探討接受VA-ECLS輔助治療患者出院後身體健康狀態之影響因素

Related Factors of Physical Health after Discharge in Patients who Underwent Venoarterial Extracorporeal Life Support

背景：接受靜脈－－動脈型式體外維生系統(veno-arterial extracorporeal life support, VA-ECLS) 輔助治療患者移除ECLS 管路後，屬下肢合併症高風險群，出院面臨身體活動功能障礙，衝擊出院後身體健康狀態。
目的：探討接受VA-ECLS 患者出院後身體健康狀態之影響因素。
方法：採橫斷式相關性研究設計，於臺灣北部某醫學中心心臟外科門診收案，納入2009 年10 月至2019 年6 月接受VA-ECLS 存活出院成年患者131 人，問卷包括醫院焦慮與憂鬱量表及SF-36 生活品質問卷之身體健康構面，以多元線性複迴歸分析身體健康狀態之影響因素。
結果：身體健康平均得分46.48 ± 10.37，憂鬱、年齡以及呼吸器使用天數是身體健康狀態之顯著影響因素，能解釋32.8% 的變異量。憂鬱情形愈低者(β = -0.491, p < .001) 之身體健康狀態越佳；年齡愈小者(β = -0.171, p < .05) 之身體健康狀態越良好；呼吸器使用天數越少者(β =-0.157, p < .05)，其身體健康狀態愈佳。
結論：憂鬱是影響VA-ECLS 患者出院後身體健康最顯著因素。改善患者身體健康狀態不僅聚焦接受ECLS 之適應症治療，也應重視其心理健康，故在提供復健計畫的同時必須進行心理評估，提供相關心理諮商，如此才能有效提升患者出院後整體身體健康狀態。

Background: The patients who underwent venous-arterial extracorporeal life support (VA- ECLS) are at a high risk of lower limb complications during or after using ECLS. Physical function impairment affected the physical health after being discharged from the hospital.
Purpose: To explore the factors that affect physical health of patients who underwent VA-ECLS after discharge.
Methods: This study conducted in a cardiovascular surgery clinic of a medical center in northern Taiwan was a cross-sectional and correlational study. Patients who underwent VA-ECLS from October 2009 to June 2019 were recruited. One hundred thirty-one patients participated in this study. The questionnaires included the Hospital Anxiety and Depression Scale and the Physical Component Summary (PCS) of the Medical Outcomes Study Short Form 36-Item Version 2 Health Survey (SF-36v2). Multiple linear regression was used to examine the related factors of physical function.
Results: In this study, the mean score of the PCS was 46.48±10.37. Stepwise multiple linear regression analysis indicated depression, age, and duration of intubation were significantly associated with physical health, which explained 32.8% variation of the physical health. Patients who had a lower level of depression (β= -0.491, p < .001), were younger (β= -0.171, p < .05), and had a shorter duration of intubation had a better physical health status.
Conclusions: Depression is a significant factor that was associated with physical health of patients who underwent VA-ECLS after discharge. In order to improve the physical health of patients, we should not only focus on diseases, but also on mental health. Therefore, psychological assessment and counseling must be incorporated into rehabilitation plans to effectively improve patients’overall physical health.