Grady K L, Jalowiec A, White-Williams C
Department of Medicine, Section of Cardiology Rush-Presbyterian-St. Luke's Medical Center, Chicago, Ill 60612-3824, USA.
J Heart Lung Transplant. 1998 Apr;17(4):383-94.
The purpose of this report is to determine the extent of difficulty following and self-reported compliance with prescribed activities at 1 year after heart transplantation, identify postoperative predictors of compliance at 1 year after transplantation, and compare difficulty following and compliance with the therapeutic regimen at 1 year versus 2 years after transplantation.
Data were collected from a nonrandom sample of 120 adult patients 1 year after heart transplantation and 76 of 120 patients 2 years after transplantation. Patients were 83% male, mean age 54 years, 86% were married, 28% were employed, and 91% were in NYHA class I at 1 year after transplantation. Data were collected from the Assessment of Problems with the Heart Transplant Regimen, Quality of Life Index, Heart Transplant Symptom Checklist, Sickness Impact Profile, Heart Transplant Stressor Scale, Jalowiec Coping Scale, Social Support Index, Heart Transplant Intervention Scale, Rating Question Form, and chart review. Data were analyzed via frequencies, multiple regression, paired t-tests, and the Wilcoxon matched-pairs signed-ranks test.
At both 1 year and 2 years after transplantation, patients had almost no difficulty following the heart transplantation regimen and complied almost all of the time with taking medications, attending clinic, and completing scheduled tests. Patients complied less with following a diet, exercising, and taking their vital signs. Predictors of compliance at 1 year after heart transplantation differed by prescribed activity, explaining from 13% to 52% of variance (p < or = 0.0001).
These findings indicate the need to continue the study of heart transplant recipient compliance longitudinally for individual prescribed activities and provide evidence and direction for the development of interventions to enhance patient compliance.
本报告的目的是确定心脏移植术后1年患者在遵循医嘱活动方面的困难程度以及自我报告的依从性，识别移植术后1年依从性的术后预测因素，并比较移植后1年与2年在遵循医嘱活动和治疗方案依从性方面的差异。
数据收集自心脏移植术后1年的120例成年患者的非随机样本，以及术后2年的120例患者中的76例。患者中83%为男性，平均年龄54岁，86%已婚，28%有工作，移植术后1年时91%的心功能分级为纽约心脏协会（NYHA）I级。数据收集自心脏移植方案问题评估、生活质量指数、心脏移植症状清单、疾病影响概况、心脏移植应激源量表、贾洛维克应对量表、社会支持指数、心脏移植干预量表、评分问卷表以及病历回顾。通过频率分析、多元回归、配对t检验和威尔科克森配对符号秩检验对数据进行分析。
在移植术后1年和2年时，患者在遵循心脏移植方案方面几乎没有困难，并且几乎在所有时间都能坚持服药、就诊和完成定期检查。患者在遵循饮食、锻炼和测量生命体征方面的依从性较低。心脏移植术后1年依从性的预测因素因规定活动而异，可解释13%至52%的方差（p≤0.0001）。
这些发现表明需要针对个体规定活动对心脏移植受者的依从性进行纵向持续研究，并为制定提高患者依从性的干预措施提供证据和方向。
