心臟移植病患之疲倦、憂鬱與生活品質之探討

Exploration of Fatigue, Depression and Quality of Life in Heart Transplant Recipients

周玉英(Yu-Ying Chou)

指導教授 ： 孫秀卿

共同指導教授 ： 賴裕和 ； 王水深

國立臺灣大學/醫學院/護理學研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.00675

摘要

本研究目的在探討心臟移植後患者之症狀困擾、疲倦、憂鬱與生活品質現況及不同階段之特質、相關因素，並預測生活品質之重要影響因子。採橫斷式、相關性之探索性研究，於 2008 年 10 月 2 日至 2009 年 3 月 26 日止，立意取樣於台北市某醫學中心，以結構式問卷之症狀困擾量表、疲倦症狀量表、醫院焦慮憂鬱表之憂鬱次量表，以及生活品質健康量表等收集資料，有效問卷共 108 份。以SPSS 16.0 統計軟體進行分析，研究結果（1）整體之症狀頻率與困擾前五名為疲倦、健忘、視力減退、肌肉無力、青春痘等。依移植後不同階段，症狀表現及困擾皆不同。（2）疲倦平均強度屬中度疲倦；疲倦干擾屬輕度干擾。疲倦平均強度之相關因素有年齡（rs = -.30, p < .01）、每週運動次數（rs = - .24, p < .05）、生活及醫療上困擾事件總數（rs = .29, p < .01）、血中尿素氮（rs = - .22, p < .05）、藥物種類總數（rs = -.24, p < .05）、最大攝氧量（rs = .41, p < .01）、症狀困擾（rs = .27,p < .01）及憂鬱（rs = .22, p < .05）等；疲倦干擾之相關因素有包括目前生活及醫療上困擾事件總數（rs = .32, p < .01）、AST（rs = -.22, p < .05）、血中尿素氮（rs =-.26, p < .01）、藥物種類總數（rs = -.19, p < .05）、症狀頻率（rs = .28, p < .01）、症狀困擾（rs = .40, p < .01）及憂鬱（rs = .26, p < .01）等。（3）憂鬱之相關因素有術後職業（t = -3.12, p < .01）、目前生活及醫療上困擾事件總數（rs = .41, p < .01）、術後時間（rs = .20, p < .05）、身體功能（rs = - .32, p < .01）、症狀頻率（rs = .32, p< .01）及症狀困擾（rs = .22, p < .05）、疲倦強度（rs = .22, p < .05）及疲倦干擾（rs= .26, p < .01）等。（4）生理構面生活品質平均 41.57 分，心理構面生活品質平均47.56 分；心臟移植患者之生活品質略差於一般健康成人。（5）生理構面生活品質之預測因素為身體功能、心臟功能分類、生活及醫療上困擾事件總數及移植前是否有其他慢性病等 4 項，共可解釋 35.6 %的變異量。心理構面生活品質之預測因素為疲倦干擾、症狀困擾、憂鬱及心臟功能分類等 4 項，共可解釋 45.0 %的變異量。
本研究發現症狀困擾、疲倦干擾、憂鬱以及身體功能、心臟功能分類、生活及醫療上困擾事件總數及移植前是否有其他慢性病等皆為心臟移植後患者生活品質之影響因素。結果可提供醫療人員確認心臟移植後病患感受症狀困擾、疲倦及憂鬱之高危險群，以提供適切之照護措施與衛教，並進行移植後改善生活品質之復健計畫。

關鍵字

心臟移植 ； 症狀困擾 ； 疲倦 ； 憂鬱 ； 生活品質

並列摘要

The purpose of this study is to explore the symptom distress, fatigue, depression and quality of life in heart transplant recipients, and associated factors of quality of life (QOL). The 108 outpatients who undergone heart transplantation were recruited from the Department of Cardiac Surgery, Nation Taiwan University Hospital, during October 2, 2008 and March 26, 2009. A cross - sectional correlated study was designed. A set of questionnaire with the Transplant Symptom Frequency and Symptom Distress Scale, Hospital Anxiety and Depression Scale (HADS) , Fatigue Symptom Inventory (FSI) , and 12-item Short-Form Health Survey (SF-12) were used to collected symptom distress, fatigue, depression, and QOL . Data were analyzed with SPSS 16.0 software.
The main results include: (1) Top five most distressed symptoms were fatigue,
forgetfulness, poor vision, muscle weakness, and acne. The symptom frequency and symptom distress are changed as time after heart transplantation; (2) Fatigue intensity is moderate, and fatigue interference is mild. Correlated factors with fatigue intensity were age (rs = -.30, p < .01) , exercise frequency every week (rs = - .24, p < .05) , life interference events (rs = .29, p < .01) , blood urea nitrogen (rs = - .22, p < .05) , medicine receive (rs = -.24, p < .05) , PeakVO2 (rs = .41, p < .01) , symptom distress (rs = .27, p < .01) , and depression (rs = .22, p < .05) . Besides, Life interference events (rs = .32, p< .01) , AST (rs = -.22, p < .05) , blood urea nitrogen (rs = -.26, p < .01) , medicine received (rs = -.19, p < .05) , symptom frequency (rs = .28, p < .01) , symptom distress (rs = .40, p < .01) , and depression (rs = .26, p < .01) were associated with fatigue interference. (3) Correlated factors with depression were employment (t = -3.12, p < .01) , Life interference events (rs = .41, p < .01) , operation period after heart transplantation (rs = .20, p < .05) , physical function (rs = -.32, p < .01) , symptom frequency (rs = .32, p < .01) , symptom distress (rs = .22, p < .05) , fatigue intensity (rs = .22, p < .05) , and fatigue interference (rs = .26, p < .01). (4) Recipients showed the score of PCS was 41.57 and MCS was 47.56, respectively. (5) For physical domain of QOL that the predictors including physical functional status, NYHA classification, life interference events, and the presence of chronic disease before transplantation ; for mental domain of QOL that the predictors including fatigue interference, symptom distress, depression, and NYHA classification. These major factors which may help to identify the potential risk of symptom distress, fatigue, and depression can be further provided to be a reference of rehabilitation-program. Besides, the quality of life also can be improved.

並列關鍵字

Heart Transplantation ； Symptom Distress ； Fatigue ； Depression ； Quality of life

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