裝置永久性心律調節器病患之生活品質及其相關因素

Quality of Life and Associated Factors in Patients with Permanent Cardiac Pacemakers

本研究為一相關性研究，採縱貫性世代研究法探討病患裝置永久性心律調節器前後之生活品質與影響因素，以立意取樣法（Purposive sampling）於台北市二所醫學中心收集73位個案，進行術前與術後二個月、四個月結構式問卷訪談，資料經統計分析後發現：病患術前生活品質得分為65.0±15.5（滿分為97分），術後生活品質漸改善，至術後二個月呈穩定狀態，並持續至四個月。而生活品質與獨居狀況，主要照顧者類別及所裝置之心律調節器機型有關；術前受心律不整之干擾程度得分低於標準值，術後二個月得分提升至近標準值，術後四個月在標準範圍內；術前對心律調節器態度得分為24.7±4.0（滿分為33分），術後二個月態度得分較術前低，術後四個月回到24.7±4.5；術後二個月自我照顧情形在中上程度，術後四個月與二個月無顯著差異，但在「知識」層面有顯著進步。術前心律不整干擾程度愈低、對心律調節器態度愈正向，其術前之生活品質愈佳；術後二個月及四個月，心律不整干擾程度愈低、對心律調節器態度愈正向、自我照顧情形愈好，其生活品質愈佳。「受心律不整之干擾程度」為各階段生活品質之最具影響力之因素。本研究結果可提供裝置永久性心律調節器病患整體性護理的參考，以協助其安全且有自信地與永久性心律調節器共處。

The purpose of this study is to investigate the quality of life (QOL) and the influencing factors in patients prior to and after the implantation of permanent pacemakers. A correlated, longitudinal cohort study design was adopted and purposive sampling was applied to recruit subjects from two medical centers in Taipei City. Subjects were interviewed before the implantation of permanent pacemakers. After signing the informed consent, subjects filled out a set of structured questionnaires which inquiring about their quality of life, perceived distress from arrhythmia, attitude toward pacemakers, and self-care behaviors. Follow-up interviews were conducted at 2 month and 4 month after the implantation of permanent pacemakers. Data was processed by SPSS 8.0 and the major statistical procedures applied were paired t-test, repeated measures of ANOVA, Pearson correlation and multiple regression. The results of the data analysis revealed that: 1) Patients had moderate QOL prior to the implantation of permanent pacemakers and the QOL improved significantly after permanent pacemakers implantation. Such improvement continued to the forth month. Living status and types of caregivers had significant influence on QOL of the patients; 2) Patients had below-standard levels of distress from arrhythmia before the implantation of permanent pacemakers. The distress improved significantly after the implantation of permanent pacemakers and was above the standard level at the forth month; 3) Patients had good attitude toward permanent pacemakers before the implantation of permanent pacemaker. Then attitude became a little negative at the second month after permanent pacemakers implantation and returned to good at the forth month; 4) Patient presented good self-care to their permanent pacemakers at the second month; 5) Prior to the implantation of permanent pacemakers, patients with less distress and having more positive attitude toward permanent pacemakers had better QOL; 6) After the implantation of permanent pacemakers, patients perceived distress from arrhythmia, having more positive attitude toward permanent pacemakers, and performing better self-care had better QOL; 7) The degree of perceived distress from arrhythmia was the most powerful predictor of the QOL prior to, and after the implantation of permanent paccmaker. The finding of the study provide practical information in helping patients live with permanent paccmakers.