Lundmark Martina, Lennerling Annette, Almgren Matilda, Forsberg Anna
Thoracic Intensive Care Unit, Skåne University Hospital, Lund, Sweden.
Department of Health Sciences, Lund University, Lund, Sweden.
Scand J Caring Sci. 2019 Mar;33(1):176-184. doi: 10.1111/scs.12618. Epub 2018 Oct 15.
In recent years, survival after lung transplantation has remained largely unchanged despite improvements in short-and intermediate-term survival, indicating the need to identify factors associated with recovery and long-term survival. Very little is known about how lung recipients recover after lung transplantation and whether such factors are related to symptom distress and well-being. This constitutes the rationale of the study.
The aim was to explore symptom prevalence and distress as well as the degree of self-reported perceived recovery and well-being 1-5 years after adult lung transplantation.
This multicentre, cross-sectional nationwide study includes 117 lung recipients due for follow-up at 1 year (n = 35), 2 years (n = 28), 3 years (n = 23), 4 years (n = 20) and 5 years (n = 11). Three different self-assessment instruments were utilised; The Postoperative Recovery Profile, the Organ Transplant Symptom and Well-Being Instrument, and the Psychological General Well-Being Instrument. Ethical approval of the study was obtained.
Few (5.7%) lung recipients were recovered 1-5 years after lung transplantation and 27.6% were not recovered at all. No relationship was identified between present lung function and self-reported recovery or well-being. There was a strong relationship between recovery and well-being. It is possible to be partly recovered and experience good health. The most prevalent symptoms were tremor 66%, breathlessness 62%, and decreased libido 60%, while the symptoms perceived as most distressing were embarrassment about appearance, decreased libido, and poor appetite.
The cross-sectional design prevents identification of any causal relationships. Patient loss due to transplant mortality and inclusion difficulties resulted in a fairly small sample.
Our findings suggest the need for changes in follow-up care such as systematic measurement of the degree of self-reported recovery and symptoms. This entails self-management support tailored to the recipients' symptom-management and health-management requirements.
近年来，尽管肺移植术后短期和中期生存率有所提高，但长期生存率基本保持不变，这表明需要确定与康复及长期生存相关的因素。关于肺移植受者术后如何康复以及这些因素是否与症状困扰和健康状况相关，目前知之甚少。这构成了本研究的理论基础。
旨在探讨成人肺移植术后1至5年的症状发生率、困扰程度以及自我报告的康复程度和健康状况。
这项多中心、全国性的横断面研究纳入了117名肺移植受者，他们分别在术后1年（n = 35）、2年（n = 28）、3年（n = 23）、4年（n = 20）和5年（n = 11）进行随访。使用了三种不同的自我评估工具；术后康复概况、器官移植症状与健康状况量表以及心理总体健康量表。本研究获得了伦理批准。
肺移植术后1至5年，很少有受者（5.7%）康复，27.6%的受者完全未康复。目前的肺功能与自我报告的康复或健康状况之间未发现关联。康复与健康状况之间存在密切关系。有可能部分康复且身体健康状况良好。最常见的症状是震颤（66%）、呼吸急促（62%）和性欲减退（60%），而最令人困扰的症状是对外表感到尴尬、性欲减退和食欲不振。
横断面设计无法确定任何因果关系。由于移植死亡率和纳入困难导致的患者流失导致样本量相当小。
我们的研究结果表明，需要改变随访护理方式，例如系统测量自我报告的康复程度和症状。这需要根据受者的症状管理和健康管理需求提供自我管理支持。
