血液透析病患日常生活功能、心理困擾與遵從醫囑狀況及其相關因素之研究－以臺北市某兩家醫院為例

Abstract

本研究旨在探討血液透析病患之日常生活功能、心理困擾與遵從醫囑狀況，以台北市某教學醫院及其合作醫院之血液透析室門診病患為對象，採結構式問卷為工具，共得135份有效問卷，回收率68.9%，另收集其血磷、血鉀和水份控制資料，並以單因子變異數分析、匹爾森積差相關、複回歸分析等進行分析，主要發現如下： 一、研究對象日常生活功能佳（93.6/100），可完全獨立者約佔三分之二，中度依賴者約五分之一。 二、研究對象心理困擾程度介於「沒有」至「輕度」間，四分之三以上沒有明顯困擾，困擾問題以睡眠困難為主。 三、研究對象醫囑遵從行為得分高於中間值，顯示偏好，其中又以水份控制行為最好；且大專教育程度者、血液透析時間五年以上者的醫囑遵從行為較佳。病情控制方面，血鉀、血磷和水份控制均佳者佔45％，但有近15％的人其中兩項控制不佳，而有3％三項控制均不佳。 四、研究對象日常生活功能與心理困擾呈顯著負相關，但日常生活功能、心理困擾與醫囑遵從狀況相關性低。 五、個人背景因素、社會支持、日常生活功能、心理困擾可解釋醫囑遵從行為變異量23.5%，其中教育程度、血液透析時間、社會支持為重要變項。相反地，四類變項未能有效預測病情控制狀況。

The purpose of this study was to explore the activities of daily living, psychological distress and medical compliance of hemodialysis patients. The subjects were selected from the outpatient dialysis centers of a teaching hospital in Taipei city and its cooperative hospital. Data were collected by structured questionnaire and medical record. One hundred and thirty five provided valid data with 68.9% response rate. One-way ANOVA, Pearson correlation, and multiple regression analysis were used to analyze the data. The results indicated that: 1. The activities of daily living of the subjects were good (93.6/100). Two-thirds of the subjects were totally independent while one-fifth of them were moderately dependent. 2. Psychological distress among subjects ranges from “None distress” to “Mild distress”. More than three-quarters reported no obvious distress at all. The main distress problem of the subjects was sleep disturbance. 3. The average score of compliant behavior was higher than median, and water control behavior had the highest score. Patients with college educational level and with hemodialysis duration longer than five years have better compliant behavior compared with their counterparty. Totally, 45% had well control in potassium, phosphorus, and water. But 3% of the subjects lost control of all these disease indicators. 4. There was significantly negative correlation between activities of daily living and psychological distress. But activities of daily living and psychological distress were not related to compliant behavior. 5. The individual background factors, social support, activities of daily living , and psychological distress among subjects could explain 23.5% variance of compliant behavior. The important predictors of compliant behavior were level of education, dialysis duration, and social support. On the contrary, these variables could not predict the disease control situation.