Littlefield C, Abbey S, Fiducia D, Cardella C, Greig P, Levy G, Maurer J, Winton T
Department of Psychology, Toronto Hospital, University of Toronto, Ontario, Canada.
Gen Hosp Psychiatry. 1996 Nov;18(6 Suppl):36S-47S. doi: 10.1016/s0163-8343(96)00082-5.
The purpose of this study was to describe the quality of life of patients who have received a transplant of the heart, liver, and lungs. We wished to document how the different patient groups fared in relation to each other with respect to physical, psychological, and social functioning, as well as in relation to published normative data. We also wished to identify factors that contribute to better functioning. We sent out a questionnaire by mail and received responses from 55 heart, 149 liver, and 59 lung transplant recipients (82% response rate). Measures included the SF-36, Mental Health Inventory, the State Anxiety Inventory, the UCLA Loneliness Scale-Revised, a quality of life measure that rated degree of improvement since transplantation, a measure of degree of difficulty in following medical and lifestyle regimens, sleep disturbance, and the Illness Intrusiveness Rating Scale. Results indicated that lung transplant patients reported better functioning than heart or liver transplant patients in all three domains of physical, psychological, and social functioning. Lung patients' level of functioning was equivalent to or better than published norms for the SF-36. Heart and liver recipients reported equivalent functioning to published norms in some domains, but reported impairment in the areas of physical and social functioning. Heart patients especially reported greater intrusiveness of their illness on their daily lives and indicated more difficulty complying with their lifestyle regimen. In all three groups, a large majority of patients reported feeling that life had improved since transplant with respect to health, energy level, activity level, and overall quality of life. Fewer patients reported improvements in the areas of sex life, marriage, family relationships, and social relationships. Where there were differences among the three patient groups, again it was the lung patients who reported more improvement in life since transplantation. Patients with better physical functioning tended to have more energy and pep, to be younger, to see themselves as being in better health, to feel less intrusion on their lives of their illness, and to be employed. Those with better psychological functioning tended to report less sleep disturbance, less loneliness, better social functioning, more vitality, and to be older. Better social functioning was associated with better mental health, less illness intrusiveness, and less role impairment as a result of physical or emotional factors. Relatively few patients-roughly a quarter of the total sample-reported that they were working either full or part time. We conclude that transplantation results in improved quality of life overall, but that problems persist for some patients in their physical and social functioning. Interventions aimed at improving rehabilitation in specific targeted areas may enable patients to resume a more fulfilling lifestyle posttransplant.
本研究的目的是描述接受心脏、肝脏和肺移植患者的生活质量。我们希望记录不同患者群体在身体、心理和社会功能方面相互之间的情况，以及与已发表的标准数据相比的情况。我们还希望确定有助于功能改善的因素。我们通过邮件发放了问卷，共收到55名心脏移植受者、149名肝脏移植受者和59名肺移植受者的回复（回复率为82%）。测量指标包括SF-36健康调查量表、心理健康量表、状态焦虑量表、加州大学洛杉矶分校孤独感量表修订版、一项评估自移植以来改善程度的生活质量指标、一项评估遵循医疗和生活方式方案难度程度的指标、睡眠障碍以及疾病侵扰评定量表。结果表明，在身体、心理和社会功能的所有三个领域，肺移植患者的功能状况均优于心脏或肝脏移植患者。肺移植患者的功能水平等同于或优于SF-36已发表的标准。心脏和肝脏移植受者在某些领域的功能状况与已发表的标准相当，但在身体和社会功能方面存在受损情况。心脏移植患者尤其报告称其疾病对日常生活的侵扰更大，并且表示在遵循生活方式方案方面困难更大。在所有三个组中，绝大多数患者报告称自移植以来在健康、精力水平、活动水平和总体生活质量方面生活有所改善。较少患者报告在性生活、婚姻、家庭关系和社会关系方面有所改善。在三个患者群体之间存在差异的方面，同样是肺移植患者报告自移植以来生活改善更多。身体功能较好的患者往往精力更充沛、更年轻、自认为健康状况更好、感觉疾病对其生活的侵扰更小且有工作。心理功能较好的患者往往报告睡眠障碍更少、孤独感更少、社会功能更好、更有活力且年龄更大。更好的社会功能与更好的心理健康、更少的疾病侵扰以及因身体或情感因素导致的角色受损更少相关。相对较少的患者——约占总样本的四分之一——报告称他们正在全职或兼职工作。我们得出结论，移植总体上会导致生活质量提高，但一些患者在身体和社会功能方面仍然存在问题。针对特定目标领域改善康复的干预措施可能使患者在移植后恢复更充实的生活方式。
