- 學位論文
心臟移植術後病患非預期性再入院之因素探討
Factors related to the unplanned readmission for the heart transplant recipients
摘要
國內心臟移植醫療科技的進步提高了病患的存活率，但病患卻常因種種的術後合併症而再入院觀察治療，顯示病患仍有術後長期照顧上的後續問題，而「非預期性再入院」則較死亡率能反映出出院後的照護品質，本研究旨在探討心臟移植術後病患之非預期性再入院率、原因及其相關因素，以立意取樣的方式選取個案，共收得71位不同移植年數之心臟移植術後病患，採橫斷性描述性的相關性研究方法進行結構式問卷收集資料，包括基本資料問卷、疾病相關資料、藥物使用量表、症狀困擾與處置量表、健康促進生活型態量表，研究結果顯示心臟移植術後病患最近一年內之非預期性再入院率為35.2 %，且移植5(含)年內之非預期性再入院率(52.2 %)顯著高於移植5年以上者(27.1 %)，非預期性再入院原因最主要為感染(31.8 %)、排斥(25.0 %)與同種異體移植心血管病變(18.2 %)，相關因素為症狀出現項目多寡(t = 2.59，p < 0.05)與是否對該症狀感到困擾(t = 2.71，p < 0.05)，而藥物使用方式及健康促進生活型態與非預期性再入院雖未達統計上之顯著差異，但臨床現況則顯示可能的相關性存在，本研究結果可提供相關醫護人員對心臟移植術後病患後續照顧上的參考，未來得以提供此類病患適切的護理措施以提高其存活率及降低非預期性再入院率。
並列摘要
Thanks to advances in medical science with respect to the technology of heart transplantation, patients in Taiwan have shown an increased survival rate. On the other hand, very often patients must nevertheless receive hospitalization for observatory treaments because of a veriety of post-surgical complications. Such facts suggest the subsequent problems of long-term care that still affects patients. An “unanticipated re-hospitalization” rate will better reflect the quality of post-hospitalization care than a mortality rate. The present study is intended to probe into the rate of unanticipated re-hospitalization of post-surgical heart transplant patients, and the causes and the relevant factors leading to such rates. A descriptive cross-section design with purposive sampling was used in this study. The study proceeded with structural questionnaires to collect data, including demographic information, disease related questionnaire, drug regimen compliance, symptom distress and management questionnaire, and health-promoting lifestyle profile. A total of 71 patients were recruited in different periods after their heart-transplants. The major findings of this study show a rate of unanticipated re-hospitalization at 35.2% within one year. Additionally, they show a rate of unanticipated re-hospitalization at 52.2% within five years (inclusive), significantly higher than those over five years at 27.1%. The leading causes to unanticipated re-hospitalizations include infection (31.8%), rejection (25.0%) and cardiac allograft vasculopathy (18.2%). The relevant factors include whether the number of emerging symptoms (t = 2.59, p < 0.05) and the level of symptoms distress (t = 2.71, p < 0.05). The drug regimen compliance and health-promoting lifestyle data show no statistical significance with the unanticipated re-hospitalization. The clinical status, nevertheless, shows the existence of a possible relationship between them. The findings in the present study might function as a reference to medical professionals on their follow-up care of post-heart-transplant patients. In the future, they will be, in turn, able to provide appropriate medical care toward such patients to maximize the survival rate and rate of unanticipated re-hospitalization.