HIV感染者和艾滋病患者抑郁状态与社会支持的相关性研究

目的 探讨HIV感染者和艾滋病患者(PLWHA)的抑郁状态与社会支持状况,以及二者之间的相关性.方法 采用Zung抑郁自评量表(SDS)、社会支持评定量表(SSRS)对82例PLWHA进行问卷调查.结果 PLWHA的SDS评分(42.81±9.24)分,显著高于常模(P<0.01);50例(60.98%)存在抑郁状态;SSRS得分30.06±4.02,显著低于常模(P<0.01).PLWHA抑郁与社会支持呈负相关(均P<0.01);婚姻状况、文化程度、感染方式、病程及医疗费用支付方式影响SDS及SSRS得分(P<0.05,P<0.01).结论 PLWHA抑郁发生率高.社会支持水平较低;护理人员应采取有效干预措施提高PLWHA的社会支持水平,以改善其抑郁状态,提高其生活质量.     

心理行为干预对重症肝炎人工肝治疗患者生存质量的影响

目的 探讨心理行为干预对重症肝炎人工肝治疗患者的依从性及生存质量的影响.方法 将40例重症肝炎患者随机分为对照组和干预组各20例,对照组予常规护理干预;干预组在此基础上予心理行为干预,包括健康教育、诱导宣泄、个别心理疏导、家庭及社会支持及一般护理于预等措施.采用SF-36、焦虑自评量表(SAS)、抑郁自评量表(SDS)对干预结果进行评定.结果 干预后两组患者依从性、SF-36总分及各因子分,SAS、SDS得分比较,差异有显著性意义(P<0.05,P<0.01).结论 心理行为干预可减轻重症肝炎人工肝治疗患者焦虑、抑郁症状,纠正患者消极的认知,提高对人工肝治疗的依从性,可提高生存质量.     

尿毒症患者心理状况评估及护理对策

目的探讨尿毒症患者的心理健康状况,为心理支持提供依据。方法采用焦虑自评量表(SAS)和抑郁自评量表(SDS),让患者在血液透析前24～72h自评,根据指导语提示不记名独立完成评定。结果 101例尿毒症患者的SAS、SDS总分均值分别与常模比较P<0.01,都存在不同程度的焦虑和抑郁。结论尿毒症患者会出现焦虑和抑郁等较普遍的心理障碍,应对他们及早心理干预,提供针对性的心理支持,以提高治疗效果和生活质量。     

中文版便秘患者症状自评量表的信度与效度研究

目的评价中文版便秘患者症状自评量表(PAC-SYM)的信度、效度和反应度。方法采用中文版PAC-SYM量表、便秘患者生活质量自评量表(PAC-QOL)、简明健康调查问卷(SF-36)和ZUNG焦虑、抑郁自评量表(SAS/SDS)对155例功能性便秘患者进行问卷调查,其中20例患者1周后重测,39例患者接受生物反馈治疗后再次采用PAC-SYM量表评估,对测量结果进行信效度分析。结果中文版PAC-SYM量表内部一致性信度Cronbach′sα系数为0.81～0.91,重测信度组内相关系数(ICC)为0.79～0.91;该量表内容效度指数(CVI)为0.82;中文版PAC-SYM量表总分及各维度得分与SF-36、PAC-QOL、SAS/SDS总分均显著相关(均P<0.01);生物反馈治疗后,PAC-SYM量表总分及各维度得分均较治疗前显著降低(均P<0.01)。结论中文版PAC-SYM量表具有较好的信度、效度和反应度,可用于中国功能性便秘患者症状评估及疗效评价。     

终末期肾病患者睡眠质量与焦虑抑郁情绪的相关性研究

目的探讨终末期肾病患者的睡眠质量与焦虑、抑郁情绪及其相关性。方法对83例终末期肾病患者采用匹兹堡睡眠质量指数(PSQI)、焦虑自评量表(SAS)和抑郁自评量表(SDS)进行调查。结果终末期肾病患者PSQI总分为(11.45±5.37)分,SAS评分为(46.25±8.58)分,SDS评分为(43.67±7.92)分;PSQI与SAS、SDS呈显著正相关(均P0.01)。结论终末期肾病患者睡眠质量较差,焦虑、抑郁情绪严重,且睡眠质量与焦虑、抑郁情绪有相关性。需运用心理干预治疗提高终末期肾病患者的睡眠质量。     

乳腺癌根治术后形体改变患者心理社会因素与生活质量的相关性分析

目的:了解乳腺癌根治术后形体改变患者的生活质量水平,并探讨其与心理社会因素的关系。方法:采用一般资料调查表、焦虑自评量表(Self-rating anxiety scale,SAS)、抑郁自评量表(Self-rating depression scale,SDS)、Connor-Davidson心理弹性量表(Connor-Davidson resilience scale,CD-RISC)、社会支持量表和生活质量测定量表(Functiond assessment of cancer therapy-breast,FACT-B)对98例乳腺癌根治术后患者进行调查分析;以FACT-B评分平均值作为分界点将患者分为生活质量高水平组和生活质量低水平组。结果:98例乳腺癌根治术后患者SAS量表评分为(53.90±6.80)分、SDS量表评分为(55.96±6.13)分、CD-RISC量表评分为(64.91±7.62)分、社会支持量表评分为(35.70±4.38)分、FACT-B量表评分为(70.27±13.61)分。生活质量高水平组SAS评分、SDS评分显著低于生活质量低水平组,差异有统计学意义(P0.05);CD-RISC评分、社会支持量表得分显著高于生活质量低水平组,差异有统计学意义(P0.05)。Pearson相关性分析显示,FACT-B评分与年龄、CD-RISC评分、社会支持量表得分呈显著正相关(P0.05),与SAS评分、SDS评分呈显著负相关(P0.05)。多元线性回归分析结果显示,年龄、CD-RISC评分、社会支持量表得分是影响乳腺癌根治术后患者生活质量水平的独立相关因素(P0.05)。结论:年龄、心理弹性水平及社会支持水平是乳腺癌根治术后患者生活质量水平的独立相关因素,在临床工作中应加强对乳腺癌根治术后患者心理弹性、社会支持等心理社会因素的评估,采取针对性干预措施以改善患者生活质量水平。     

骨肿瘤患者情感障碍相关因素调查分析

目的 了解骨肿瘤患者抑郁、焦虑情绪的发生率,并对其相关因素进行分析.方法 对210例骨肿瘤住院患者,应用抑郁自评量表(SDS)、焦虑自评量表(SAS)、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)和自行设计的情感障碍影响因素调查表,进行情感状况及其相关因素的调查和分析.结果 骨肿瘤患者抑郁和焦虑的发生率分别为52.9%和21.4%;患者的SDS、SAS标准分显著高于常模(均P＜0.01);不同病期骨肿瘤患者的情感障碍阳性率比较,差异有显著性意义(均P＜0.01).影响骨肿瘤患者的情感因素诸多,但以对医疗费用(73.3%)、治疗效果的担心(62.9%)最为显著.结论 骨肿瘤患者情绪障碍严重,应及早给予心理干预和必要的社会支持,以提高患者的治疗效果及生存质量.     

慢性心力衰竭患者睡眠质量及其影响因素调查分析

目的了解慢性心力衰竭(心衰)患者住院期间的睡眠质量及其影响因素.方法采用匹兹堡睡眠质量指数(PSQI)量表,焦虑自评量表(SAS),抑郁自评量表(SDS)和睡眠影响因素调查表对100例慢性心衰患者进行问卷调查.结果 73.0%慢性心衰患者有睡眠问题,PSQI总分及7个分项得分与国内常模相比较,差异有显著性意义(均P<0.01);心功能等级、SAS、SDS和环境质量与睡眠质量呈正相关关系;影响因素依次为生理(呼吸困难、心悸、咳嗽、咳痰),心理(担心疾病、经济困难、家庭功能不良)和环境(院内噪声、夜间治疗护理)三方面.结论慢性心衰患者的睡眠质量较差,应采取有效的护理措施控制影响睡眠的各种因素.     

心血管疾病患者生活质量与心理健康状况的相关性研究

目的探讨心血管疾病患者心理健康、生活质量状况以及两者之间的关系,为制定科学的临床干预措施提供依据。方法分别采用生活质量评定简表(SF-36)中文版和症状自评量表(SCL-90)评估121例心血管疾病患者的生活质量水平和心理健康状况,并进行相关性分析。结果患者的SF-36 8个维度中生理机能、躯体疼痛、活力、心理健康4个维度评分显著低于国内常模(均P<0.01),SCL-90因子除强迫、抑郁、精神病性外,其余6个因子评分显著高于国内常模(P<0.05,P<0.01)。患者SF-36部分维度评分与SCL-90部分因子评分呈显著负相关(P<0.05,P<0.01)。结论心血管疾病患者的生活质量不高,心理健康欠佳,且两者之间密切相关;护理人员应加强心理护理,尤其通过扎实的生活护理和健康教育,改善患者的心理健康状态,提高患者生活质量。     

150例急性肠套叠患儿家属焦虑抑郁情绪的相关因素分析及护理干预

目的:调查分析住院解肠套叠住院患儿家属焦虑与抑郁患病情况及其相关的影响因素.方法:收集中国医科大学附属盛京医院小儿外科病房肠套叠住院患儿的直系家属150例,应用焦虑自评量表(SAS)及抑郁自评量表(SDS)进行测评并对结果进行分析.结果:肠套叠家属的焦虑、抑郁自评量表的焦虑得分(61.30±14.21)分,抑郁评分(54.00±14.89)分,与正常人群国内常模比较有显著性差异(P＜0.01);文化程度和年龄在焦虑和抑郁得分上的差异均具有统计学意义(P＜0.01;P＜0.01);性别对焦虑和抑郁得分的影响不显著(P＞0.05).结论:肠套叠患者家属的焦虑和抑郁状况受到多种因素不同程度的影响,而文化程度和年龄对焦虑和抑郁的程度影响较大,临床上应采用不同的措施来降低肠套叠家属的焦虑和抑郁情绪.     

Waiting for lung transplantation: quality of life, mood, caregiving strain and benefit, and social intimacy of spouses

BACKGROUND: The emotional and physical well-being of lung transplant patients is enhanced by the availability and stability of a primary caregiver. METHODS: We describe the quality of life (QOL), mood, caregiving strain and benefits, and social intimacy of 73 lung transplant caregivers who completed the QOL Inventory, SF-36 Health Survey, Profile of Mood States, Caregiver Strain Index, Caregiver Benefit Index, and Miller Social Intimacy Scale. RESULTS: Clinically low QOL was reported by 17.8-35.6% of spouses. Relative to a normative sample, spouses reported significantly lower physical (z = 4.01, p < 0.001) and emotional (z = 7.01, p < 0.001) QOL. Over half (56.2%) had clinically elevated caregiving strain. Heightened physical strain (80.8%), inconvenience (79.5%), feeling confined (72.6%), feeling upset that patient has changed so much (69.9%) contributed most to caregiver strain, while discovering inner strength (60.3%), support from others (53.4%), and realizing what is important in life (42.5%) were noted caregiving benefits. Higher caregiving strain was associated with more mood disturbance (r = 0.42, p < 0.001), lower emotional QOL (r = -0.39, p < 0.002), lower social intimacy (r = -0.37, p < 0.002), and longer disease duration (r = 0.55, p < 0.001). CONCLUSION: Spouses of patients awaiting lung transplantation may experience QOL deficits and high caregiver strain. Interventions to improve QOL and reduce caregiver strain are needed.     

The effect of bronchiolitis obliterans syndrome on health related quality of life

Bronchiolitis obliterans syndrome (BOS) is the most important factor limiting long-term survival after lung transplantation, and has a substantial impact on patients' daily life in terms of disability and morbidity. Aim of our study was to examine the effects of BOS on health related quality of life (HRQL) in lung transplantation patients. Data on HRQL from 29 patients who developed BOS at least 18 months earlier were studied longitudinally. HRQL measures were: the Nottingham Health Profile (NHP), the State Trait Anxiety Inventory (STAI), the Self-rating Depression Scale (ZUNG), and the Index of Well Being (IWB). Furthermore questions concerning activities of daily life and dyspnea were asked. The majority of the patients were male, and the most common diagnosis was emphysema. After the onset of BOS, significantly more restrictions were reported on the dimensions energy and mobility of the NHP. These restrictions appeared to increase over time. After the onset of BOS, STAI scores remained more or less stable and close to the value of the general population. ZUNG scores were significantly higher after the onset of BOS, and patients experienced a lower level of well being than the general population. The percentage of patients that reported to be able to perform activities of daily life without effort declined dramatically after the onset of BOS. Furthermore, the percentage of patients complaining of dyspnea increased after the onset of BOS. In conclusion, our study showed that HRQL was negatively affected by the onset of BOS. However, in spite of these less favorable long-term results, even patients who develop BOS may at least temporarily benefit from a lung transplantation.     

Factors influencing change in health-related quality of life after liver transplantation

OBJECTIVE: To assess health-related quality of life (HRQoL) in patients following liver transplantation and the factors associated with HRQoL variation. METHODS AND MATERIALS: Sociodemographic and clinical data were collected for 60 consecutive patients activated for liver transplantation in a single hospital. Patients were classified according to the severity of the cirrhosis (Child-Pugh class) and disease etiology (alcoholic cirrhosis, viral cirrhosis, cholestatic diseases, and hepatocarcinoma). HRQoL was assessed by three different questionnaires: the Health Survey Short Form 36 (SF-36), the Hospital Anxiety and Depression Scale (HAD), and a specific-symptom questionnaire. Questionnaires were completed during the pre-operative period and six months after transplantation. RESULTS: In the pre-operative period, patients with Child A had higher mean levels of HRQoL than did those in other groups. At six months following transplantation, there were no significant differences among the groups, largely because gains obtained by patients with Child B and C were much greater than those attained by patients with Child A. Across the four etiological groups, there were significant differences in all domains of the three questionnaires, except SF-36-bodily pain and HAD-anxiety, prior to transplantation, because patients with hepatocarcinoma had much better HRQoL. After transplantation, there were no differences because patients with viral and alcohol-induced cirrhosis achieved greater gains with respect to the neoplastic group. During the pre-operative period, the scores for all areas of the SF-36 and for all groups were below the general population normalized score of 50 (except for patients with Child class A and those affected with hepatocarcinoma). Six-months post-transplantation, the scores on most of the domains remained below 50, except for certain mental areas in which higher scores were attained. CONCLUSIONS: Health-related quality of life is influenced by the severity and etiology of cirrhosis-patients with Child class C and those with alcoholic or viral cirrhosis have the poorest quality of life. There were no differences observed among the groups after the transplantation, as the patients with the lowest HRQoLs prior to surgery demonstrated greater gains in HRQoL associated with liver transplantation.     

The Effects of Physical Quality of Life,Time, and Gender on Change in Symptoms of Anxiety and Depression after Liver Transplantation

Previous research demonstrated that physical health-related quality of life (HRQOL) improves after liver transplantation, but improvements in mental HRQOL are less dramatic. The aim of this study was to test the effects of physical HRQOL, time post-transplant, and gender on pre- to post-transplant change in anxiety and depression. Longitudinal HRQOL data were prospectively collected at specific times before and after liver transplantation using the SF-36® Health Survey (SF-36), Center for Epidemiologic Studies Depression Scale (CES-D), and Beck Anxiety Inventory (BAI). Within-subject change scores were computed to represent the longest follow-up interval for each patient. Multiple regression was used to test the effects of baseline score, time post-transplant, gender, and SF-36 physical component summary scores (PCS) on change in BAI and CES-D scores. About 107 patients (74% male, age?=?54?±?8 years) were included in the analysis. Time post-transplant ranged 1 to 39 months (mean?=?9?±?8). Improvement in symptoms of anxiety and depression was greatest in those patients with the most severe pre-transplant symptoms. Significant improvement in symptoms of depression occurred after liver transplant, but the magnitude of improvement was smaller with time suggesting possible relapse of symptoms. Better post-transplant physical HRQOL was associated with a greater reduction in symptoms of anxiety and depression after liver transplantation. This demonstrates clear improvements in post-transplant mental HRQOL and the significant relationships between physical and mental HRQOL.     

Osteoporosis is a prevalent finding in patients with solid organ failure awaiting transplantation – a population based study

Dolgos S, Hartmann A, Isaksen GA, Simonsen S, Bjørtuft Ø, Boberg KM, Bollerslev J. Osteoporosis is a prevalent finding in patients with solid organ failure awaiting transplantation – a population based study
Clin Transplant 2010 DOI: 10.1111/j.1399‐0012.2010.01231.x.
© 2010 John Wiley & Sons A/S. Abstract: Post‐transplant bone disease is common in solid organ recipients; however, there is limited information on their pre‐transplant bone status. We aimed to compare bone mineral density (BMD) in different categories of patients with end‐stage organ failure awaiting transplantation (Tx) in Norway. Overall 291 adult patients were enrolled, including 60, 84, 81 and 66 patients with end‐stage lung, liver, kidney and heart failure, respectively. Mean age was 51 ± 12 yr with no significant differences between the groups. We measured BMD in lumbar spine, femur, proximal one third and ultra‐distal radius by dual energy X‐ray absorptiometry. Differences in T‐ and Z‐scores between the groups were compared by ANOVA. Low bone mass was found in all four groups of patients. Both T‐ and Z‐scores differed (p < 0.05) at all measured sites between the groups. Patients with lung failure had the highest prevalence of osteoporosis (67%) and lowest Z‐scores, followed by patients with liver (31%), kidney (24%), and heart (23%) failure. Osteoporosis is prevalent in all groups of organ transplant candidates, and poor bone health is remarkably pronounced in patients with chronic lung disease. General practitioners and specialists who care for these patients before they are referred for transplantation should consider measures to prevent osteoporosis at an earlier stage.     

Heart and Lung Transplantation in the United States, 1997–2006

This article highlights trends in heart and lung transplantation between 1997 and 2006, drawing on data from the OPTN and SRTR. The total number of candidates actively awaiting heart transplantation declined by 45% over the last decade, dropping from 2414 patients in 1997 to 1327 patients in 2006. The overall death rates among patients awaiting heart transplantation declined over the same period. The distribution of recipients among the different status groups at the time of heart transplantation changed little between the inception of the new classification system in 1999 and 2005. Deaths in the first year after heart transplantation have steadily decreased. At the end of 2006, 2885 candidates were awaiting a lung transplant, up 10% from the 1997 count. The median time-to-transplant for listed patients decreased by 87% over the decade, dropping from 1053 days in 1997 to 132 days in 2006. Selection for listing and transplantation has shifted toward more urgent patients since the May 2005 implementation of a new lung allocation system based on survival benefit and urgency rather than waiting time. Only 31 heart-lung transplants were performed in 2006, down from a high of 62 in 1997.     

Quality of life after lung transplantation: a cross-sectional study.

BACKGROUND: The increase in life expectancy has raised the importance of quality of life after lung transplantation, although this issue has not yet been systematically investigated. The aim of this cross-sectional study was to provide an overview of quality of life in lung transplant patients. METHODS: Between April and July 2001, a set of 4 questionnaires were given to all adult, German-speaking lung transplant recipients (n = 108; response rate 87% [n = 94]): St. George's Respiratory Questionnaire (SGRQ), a lung-specific health status instrument; the Short Form-36 (SF-36), a general quality of life measure; the Hospital Anxiety and Depression Scale (HADS-D) and a self-reported questionnaire concerning sexual functioning, physical symptoms, adverse effects of immunosuppression and satisfaction with outcome. RESULTS: With regard to the SGRQ, all lung transplant recipients had significantly better scores, which reflected an enhanced quality of life compared with the reference value for patients with obstructive pulmonary disease (SGRQ: p < 0.001 in all sub-scales). The Hospital Anxiety and Depression Scale and the Mental Component Summary Scale of the SF-36 did not differ significantly compared with published normative data in the healthy population. However, the side effects of immunosuppression proved to be a major factor influencing the quality of life of lung transplant recipients (11% influenced strongly and 24% moderately). Seventy-six percent of lung transplant patients were highly satisfied with the transplant outcome and 92% would opt for the procedure again. Among all lung transplant recipients, those with cystic fibrosis were most satisfied (significantly) with their quality of life. CONCLUSIONS: Although lung transplant patients must cope with the side effects of immunosuppression, they report a highly satisfying quality of life with regard to physical and emotional well-being and social and sexual function.     

Health related quality of life (HRQOL) of kidney transplanted patients: variables that influence it

The incidence and prevalence of patients on renal replacement therapy (RRT) who receive a renal transplant are continuously increasing in Spain. At the moment, they are the main group of end-stage renal disease (ESRD) patients in our region (60% of total RRT patients). The aim of the present study was to assess the health related quality of life (HRQOL) of kidney transplanted patients of our region, and to identify socio-demographic and clinical variables that influence it. The intention was also to compare the HRQOL of these patients with that of chronic haemodialysis (HD) patients and of the general population. METHODS: Two hundred and ten kidney transplanted patients and 170 HD patients were evaluated using the Karnofsky performance scale (KPS), sickness impact profile (SIP), and SF-36 Health Survey (SF-36). Socio-demographic and clinical data, including a comorbidity index (CI), were also collected. To compare our patients with the general population we used SF-36 mean scores from an aleatory sample taken from our region. RESULTS: Transplant patients had lower mean scores on SIP dimensions and higher scores on SF-36 dimensions than chronic HD patients. In transplant patients, we found significant differences on SIP and SF-36 scores in gender, educational level, haematocrite and haemoglobin, CI, time since transplantation, and KPS. CONCLUSIONS: The HRQOL of transplant patients is clearly better than that of chronic HD patients and similar to that of the general population. Differences in the HRQOL within transplant patients did not appear to be as a result of patient's age, but rather it would appear to be a consequence of gender, analytic figures, CI, KPS score, time with transplant, and educational level.     

肝硬化患者肝移植术后生存质量的变化

目的调查肝硬化患者肝移植前后生存质量的变化情况。方法研究对象为在中山大学附属第三医院移植中心行首次肝移植手术的68例肝硬化患者。分别在术前,术后0～6个月、7～12个月、12个月以上对患者进行问卷调查。问卷采用健康调查简表(medical outcome study 36-item short form health survey,SF-36)与疾病专用调查表——慢性肝病问卷(chronic liver disease questionaire,CLDQ)。结果在肝移植术前,肝硬化患者的SF-36和CLDQ各维度评分均偏低。术后各时段SF-36的生理机能、躯体疼痛、一般健康、精力和CLDQ的腹部症状、乏力、全身症状、活动评分均较术前明显升高(均为P<0.05);与术前比较,术后0～6个月SF-36的生理职能、社会功能、情感职能、精神健康和CLDQ的情感功能、焦虑评分差异无统计学意义(均为P>0.05),但术后7～12个月、术后12个月以上述维度评分比较差异均有统计学意义(均为P<0.05);术后随着时间的推移,两表各维度得分逐步升高。结论肝硬化肝移植患者术后的生存质量与术前比较有明显改善,术后早期以生理功能方面改善明显,随时间的推移,生存质量其他指标如心理状态和社会功能也得到明显的改善。