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標題: | 接受體外維生系統(葉克膜)治療後病患之健康狀態及生活品質 Health status and quality of life of Extra Corporeal Membrane Oxygenation survivors |
作者: | Fong-Tzu Hsieh 謝芳慈 |
指導教授: | 羅美芳(Meei-Fang Lou) |
關鍵字: | 葉克膜,健康狀態,生活品質,SF-36生活品質問卷, extra corporeal membrane oxygenation(ECMO),health status,quality of life (QoL),short-form 36-item questionnaire (SF-36), |
出版年 : | 2013 |
學位: | 碩士 |
摘要: | 研究背景:葉克膜為重症病患常見之侵入性治療,但研究文獻大多以存活結果為主,缺乏生活品質相關研究。
研究目的:本研究目的為瞭解接受葉克膜治療的重症成人病患,出院後的1.健康狀態與生活品質、2.個人基本資料及疾病相關資料和健康狀態、生活品質的相關性或差異性、3.生活品質的影響因素、4.出院後約2-3年期間的存活狀況及死亡風險因素、5.個人歷經重大治療後的改變,以及返家適應過程中遭遇的困難。 研究方法:本研究採橫斷式調查研究法,以結構式及半結構式問卷為研究工具,採方便取樣,收案對象為2009-2011年於某醫學中心接受葉克膜治療後出院之成人病患。研究工具包括:病患基本資料及疾病相關資料、巴氏量表、工具性日常生活功能量表、諾丁漢健康評估量表(第二部分)、Short Form-36(SF-36)生活品質問卷及返家生活適應半結構式問卷。 研究結果:共收案100位病患,平均年齡為48.95±14.75歲,有葉克膜相關併發症共10例;查爾森共病症指數為2.39±2.45分、巴氏量表得分為96.15±13.16分、工具性日常生活功能量表得分為7.12±1.99分、諾丁漢健康評估量表(第二部分)目前受影響項目為2.27±2.85項、生活品質生理組成量表得分為49.25± 9.51分、生活品質心理組成量表得分為48.13±10.46分。健康狀態中身體結構功能(查爾森共病症指數,r = -0.33, p < 0.01)、活動能力(巴氏量表,r = 0.57, p < 0.01;工具性日常生活功能量表,r = 0.64,p < 0.01)、社會參與度(諾丁漢健康評估量表第二部分目前受影響項目,r = -0.76,p < 0.01)和生活品質(SF-36)彼此相關。生活品質之影響因素,在生理組成方面之影響因素為諾丁漢健康評估量表(第二部分)目前影響項目數(β= -0.62,adjusted R2 = 57.9%,p = 0.00)、巴氏量表得分(β= 0.24,adjusted R2 = 5.2%,p = 0.00)、工作狀態(β= 0.14,adjusted R2 = 1.6 %,p = 0.02);在心理組成方面之影響因素為諾丁漢健康評估量表(第二部分)目前影響項目數(β= -0.33,adjusted R2 = 10.2 %,p = 0.00 )及性別(β= -0.19,adjusted R2 = 2.7%,p = 0.05 )。整體存活狀況自出院開始計算存活率為83.67%,影響存活的死亡風險因素(Hazard Ratio, HR)為65歲以上(HR = 2.59,p = 0.05)、查爾森共病症指數(HR =1.13,p = 0.03)、加護病房住院天數(HR =1.02,p = 0.00)及住院天數(HR =1.01,p= 0.00)。住院過程中,病患回憶表示多以生理層面不適居多,特別是插管、約束、認知改變(譫妄);而返家過程中,大多數病患覺得肢體復健過程很辛苦。經過此次重大疾病住院過程,許多病患開始改變生活型態,特別是飲食和作息。同時,許多病患也把健康和家人視為最重要的事物。 結論/建議:1.本研究結果支持「國際健康功能與身心障礙分類系統」之理論架構,健康狀態中的身體功能和結構、活動能力、社會參與度彼此相關且會影響生活品質;2.本研究生活品質和其他重症病患生活品質相比,接近心臟手術病患;也較其它重症病患常模得分為高,但較一般正常人常模低分。建議在住院過程中,盡可能緩解病患插管及約束所造成不適以及及早進行復健相關活動,對於病患肢體活動及返家適應、生活品質,都會有所改善。 Background: Extra corporeal membrane oxygenation (ECMO) is a common invasive treatment for critically ill patients. Most ECMO research has focused on survival outcomes and scant studies have evaluated quality of life (QoL). Objectives: This study investigated critically ill adults treated using ECMO regarding the following: (1) health status and QoL after hospital discharge; (2) the differences or correlations among demographic data, disease-related information, health status, and QoL; (3) the factors that influence QoL; (4) survival status and risk factors during the 2–3 years following hospital discharge; and (5) changes and difficulties adapting after ECMO treatment. Methods: A cross-sectional survey was conducted using structured and semi-structured questionnaires and a convenient sampling method was adopted. The research participants comprised recovered adult patients who were treated with ECMO at a medical center between 2009 and 2011. The research tools comprised the patient demographic data and disease-related information, Barthel Index, instrumental activities of daily living (IADL), Notthingham health profile (NHP) part II, Short-Form 36-item questionnaire (SF-36), and a semi-structured questionnaire regarding adaptation to life after hospital discharge. Results: The 100 participants averaged 48.95±14.75 years of age. Of these patients, 10 patients were diagnosed with ECMO-related complications. The average scores for the Charlson comorbidity index (CCI), Barthel index, and IADL were 2.39±2.45, 96.15±13.16, and 7.12±1.99, respectively. The average number of currently affected items in the NHP part II was 2.27±2.85. The average scores for the physical component summary (PCS) and mental component summary (MCS) were 49.25±9.51 and 48.13±10.46, respectively. Body structure and function (CCI, r = -0.33, p < .01), activity (Barthel Index, r = 0.57, P < .01; IADL, r = 0.64, p < .01), and social participation (currently affected items in the NHP part II, r = -0.76, p < .01) correlated with QoL (SF-36). The factors that influenced QoL in the PCS were the number of currently affected items in the NHP part II (β= -0.62, adjusted R2 = 57.9%, p = .00), Barthel Index (β = 0.24, adjusted R2 = 5.2%, p = .00), and work status (β = 0.14, adjusted R2 = 1.6%, p = .02); the factors that influenced QoL in the MCS were the number of currently affected items in the NHP part II (β = -0.33, adjusted R2 = 10.2%, p = .00) and gender (β = -0.19, adjusted R2 = 2.7%, p = .05). The overall survival rate was 83.67% since discharge, and the factors affecting survival were age > 65 years (hazard ratio, HR = 2.59, p = .05), CCI (HR =1.13, p = .03), length of stay in the intensive care unit (HR =1.02, p = .00), and the length of stay in the hospital (HR =1.01, p = .00). During hospitalization, the patients typically expressed physical discomfort related to intubation, restraint, and changes in cognition (delirium). After discharge, most patients considered physical rehabilitation challenge; their critical experiences in the hospital prompted numerous patients to change their lifestyles, particularly their diets and the ways they arranged their schedules. In addition, numerous patients reported that their health and family were vital. Conclusion and Suggestions: (1) The results of this study support the theoretical framework of the “International classification of functioning, disability, and health (ICF)”: body structure and function, activity, and social participation are intercorrelated and affect QoL. (2) Compared with other critically ill patients, patients in this study exhibited a similar QoL as patients who underwent cardiac surgery. Regarding QoL, the patients in this study attained higher scores compared with other critical groups, but lower than normal norms. We suggest that patient discomfort caused by intubation and restraint should be alleviated as much as possible, and rehabilitation programs should be initiated as soon as possible to improve patient limb activity, adaptation to home life, and QoL. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/58749 |
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