肾移植后患者生活质量评分专用量表的制订及相关因素分析

Development of a Questionnaire for Assessing the Quality of Life for Chinese Renal-transplant Recipients

目的 制订针对国人的肾移植后生活质量评分专用量表（下称专用量表），为评价国人肾移植后生活质量提供量化工具；研究肾移植患者生活质量的影响因素，为提高护理质量提供参考。方法 选取肾移植术后6个月肾功能稳定的357例患者，应用终末期肾脏疾病移植患者症状调查表（ESRD-SCL）、健康状况问卷（SF-36）及自制的一般情况问卷进行调查。对条目池中的各条目做统计学测评，选择条目池中回答阳性率较高（〉20％）的条目，应用因子分析正交旋转进行统计分析，筛选因子载荷≥0．4的条目构成初步量表；然后时初步量表的信度、效度进行分析考评。结果 48个条目入选，分属认知能力（12个条目）、药物相关不良反应（9个条目）、心理及情绪（7个条目）、心肾等器官功能（9个条目）、体质（11个条目）。Cronbach’s α为0．74～0．87。条目形式采用等距等级条目，每个条目有5个选项，评分分别定义为0～4分（0=完全没有，1=轻微，2=比较严重，3=很严重，4=非常严重）。患者的认知能力与其文化程度、药物相关不良反应与性别、心理及情绪方面与文化程度、心肾等器官功能与年龄、体质与体重指数相关性最大（r=-0．21、-0．33、-0．32、0.22、0．30，均P〈0．05）。结论 该专用量表有良好的信度和效度，适用于了解我国肾移植术后患者的生活质量状况；肾移植患者的文化程度、性别、年龄、体重指数、移植后时间及有无糖尿病等对生活质量影响相对较大。

Objective To develop a disease-specific questionnaire for assessing the quality of life （QOL） for Chinese renal transplant recipients, and to study the correlation factors of QOL of patients after transplantation to provide information for more effective nursing care. Methods Three hundred and fifty-seven patients who had undergone renal transplantation and had stable renal function were studied and ESRD-SCL, SF-36 and a self-designed questionnaire for general information were used to conduct the survey. The items with higher positive results （〉 20%） were selected and statistically analyzed by using Varimax rotation technique. The items with factor loading greater than 0.4 were used to form a questionnaire and the reliability and validity of the questionnaire were evaluated. Results Forty-eight items were included in the questionnaire, including cognitive capacity （12 items）, side effects of medicine （9 items）, psychological distress （7 items）, cardiac and renal dysfuction （9 items）, physical capacity （11 items）. The Cronbach＇s α ranged from 0.74 to 0.87. All items were of equal interval and were scored on a 5-point scale, with 0 = nil, 1 = slight, 2=moderately, 3=severe and 4=extremely severe. The cognitive ability of the patients and educational background, drug-related adverse reaction and sex, mental state and educational background,cardiac and renal function and age, physical condition and body mass index showed highest correlation （r= -0.21. -0. 33,-0. 32,0. 22,0. 30, P〈5 0.05 for all）. Conelusion The questionnaire has very good reliability and validity and is suitable for the evaluation of QOL of post-transplant patients. The educational background, sex. age, body mass index, post- transplant time and presence of diabetes substantially affect the QOL of the patients.