急性骨髓性白血病病人住院期間身心健康變化與治療週期相關性之探討

Abstract

目的：本文主要的目的有二: 一是描述急性骨髓性白血病（acute myeloid leukemia, AML）病人住院接受治療期間之生活品質及身心健康狀況，二是探討身心健康、疾病治療與生活品質間的相關性，做為研擬照護措施，提升未來治療預後品質之參考依據。 方法：本研究採前瞻性縱貫式設計，資料收集三次，包含住院期間化療開始72小時內（T1）及化療後第十至十四天（T2），第三次是住院第35天或是早於第35天的出院日（T3）。病人接受研究團隊護理師及研究助理會談，使用匹茲堡睡眠量表（Pittsburgh Sleep Quality Index, PSQI）、華人健康量表（Chinese Health Questionnaire, CHQ-12）、家庭支持功能量表（Family support scale, APGAR），及世界衛生組織生活品質量表（quality of life, WHOQOL-BREF）收集資料。入院後包含化療期間、化療後觀察期及結束收案此三階段之病歷及參與者自填資料，包含感染、營養少於身體所需、疼痛、疲倦等，以及心理健康等相關的症狀，例如憂鬱焦慮、睡眠困擾等情形。敗血性休克快速評估表（Quick Sequential Organ Failure Assessment, qSOFA）則用來評估呼吸速率、意識狀況、收縮動脈壓等臨床指標；研究中也進行病歷查閱，了解過去病史與重要的精神科藥物使用史。 結果：共納入29位AML病人，發現病人住院期間T2其生活品質、心理健康狀況、睡眠品質、各項症狀困擾、疲倦及感染情形最為嚴重，其中與AML病人住院期間T2生活品質較佳的要素有:已婚、教育程度高中以上、非初診斷之病人、有營養補充性支持、無敗血症徵兆、無心理健康困擾及睡眠品質佳等七項。 結論：七項影響AML住院化療期間T2生活品質之要素中，臨床醫療人員除了應特別注重潛在生活品質較差的人口學特徵之病人外，在照護上應加強AML化療後病人之心理健康與睡眠品質等面向之評估與關注，例如給予包含藥物與非藥物之適切支持性治療或處置，建立通暢的溝通管道或協助找尋社會支持，以期能促進生活品質並使醫療照護能發揮最佳價值。

Objectives: The purposes of this study are two-folded. The first objective is to describe the psychosocial reactions and quality of life for hospitalized patients with acute myeloid leukemia （AML）. The other objective is to evaluate the associations between quality of life, psychosocial health, and AML treatment course in order to design therapeutic plan and enhance quality of care. Materials and methods: This is a prospective cohort study collecting data in three different time periods, including the first 72 hours （T1） and the 10th to 14th day （T2） post chemotherapy, and the 35th day of hospitalization or the sooner discharge day before the 35th day （T3）. Patients were interviewed by nurses or assistants and self-reported on several questionnaires, including Pittsburgh Sleep Quality Index （PSQI）, Chinese Health Questionnaire （CHQ-12）, Family support scale （Family APGAR）, and quality of life （WHOQOL-BREF）. The Quick Sequential Organ Failure Assessment （qSOFA） was applied to assess clinical treatment reactions. We also conducted chart reviews to verify the past history of health and the use of psychotropic medications. Results: A total of 29 participants completed were enrolled this study. The patients with AML receiving chemotherapy had the most disturbances at T2 （i.e., the 10th to the 14th of chemotherapy）, such as poor QOL, mental distress, poor sleep quality, fatigue, infected and chemotherapy-related symptoms etc. Some factors were associated with better QOL, including being married, having high school or above degree, not first episode of AML, with nutritional support, no signs of sepsis, no psychological distress and better sleep quality. Conclusion: Facing above 7 associated factors with poor quality of life, clinicians and nurses responsible for the care of patients with AML should pay more attention on psychosocial status and sleep disturbances to better manage negative impacts on quality of life during hospitalization after chemotherapy. Clinicians, including nurses, can provide medical and non-medical managements, adequate support and communication; to improve QOL for patients with AML receiving chemotherapy during hospitalization.