Serrano-Ikkos E, Lask B, Whitehead B, Eisler I
Department of Psychological Medicine, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom.
J Heart Lung Transplant. 1998 Dec;17(12):1177-83.
Poor adherence to treatment after organ transplantation is life threatening. Clinical experience indicates that failure to adhere to the medical regimen after pediatric heart or heart-lung transplantation is more common than might be anticipated. This is the first empirical study of adherence in this population.
The subjects were 53 children and adolescents (mean age 10.3 years) who underwent transplantation and were followed up for 12 months after transplantation. At each attendance blood levels of cyclosporine were measured and medical diaries checked. For children who had undergone heart-lung transplantation, serial measures of respiratory function were obtained, both at home and in the laboratory. Levels of adherence to the immunosuppressive therapy and completion of the medical diary were determined on the basis of prior operational definitions.
Satisfactory adherence to medication and satisfactory completion of the diaries were found in 37 children (70%). Satisfactory adherence to medication but unsatisfactory completion of the diaries were found in 11 children (21%). There was poor adherence to medication in 5 other children (9%) regardless of whether the diary was satisfactorily completed. Independent variables associated with poor adherence to medication were heart-lung as opposed to heart transplantation, one-parent or blended families, and family adjustment.
Nearly one third of the sample showed unsatisfactory adherence to the treatment regimen. This relatively high prevalence indicates the importance of close monitoring of adherence. The identification of family characteristics as risk factors indicates a need for more intensive psychoeducational family counseling in the 12 months after transplantation.
器官移植后治疗依从性差会危及生命。临床经验表明，小儿心脏或心肺移植后不遵守医疗方案的情况比预期更为常见。这是对该人群依从性的首次实证研究。
研究对象为53名儿童和青少年（平均年龄10.3岁），他们接受了移植手术，并在移植后随访12个月。每次就诊时测量环孢素的血药浓度，并检查医疗日记。对于接受心肺移植的儿童，在家中和实验室均获取了呼吸功能的系列测量值。根据先前的操作定义确定免疫抑制治疗的依从性水平和医疗日记的完成情况。
37名儿童（70%）药物依从性良好且日记完成情况令人满意。11名儿童（21%）药物依从性良好但日记完成情况不令人满意。另外5名儿童（9%）药物依从性差，无论日记是否令人满意地完成。与药物依从性差相关的独立变量是心肺移植而非心脏移植、单亲或混合家庭以及家庭适应情况。
近三分之一的样本对治疗方案的依从性不令人满意。这种相对较高的患病率表明密切监测依从性的重要性。将家庭特征确定为风险因素表明在移植后12个月需要更强化的心理教育家庭咨询。
