肾移植受者免疫抑制药物服药依从性相关因素的研究

发布时间：2018-09-11 21:07

【摘要】：目的:1.描述肾移植受者的免疫抑制药物服药依从性现状。2.描述肾移植受者服用免疫抑制药物的感知服药依从行为障碍以及长期服用免疫抑制药物的自我效能。3.探讨肾移植受者的人口统计学资料、社会支持、免疫抑制药物治疗满意度、对免疫抑制药物服用知识的掌握情况、感知服药依从行为的障碍以及服用免疫抑制药物的自我效能对其免疫抑制药物服药依从性的相关性。方法:本研究采用横断面设计,采取便利抽样的方法于2016年11月至2017年1月选取南方医科大学附属南方医院移植随访门诊就诊的肾移植受者为研究对象,依据健康信念模式对其免疫抑制药物服药依从性进行调查。研究工具包括由研究者自行设计一般情况调查表、免疫抑制药物依从性Basel评估量表(BAASIS)、领悟社会支持量表(PSSS)、长期服药行为自我效能量表(LTMBSES)、免疫抑制药物治疗障碍量表(ITBS)、药物治疗满意度量表(TSQM)及药物使用知识量表等。使用IBM SPSS 23.0统计软件对数据进行统计分析,数据分析时采用描述分析、相关性检验、单因素方差分析以及建立多元逐步回归模型等。结果:依照纳入和排除标准,本研究共发放问卷233份,回收问卷221份,其中有效问卷为217份。本研究中,肾移植受者术后服药依从性差的发生率为44.7%;其中,不按时服药的状况最为严重,37.4%的肾移植受者在过去一个月内曾提前或推后两小时服药;移植受者漏服药的状况次之,13.6%的肾移植受者在过去一个月至少有一次的漏服药。同时,有8例肾移植受者不按医嘱剂量服药,2例肾移植受者擅自停药。不同器官来源的肾移植受者,服药依从性之间存在差异(t=-2.497,p=0.036);亲属来源的肾移植受者比医院来源的肾移植受者服药依从性差。相关性检验分析结果显示,肾移植受者的术后时间越长,其服药依从性越差(r=0.225,p=0.001);受者感受到的社会支持水平越高,其服药依从性越好(r=-0.190,p=0.005);肾移植受者在个人态度、任务相关及行为因素方面的自我效能越高,其服药依从性越好(r=-0.134,p=0.048;r=-0.134,p=0.047);肾移植受者对服用免疫抑制药物时可能发生的不可控障碍及可控障碍的感知越少(r=0.275,p=0.000;r=0.200,p=0.003)、对免疫抑制药物所产生的副作用对机体的影响满意度越高,其服药依从性越好(r=-0.145,p=0.033);同时,肾移植受者对免疫抑制药物的相互作用知识掌握的越好,其免疫抑制药物服药依从性越好(r=-0.145,p=0.033)。多因素分析结果显示,肾移植受者感知的不可控障碍、朋友支持、器官来源以及术后时间是影响其服药依从性的主要因素,上述四个变量共解释肾移植受者免疫抑制药物服药依从性总方差变异的19.6%。结论:本研究中,肾移植受者服药依从性差的现象发生率较高。鉴于免疫抑制药物服药依从性对移植受者的重要意义,研究人员建议从受者、医疗机构及其社会支持系统等方面采取相应措施,使肾移植受者意识到服药依从性差所带来的严重后果以及维持良好服药依从性的策略等,以提高该群体的服药依从性。
[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.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.2

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