腎臟移植手術後病人自我管理、身心壓力及健康成果之關係探討

Abstract

【背景與目的】 腎臟移植的主要適應症為末期腎臟疾病，一般認為腎臟移植的成果優於血液透析與腹膜透析治療，然手術後還是有可能經歷各種生理與心理的壓力而衝擊到病人的健康，腎臟移植病人的健康一般是以客觀的移植體存活及主觀的生活品質為指標，移植成功指的是移植體與病人的存活，而隨著移植體存活與病人存活率的提升，移植照護目標也轉向以提升病人的生活品質為重點，許多的因素可以影響腎臟移植病人的健康，有些是屬於醫療介入因素，有些則是受到病人的知識行為與社會背景所影響，從過去相關研究指出病人的自我效能及自我管理可以有效降低生理心理壓力，而促進病人的健康，因此本研究目的為探討腎臟移植手術後病人的自我效能及自我管理對壓力及健康的影響。 【方法】 本研究為一相關研究，以longitudinal panel收集資料，每位個案收集兩次資料，間隔6個月，採目的取樣法，自民國94年8月起到95年11月止於北部某一醫學中心共收集到150位個案。最主要的資料收集工具為自擬量表及問卷、貝克氏憂鬱量表以及MOS SF-36生活品質量表中文版，資料分析方法主要以多元迴歸分析法( multiple regression)進行因徑分析(path analysis)， 【結果】 本研究的主要研究結果歸納為：150位病人的移植手術後平均年數為4.64年，平均年齡41.79歲，多數為臨危捐贈(屍腎)移植(n=128, 85.3%) ，生活品質次量表得分最高的是「生理功能」，得分最低的是「一般健康」，在兩次資料收集的過程中，移植腎功能及生理健康有顯著進步。在第一次收案時間，自我效能的平均得分為42.31，問題解決為30.56，自我照顧行為為39.73，夥伴關係為11.94。自我效能對問題解決、夥伴關係及自我照顧行為呈現正向的直接影響效果，β值分別為0.50、0.44及0.54；自我效能對心理健康的整體影響效果為0.37，自我效能對生活品質的影響效果為間接的，藉著自我照顧行為的作用，而提升生活品質。自我管理方面，自我照顧行為對生活品質之心理健康的直接影響效果β值為0.25，而問題解決及夥伴關係對生活品質沒有顯著影響效果。 【結論】 腎臟移植病人的自我效能、自我管理、生理心理壓力及生活品質之間有顯著的關係，本研究結果有助於作為移植照護實務的實証基礎，且支持有關腎臟移植照護應強調促進病人的自我效能及自我管理。

【Background and specific aims】 Kidney transplantation (KT) has emerged as the renal replacement therapy of choice for patients with end-stage renal disease. Advances in surgical and medical protocols have resulted in excellent survival rates. More recently, greater attention has also been given to quality of life (QOL). Many factors influence the health outcome of kidney transplant recipients including medical issues, knowledge, behavior and social background of patients. Evidences have been shown that self-efficacy and self-management are able to decrease individual’s physical and psychological stress and to improve health effectively. The purpose of this study is to examine the effect of self-efficacy and self-management on stress and health outcome of kidney transplant recipients. 【Methods】 Logitudinal panel, descriptive correlational design and purpose sampling was employed in this study. One hundred and fifty kidney transplant recipients from single medical center participated. We have employed two data collection in six months apart dursing the period of August 2005 to Nomenber 2006. We use questionnaires which were developed by author for this study, Beck Depression Inventory and MOS SF-36 quality of life questionnaire as major data collecting tools. The data were analyzed by multiple linear regression methods. 【Results】 The mean age of the participants was 41.79 years. The mean duration post the surgery was 4.64 years. Most of the participants have received the cadaver kidney transplantation (n=128, 85.3%). The highest score of the subscale of MOS SF-36 was “physical function, PF”, the lowest score was “general health, GH”. The renal graft function and the “physical health ” of quality of life was better at the second data collecting time. At the first data collection time, the average score of self-efficacy was 42.31, problem solving was 30.56, partnership was 11.94 and self-care behavior was 39.73. Participants who have higher self-efficacy will have better problem solving (β = 0.50), partnership (β= 0.44), and self-care behavior (β = 0.54). Self-efficacy had positive effect on quality of life indirectly (the total effect was 0.37). Self-efficacy can influence the self-care behavior and then had indirect effect on the quality of life. Self-care behavior has direct effect on the “mental health ” subscale of quality of life ( β = 0.25). The score of problem solving and partnership did not show any significant effect on quality of life. 【Conclusion】 There are significant relationships among self-efficacy, self-management, physical and psychological stress, and quality of life of renal transplant recipients. These results can be used as the evidence base for the care practice of kidney transplantation. The results of this study also support that kidney transplantation care program should emphasis on promoting patient’s self-efficacy and self-management.