huv. Cov kws kho mob no tau kawm zoo hauv kev tawm tswv yim txog kev sib deev. Qhov no yog qhov tsis sib xws rau lwm tus kws kho mob tshwj xeeb uas nws txoj kev kawm ntawm SD hauv tsev kawm ntawv kho mob ib yam nkaus thaum lub sijhawm kev cob qhia nyob hauv yog qhov pov thawj tsis txaus [27,28]. Txawm li cas los xij, kev qhia txog kev sib deev ntawm tus kws kho mob urologist yuav tsis txaus raws li kev tshawb fawb tsis ntev los no tau pom tias feem ntau ntawm cov neeg nyob hauv Dutch urology (58.6 feem pua) tau hais tias lawv tsis tau txais kev cob qhia lossis kev kawm txog kev sib deev [32]. Tsis muaj kev tshawb fawb txog qib kev sib deev hauv Tebchaws Europe thaum lub tsev kawm kho mob lossis chaw nyob hauv lwm lub chaw kho mob.
Qhov tseem ceeb tshaj plaws, vim tias qhov tsis muaj txiaj ntsig ntawm SD cuam tshuam rau cov neeg mob CKD thiab lawv cov neeg koom tes [18], kev tshawb fawb yuav tsum tau ua raws li lawv xav tau kev sib tham txog kev sib deev thiab txoj kev yuav tsum tau muab.
Kev tshawb fawb ntxiv txog qhov pom ntawm lwm tus kws kho mob raum nrog rau cov neeg mob thiab lawv cov neeg koom tes tuaj yeem pab txhawb txoj kev tsim nyog los txhim kho peb cov kab ke tam sim no.
Kev txwv
Txoj kev tshawb no muaj ob peb yam kev txwv. Ua ntej, kev tsis txaus siab tsis teb yuav tshwm sim vim qhov tshwm sim ntawm cov lus teb tsawg thiab tej zaum yuav txo qis lub zog ntawm kev tshawb fawb. Txawm li cas los xij, cov yam ntxwv ntawm pej xeem tau muab piv rau cov neeg tsis teb thiab cov neeg teb. Tus cwj pwm qhia tus kheej ntawm daim ntawv nug yuav ua rau muaj cov lus teb xav tau ntawm kev sib raug zoo. Tsis tas li ntawd, nws tsis tuaj yeem tau txais kev pom zoo rau cov neeg nyob hauv qhov kev xav ntawm kev sib deev kev noj qab haus huv thiab kev sib txuas lus kev txawj ntse thaum lub sijhawm kev cob qhia nyob rau tam sim no. Cov neeg nyob hauv tsis tau mus txog vim lawv tsis yog tswv cuab ntawm Nefrovisie thaum lawv nyob. Txawm li cas los xij, tsis muaj kev sim paub tau ua los txhim kho kev kawm kev sib deev thaum lub sijhawm kev cob qhia nyob hauv xyoo dhau los. Txoj kev tshawb no tau ua los ntawm kev siv daim ntawv nug tsis raug cai. Ib daim ntawv nug uas muaj tseeb uas muaj cov khoom tshwj xeeb ntawm kev sib tham ntawm SD nrog cov neeg mob CKD tsis muaj. Peb tau txiav txim siab tsis lees paub daim ntawv nug vim tias peb tsis npaj siab yuav rov siv qhov ntsuas. Cov qauv thiab tsim qauv ntawm daim ntawv nug siv tau muab los ntawm cov lus nug uas tau siv hauv cov kev tshawb fawb yav dhau los hais txog kev sib deev thiab cov kws kho mob [20–24]. Kev siv daim ntawv nug tsis raug cai yuav ua rau muaj kev tsis txaus siab rau cov lus teb ntawm cov neeg teb vim yog cov lus nug tsis raug.
Hauv Kev Xav
Txoj kev tshawb no muaj cov pov thawj muaj txiaj ntsig rau cov qauv kev ua haujlwm ntawm Dutch nephrologists; Txawm li cas los xij, cov kev tshawb fawb tau ua nyob rau hauv Tebchaws Meskas thiab Tebchaws Askiv qhia tias qhov txiaj ntsig ntawm txoj kev tshawb no tuaj yeem siv tau rau lwm lub tebchaws sab hnub poob [26,29,30]. Lawv cov txiaj ntsig kuj tau pom qhov tsis lees paub hauv kev sib tham txog kev sib deev ntawm cov kws kho mob thiab cov neeg mob, nrog rau kev tsis muaj kev kawm.
Undoubtedly, cov neeg mob 'kev noj qab haus huv thiab lub raum ua haujlwm ua ntej tshaj qhov teeb meem nrog lawv kev sib deev. Lub hom phiaj tseem ceeb yuav tsum nco ntsoov yog kho kab mob raum thiab khaws cia raum ua haujlwm. Txawm li cas los xij, qhov cuam tshuam ntawm QoL poob qis vim SD ntawm chav kawm ntawm CKD yuav tsum tsis txhob kwv yees. SD yog ib qho teeb meem loj hauv txhua theem ntawm CKD: predialysis, lim ntshav, thiab tom qab hloov lub raum [8,33,34].
Tsis tas li ntawd, kev tshawb fawb tau pom tias qhov txo qis QoL hauv cov neeg mob tau txais hemodialysis ua rau muaj kev pheej hmoo ntawm kev tuag thiab mus pw hauv tsev kho mob [35].
Xaus
Hauv kev xaus, Dutch nephrologists tsis tham txog teeb meem nrog kev sib deev ua haujlwm ib txwm muaj. Qhov tsis muaj kev paub, kev kawm tsim nyog, thiab tsis muaj sijhawm yog qhov tseem ceeb ua rau muaj qhov tsis zoo ntawm SD hauv cov neeg mob CKD. Kev siv kev sib deev kev kawm rau hauv kev cob qhia chaw nyob thiab txhawb kev paub ntawm nephrologists txog qhov tseem ceeb ntawm SD tuaj yeem txhim kho kev saib xyuas thiab QoL rau cov neeg mob CKD. Kev tshawb fawb ntxiv yuav tsum tau ua ntawm cov neeg mob thiab lwm tus kws kho mob raum kom tsim tau ib txoj hauv kev los txhim kho peb cov kab ke tam sim no.
Kev lees paub
Kev txhawb nqa ib feem los ntawm kev pab nyiaj ntawm "Fonds SOS" los ntawm Dutch Society of Sexology (NVVS).
Los ntawm: 'Kev Sib Tham Txog Kev Sib Deev Kev Sib Deev nrog Cov Neeg Mob Raum Kab Mob: Kev Xyaum Ua Haujlwm hauv Chaw Ua Haujlwm ntawm Nephrologist' los ntawmGaby F. van Ek, et al
---J Sex Med 2015; 12:2350–2363
