發(fā)布時(shí)間：2018-09-11 21:07

【摘要】：目的:1.描述腎移植受者的免疫抑制藥物服藥依從性現(xiàn)狀。2.描述腎移植受者服用免疫抑制藥物的感知服藥依從行為障礙以及長(zhǎng)期服用免疫抑制藥物的自我效能。3.探討腎移植受者的人口統(tǒng)計(jì)學(xué)資料、社會(huì)支持、免疫抑制藥物治療滿意度、對(duì)免疫抑制藥物服用知識(shí)的掌握情況、感知服藥依從行為的障礙以及服用免疫抑制藥物的自我效能對(duì)其免疫抑制藥物服藥依從性的相關(guān)性。方法:本研究采用橫斷面設(shè)計(jì),采取便利抽樣的方法于2016年11月至2017年1月選取南方醫(yī)科大學(xué)附屬南方醫(yī)院移植隨訪門診就診的腎移植受者為研究對(duì)象,依據(jù)健康信念模式對(duì)其免疫抑制藥物服藥依從性進(jìn)行調(diào)查。研究工具包括由研究者自行設(shè)計(jì)一般情況調(diào)查表、免疫抑制藥物依從性Basel評(píng)估量表(BAASIS)、領(lǐng)悟社會(huì)支持量表(PSSS)、長(zhǎng)期服藥行為自我效能量表(LTMBSES)、免疫抑制藥物治療障礙量表(ITBS)、藥物治療滿意度量表(TSQM)及藥物使用知識(shí)量表等。使用IBM SPSS 23.0統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,數(shù)據(jù)分析時(shí)采用描述分析、相關(guān)性檢驗(yàn)、單因素方差分析以及建立多元逐步回歸模型等。結(jié)果:依照納入和排除標(biāo)準(zhǔn),本研究共發(fā)放問(wèn)卷233份,回收問(wèn)卷221份,其中有效問(wèn)卷為217份。本研究中,腎移植受者術(shù)后服藥依從性差的發(fā)生率為44.7%;其中,不按時(shí)服藥的狀況最為嚴(yán)重,37.4%的腎移植受者在過(guò)去一個(gè)月內(nèi)曾提前或推后兩小時(shí)服藥;移植受者漏服藥的狀況次之,13.6%的腎移植受者在過(guò)去一個(gè)月至少有一次的漏服藥。同時(shí),有8例腎移植受者不按醫(yī)囑劑量服藥,2例腎移植受者擅自停藥。不同器官來(lái)源的腎移植受者,服藥依從性之間存在差異(t=-2.497,p=0.036);親屬來(lái)源的腎移植受者比醫(yī)院來(lái)源的腎移植受者服藥依從性差。相關(guān)性檢驗(yàn)分析結(jié)果顯示,腎移植受者的術(shù)后時(shí)間越長(zhǎng),其服藥依從性越差(r=0.225,p=0.001);受者感受到的社會(huì)支持水平越高,其服藥依從性越好(r=-0.190,p=0.005);腎移植受者在個(gè)人態(tài)度、任務(wù)相關(guān)及行為因素方面的自我效能越高,其服藥依從性越好(r=-0.134,p=0.048;r=-0.134,p=0.047);腎移植受者對(duì)服用免疫抑制藥物時(shí)可能發(fā)生的不可控障礙及可控障礙的感知越少(r=0.275,p=0.000;r=0.200,p=0.003)、對(duì)免疫抑制藥物所產(chǎn)生的副作用對(duì)機(jī)體的影響滿意度越高,其服藥依從性越好(r=-0.145,p=0.033);同時(shí),腎移植受者對(duì)免疫抑制藥物的相互作用知識(shí)掌握的越好,其免疫抑制藥物服藥依從性越好(r=-0.145,p=0.033)。多因素分析結(jié)果顯示,腎移植受者感知的不可控障礙、朋友支持、器官來(lái)源以及術(shù)后時(shí)間是影響其服藥依從性的主要因素,上述四個(gè)變量共解釋腎移植受者免疫抑制藥物服藥依從性總方差變異的19.6%。結(jié)論:本研究中,腎移植受者服藥依從性差的現(xiàn)象發(fā)生率較高。鑒于免疫抑制藥物服藥依從性對(duì)移植受者的重要意義,研究人員建議從受者、醫(yī)療機(jī)構(gòu)及其社會(huì)支持系統(tǒng)等方面采取相應(yīng)措施,使腎移植受者意識(shí)到服藥依從性差所帶來(lái)的嚴(yán)重后果以及維持良好服藥依從性的策略等,以提高該群體的服藥依從性。
[Abstract]:OBJECTIVE: 1. To describe the status of compliance with immunosuppressive drugs in renal transplant recipients. 2. To describe perceived compliance disorders and long-term self-efficacy of immunosuppressive drugs in renal transplant recipients. 3. To explore demographic data, social support, and satisfaction with immunosuppressive drugs in renal transplant recipients. METHODS: A cross-sectional study was conducted to investigate the relationship between the self-efficacy of immunosuppressive drugs and the compliance of immunosuppressive drugs. The compliance of renal transplant recipients in the follow-up clinic of Southern Affiliated Hospital to immunosuppressive drugs was investigated according to the health belief model. The data were analyzed by IBM SPSS 23.0 statistical software. Descriptive analysis, correlation test, one-way ANOVA and multiple-factor analysis were used to analyze the data. Results: According to the inclusion and exclusion criteria, 233 questionnaires were distributed and 221 questionnaires were retrieved, of which 217 were valid. In addition, 8 kidney transplant recipients did not take the medicine according to the prescribed dose, and 2 kidney transplant recipients stopped taking the medicine without authorization. The results of correlation analysis showed that the longer the kidney transplant recipients were treated, the worse their compliance was (r = 0.225, P = 0.001); the higher the recipients felt the level of social support, the better their compliance was (r = - 0.190, P = 0.005); The higher the self-efficacy of individual attitude, task-related and behavioral factors, the better the drug compliance (r = - 0.134, P = 0.048; r = - 0.134, P = 0.047); the less the recipients perceived the uncontrollable and controllable disorders that might occur when taking immunosuppressive drugs (r = 0.275, P = 0.000; r = 0.200, P = 0.003), and the less immunosuppressive. The higher the degree of satisfaction with the side effects of drugs on the body, the better the compliance (r = - 0.145, P = 0.033); at the same time, the better the knowledge of the interaction of immunosuppressive drugs, the better the compliance of immunosuppressive drugs (r = - 0.145, P = 0.033) in renal transplant recipients. Uncontrollable disorders, friend support, organ origin and postoperative time were the main factors affecting drug compliance. These four variables explained 19.6% of variance of total variance of immunosuppressive drug compliance in renal transplant recipients. The importance of drug compliance in renal transplant recipients is discussed. The researchers suggest that the recipients, medical institutions and their social support systems should be made aware of the serious consequences of poor drug compliance and the strategies to maintain good drug compliance so as to improve drug compliance in renal transplant recipients.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R699.2

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