Grady Kathleen L, Naftel David C, Young James B, Pelegrin Dave, Czerr Jennifer, Higgins Robert, Heroux Alain, Rybarczyk Bruce, McLeod Mary, Kobashigawa Jon, Chait Julie, White-Williams Connie, Myers Susan, Kirklin James K
Northwestern Memorial Hospital, Chicago, Illinois, USA.
J Heart Lung Transplant. 2007 Nov;26(11):1182-91. doi: 10.1016/j.healun.2007.08.001. Epub 2007 Sep 27.
Researchers have not examined relationships between perception of physical functional disability and demographic, clinical, and psychological variables at 5 to 10 years after heart transplantation. Therefore, the purposes of this study were to describe physical functional disability over time and identify predictors of physical functional disability from 5 to 10 years after heart transplantation.
The study enrolled 555 patients who were between 5 and 10 years post-heart transplant (age, 54 +/- 9 years; 78% male, 88% white, 79% married). Patients completed 6 instruments that measure physical functional disability and factors that may impact physical functional disability. Statistical analyses included calculation of frequencies, means +/- standard deviation (plotted over time), Pearson correlation coefficients, and multiple regression coupled with repeated measures.
Between 5 and 10 years after heart transplantation, physical functional disability was low, and 34% to 45% of patients reported having no functional disability. More physical functional disability was associated with having more symptoms, having depression/mood/negative affect and lower use of negative coping strategies, having more comorbidities and more specific comorbidities (e.g., more orthopedic problems and diabetes); higher New York Heart Association functional class; having more acute rejection, infection, or cardiac allograft vasculopathy; being female, older, less educated, and unemployed; higher body mass index; and more hospital readmissions (explaining 46% of variance [F = 84.75, p < 0.0001]).
Demographic, clinical, and psychological factors were significantly related to physical functional disability. Knowledge of these factors provides the basis for development of therapeutic plans of care.
研究人员尚未考察心脏移植术后5至10年时身体功能残疾认知与人口统计学、临床及心理变量之间的关系。因此，本研究的目的是描述随时间推移的身体功能残疾情况，并确定心脏移植术后5至10年身体功能残疾的预测因素。
本研究纳入了555例心脏移植术后5至10年的患者（年龄54±9岁；78%为男性，88%为白人，79%已婚）。患者完成了6项用于测量身体功能残疾及可能影响身体功能残疾的因素的工具测试。统计分析包括频率计算、均值±标准差（随时间绘制）、Pearson相关系数以及重复测量的多元回归分析。
在心脏移植术后5至10年期间，身体功能残疾程度较低，34%至45%的患者报告无功能残疾。更多的身体功能残疾与更多症状、存在抑郁/情绪/负面情绪以及较少使用消极应对策略、更多合并症及更特定的合并症（如更多骨科问题和糖尿病）、更高的纽约心脏协会功能分级、更多急性排斥反应、感染或心脏移植血管病变、女性、年龄较大、受教育程度较低和失业、更高的体重指数以及更多次住院再入院情况相关（解释了46%的方差[F = 84.75，p < 0.0001]）。
人口统计学、临床及心理因素与身体功能残疾显著相关。了解这些因素为制定治疗护理计划提供了依据基础。
