肝移植随访管理中健康信念模式的建立及前瞻随机对照的临床研究

Application of the health belief model for liver transplant follow up： a prospective randomly controlled trial

目的建立肝移植特异性健康信念模式并探讨其对受者生存状况的影响。方法对在我院长期随诊的肝移植受者采取问卷调查的方式获得该群体最关切的健康问题和期望的随访模式，建立肝移植特异性健康信念模式，采取前瞻、随机、对照的研究方式用该模式干预肝移植健康管理和随访过程，观察该信念模式对肝移植受者生存状况的影响。结果（1）共有374人接受问卷调查，肝移植受者所关注的问题集中在随访的意义及合理用药等7个方面，希望通过成立移植之家和强化随访人员角色功能等方式参与随访并进行互动。（2）根据上述调查结果建立肝移植特异性健康信念模式，用该模式对前述接受调查的374例肝移植患者的健康管理和随访过程进行前瞻、随机、对照的干预研究，随诊2年，结果干预组（190例）肝功能异常、感染、原发病复发的发生率分别为16．8％（32／190）、3．2％（6／190）、2．6％（5／190）；对照组（184例）分别为21．2％（39／184）、10．3％（19／184）、9．8％（18／184），差异有统计学意义（P〈0．05）。结论建立肝移植特异性健康信念模式并用于肝移植术后健康管理和随访过程，可明显降低受者不良健康事件的发生率。

Objective To investigate the effects of a newly developed health belief model （HBM） on the survival of liver transplant recipients. Methods The most important health concerns and follow-up service expectations were learned from out-patients who received long-term liver transplant follow up, and a new HBM for liver transplant was developed. The impact of the HBM on survival was evaluated in this prospective randomly controlled trial. Results In 374 liver transplant recipients who completed the questionnaire, the most common health concerns were the implication of follow-up service and optimal medications, etc. Moreover, liver transplant club and improved role and function of health-care providers were expressed by the participants to enhance interactions with the medical staff. After 2 years＇ follow up, the incidence of abnormal liver function （ 16. 8% vs 21.2% ）, infection （ 3.2% vs 10. 3% ） and disease recurrence （2. 6% vs 9. 8% ） were significantly decreased in the study group （n = 190） when compared with the control group （ n = 184 ） （ all P 〈 0. 05 ）. Conclusion Adverse health events could be reduced following the application of HBM for liver transplantation.