心臟移植術後病患對症狀困擾之自我處置成效

Effects of Self Management on Symptom Distress of Heart Transplant Recipients

心臟疾病末期病患雖因移植醫學的進步而使其存活率提升，但接踵而來的是移植術後病患在日後長期生活上可能面臨的身、心、社會方面的困擾，嚴重者亦可能對病患造成生命上的威脅。本文之主要目的為探討心臟移植術後病患對症狀困擾之自我處置成效，採橫斷描述性的研究方法，以立意取樣的方式在臺北市某醫學中心依收案標準選取符合本研究目的的病患為研究對象，再以結構式問卷及會談方式收集資料，共收集71 位病患資料。研究結果顯示心臟移植術後病患於術後之症狀出現項目平均為11項（11.38± 5.93），而對於所出現的症狀會感到困擾之項目平均為6 項（6.06 ± 5.21），病患出現最多的前六大症狀依序為「體能變差」、「疲倦」、「腳抽筋」、「容易忘記事情」、「視力模糊」與「關節酸痛」；最感困擾的前六大症狀則依序為「體能變差」、「視力模糊」、「關節酸痛」、「腳抽筋」、「疲倦」與「情緒不穩」，而對於移植術後所產生的症狀之處置方式可歸納為三類：（1）積極的處置；（2）消極的處置；（3）隱含危害的處置，從病患之處置方式可發現病患因對症狀的不了解及錯誤的認知而使得處置成效不佳，未來建議制定「個案管理」模式及提供病患完整的居家追蹤計畫以協助心臟移植術後病患能有正確的術後照顧。

The survival rate of patients with end-stage heart disease can be increased by heart transplant. The heart transplant recipients are likely to have symptoms of physiological, psychological, and social distress. It could potentially become a serious threat to the life of a patient. The aim of the study was to explore the symptom distress and the effects of self-management on the distress for heart transplant recipients. This study was of a descriptive, cross-sectional design, and conducted at a medical center in northern Taiwan. Purposive sampling was used to recruit patients. A total of 71 patients participated in the study. Interview with structural questionnaires were used for data collection. The results showed that the average number of the heart transplants’ symptom was 11(11.38 ± 5.93), and the average number of the symptom distress was 6(6.06 ± 5.21). For all patients, the symptoms that most patients had were feeble, fatique, foot spasm, forgetting, blur vision, and joints ache in sequence. The symptom distress included feeble, blur vision, joints ache, foot spasm, fatique, and labile mood in sequence. Management of the symptom distress occurred after heart transplant might follow one of the three categories: (1) positive processing, (2) negative processing, and (3) potential harmful. In future studies, continuous postoperative follow-up should be performed and a case management system should be developed to conduct postoperative care follow-up plans for heart transplant recipients.