肝、腎移植術後患者之居家照護需求探討

Abstract

肝、腎移植為目前治療末期肝病及腎臟病變的主要治療方式之ㄧ，可讓患者免除術前急重症狀的威脅，但隨之而來的可能是患者在術後面臨手術產生的合併症以及長期服用免疫抑制劑所帶來的副作用，進而在居家生活中仍有許多照護上的需求。因此本研究目的為瞭解肝、腎移植術後患者之居家照護需求，並探討影響患者需求的重要因素。採橫斷式之相關性研究，立意取樣於台北市某醫學中心肝、腎移植外科門診，自民國99年12月至100年3月止，共收集有效問卷289份。研究工具以結構式問卷進行資料收集，包含個案基本屬性資料表、疾病特性資料表、移植症狀頻率與症狀困擾量表、醫院焦慮與憂鬱量表及移植居家照護需求量表。資料以SPSS 17.0進行描述性統計、相關分析及逐步多元迴歸分析。研究結果發現（1）移植術後罹患糖尿病、高血脂、痛風的比率顯著增加。（2）整體的症狀經驗為偶爾發生及輕度困擾；視力模糊不清、專注力或記憶力不足、睡眠困擾、累，為症狀頻率及症狀困擾共同最常出現的症狀。（3）整體的焦慮與憂鬱程度屬輕度，研究病患中含4.8%的焦慮個案、3.1%的憂鬱個案。（4）居家照護需求以醫療體系與訊息層面最未被滿足。居家照護需求之未被滿足程度的重要預測因子為症狀困擾、焦慮、移植後時間與教育年數，共可解釋36.8%的變異量。研究成果可讓臨床護理人員了解肝、腎移植術後患者的身體症狀、心理困擾與居家照護需求的現況及相關因素；加強醫療體系與訊息的宣導及提供緊急狀況時的諮詢窗口。期盼能讓患者出院後獲得持續性的照護與追蹤，提升居家自我照護能力及降低其未滿足需求的程度。

Liver / renal transplantation is one of the important treatments for end-stage liver / renal disease and acute liver / renal failure. Although transplantation can prevent recipients from suffering with critical and fatal symptoms, patients may experience the complications with surgery and immunosuppressive drugs. Furthermore, they might have many unmet needs in daily life. The aims of this study were to explore the level of home care needs among the post liver or renal transplant recipients, and identify the significant factors for unmet care needs. Totally, 289 patients were recruited by purposive sampling with a cross-sectional correlated design from organ transplant outpatient departments at a medical center in northern Taiwan. Data were collected from December, 2010 to March, 2011. A set of structured questionnaires were used to collect data including patients’ demographic and disease characteristics, the Transplant Symptom Frequency and Symptom Distress Scale, the Hospital Anxiety and Depression Scale, and the Transplant Home Care Needs Scale. Data were analyzed with descriptive statistics, Spearman’s correlation and stepwise multiple regressions by SPSS 17.0 software. The main results included (1) The prevalence rate of diabetes mellitus, hyperlipidemia and gout significantly increased after transplantation. (2) The overall symptom experience occasionally occured with mild level of distress. Difficulty seeing well, concentration or memory problems, sleep difficulties, and tiredness were the most symptoms experienced by patients both in frequency and distress domains. (3) The level of anxiety and depression were mild. There were 4.8% of the patients identified as clinically anxious cases in our study, and 3.1% were clinically depressive cases. (4)The most unmet of home care needs was health system and information domain. Through stepwise multiple regression analysis, the significant predicting variables included symptom distress, anxiety, time after transplantation and education in years, and they could explain 36.8% of variances for unmet home care needs. The results of this study can help clinical nurses to understand more about liver or renal transplant recipients’ physical and mental distress, and the high risk population with unmet needs. Therefore, in order to increase the patients’ ability of self-care, health provider can offer the sufficient health system and information with the available health resources, and provide consultation when patients are in emergency.