心脏移植等待期受者生活质量与社会支持和心理弹性的相关性研究

Relation among quality of life,social support and psychological resilience in recipients waiting for heart transplantation

目的分析心脏移植等待期受者生活质量与社会支持、心理弹性的相关性。方法选取2014年12月至2018年12月于华中科技大学同济医学院附属协和医院等待心脏移植的患者101例作为研究对象。采用一般社会调查问卷、焦虑自评量表、抑郁自评量表、生活质量量表、社会支持评定量表、Connor和Davidson心理弹性量表了解患者的焦虑抑郁情况及生活质量、社会支持和心理弹性评分。采用Cox回归方法分析心脏移植等待期受者社会支持、生活质量和心理弹性状况影响因素,采用Spearman方法分析心脏移植等待期受者的生活质量与社会支持、心理弹性的相关性。结果101例患者焦虑自评量表评分为(51.2±1.1)分,抑郁自评量表评分为(61.7±1.5)分。患者生活质量评分中躯体功能、心理功能、物质生活功能及社会功能评分分别为(41.3±2.2)、(40.6±1.4)、(49.8±2.1)、(46.5±1.3)分,总分为(45.7±4.5)分。患者社会支持评分中客观支持、主观支持以及对社会支持利用度评分分别为(8.7±2.8)、(17.6±3.8)、(6.8±1.6)分,总分为(33.5±7.6)分。患者心理弹性评分中自强评分为(20±4)分,坚韧评分为(26±3)分,乐观评分为(26±3)分,总分为(63±10)分。Cox回归分析结果显示,影响心脏移植等待期受者社会支持评分的独立危险因素分别是有生活应激事件(比值比=2.293,95%置信区间:1.547~4.364,P<0.001)和月人均收入≤1000元(比值比=1.491,95%置信区间:1.315~3.433,P=0.004);影响心脏移植等待期受者生活质量评分的独立危险因素是年龄>60岁(比值比=2.974,95%置信区间:1.482~3.112,P=0.001)和有慢性疾病(比值比=2.435,95%置信区间:1.463~6.341,P=0.002);影响心脏移植等待期受者心理弹性评分的独立危险因素是年龄>60岁(比值比=1.647,95%置信区间:1.122~4.178,P=0.005)和有生活应激事件(比值比=1.724,95%置信区间:1.216~4.989,P=0.003)。心脏移植等待期受者生活质量评分与心理弹性、社会支持评分均呈明显正相关(r=0.678、0.712,均P<0.001)。结论心脏移植等待期受者生活质量偏低,与社会支持、心理弹性密切相关,医务工作者应该充分利用社会支持系统,来提高心脏移植等待期受者的生活质量。

Objective To analyze the relation among quality of life,social support and psychological resilience in recipients waiting for heart transplantation. Methods Totally 101 patients waiting for heart transplantation in Union Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology from December 2014 to December 2018 were enrolled. General social questionnaire,self-rating anxiety scale,self-rating depression scale,quality of life scale,social support scale,Connor and Davidson psychological resilience scale were assessed. Influencing factors of social support,quality of life,psychological resilience and the correlation among them were analyzed by Cox regression and Spearman test. Results Scores of self-rating anxiety scale and self-rating depression scale were( 51. 2 ± 1. 1) and( 61. 7 ± 1. 5). Scores of physical function,psychological function,material life function and social function in quality of life scale were(41. 3 ± 2. 2),(40. 6 ± 1. 4),(49. 8 ± 2. 1) and(46. 5 ± 1. 3);the totally score was(45. 7 ± 4. 5). Scores of objective support,subjective support and utilization of social support were(8. 7 ± 2. 8),(17. 6 ± 3. 8) and(6. 8 ± 1. 6);the total score was(33. 5 ± 7. 6). Self-improvement score,toughness score and optimism score were(20 ± 4),(26 ± 3),(26 ± 3)and the total score of psychological resilience was(63 ± 10). Cox regression analysis showed that the independent risk factors affecting social support were life stress events[odds ratio( OR) = 2. 293,95% confidence interval(CI): 1. 547-4. 364,P < 0. 001] and per capital monthly income≤1 000 yuan(OR = 1. 491,95% CI: 1. 315-3. 433,P = 0. 004). The independent risk factors affecting quality of life were age > 60 years( OR = 2. 974,95% CI: 1. 482-3. 112,P = 0. 001) and chronic diseases( OR = 2. 435,95% CI: 1. 463-6. 341,P = 0. 002). The independent risk factors affecting psychological resilience were age > 60 years( OR = 1. 647,95% CI: 1. 122-4. 178,P = 0. 005) and life stress events( OR = 1. 724,95% CI: 1. 216-4. 989,P = 0. 003). Quality of life score was positively correlated with psychological resilience and social support( r = 0. 678,0. 712,both P < 0. 001).Conclusion Life quality of recipients waiting for heart transplantation is low,which is closely associated with social support and psychological resilience.