陳秀蓉Chen, Hsiu-Jung謝璧光Hsieh, Bea-Gwoun2024-12-172024-02-172024https://etds.lib.ntnu.edu.tw/thesis/detail/90b8de35af438be860cc8418f7416bde/http://rportal.lib.ntnu.edu.tw/handle/20.500.12235/122494末期心臟衰竭病人，使用左心室輔助裝置可以支持病患的血液動力學，作為等待心臟移植至移植手術間連接橋樑；對於不適合移植的病患，心室輔助器亦可成為終點治療，但裝置左心室輔助器病人仍存在有生理、心理之影響，是一壓力事件。目前，極少研究探討其心理症狀以及影響心理調適的因素，本研究目的以前瞻式、縱貫性調查臺灣北部地區某醫學中心的病人使用左心室輔助器，在術前、術後一個月及六個月，其生活品質、心理症狀（焦慮與憂鬱）的變化，並檢視病人手術後影響其生活品質之身心因素。本研究自2021年2月至2023年8月在臺北市某醫學中心，總計收案11位接受左心室輔助器的病人，以問卷方式調查術前、術後一個月與術後六個月之生活品質、焦慮與憂鬱狀況：生活品質以歐洲生活品質五點量表（EQ-5D-5L），焦慮以廣泛性焦慮量表（generalized anxiety disorder, GAD-7），憂鬱以憂鬱量表（patient health questionnaire, PHQ-9）測量。研究方法則採用無母數之佛里曼檢定與魏克生符號　　等級考驗進行術前、術後一個月及六個月之EQ-5D、GAD-7與PHQ-9分數差異檢定；並以逐步迴歸分析生活品質之預測因子。結果：左心室輔助器病人術後六個月生活品質與術後一個月的生活品質相比，進步接近顯著（p = .096），術後六個月憂鬱和手術前憂鬱分數比較是有改善的（p = .046）。術前、術後一個月與術後六個月之焦慮分數則無顯著差異。影響生活品質最重要的預測因子是出院後再度入院次數，其次是術後六個月之憂鬱。結論：心衰竭的病人接受左心室輔助器，其術後六個月憂鬱是顯著進步，且出院後再度入院的次數越少能夠預測較佳的生活品質。提示在臨床上告知病人預防再度入院與減低憂鬱，對日後生活品質將有助益。建議透過醫療人員照顧病人減少可預防的併發症，或在LVAD植入之前和之後提供心理評估，從術前到術後追蹤病人心理狀態，身、心、靈整合之全人照護，患者才能得到滿意的生活品質。For patients ineligible for transplantation, LVADs can serve as a destination therapy, but the implantation of LVADs imposes physiological and psychological impacts, constituting a stress event. Lots of articles had been widely discussed regarding to the physiological issue in LVAD. However, limited research has explored the psychological symptoms, quality of life and factors influencing patients' psychological adjustment to those artificial devices. This prospective, longitudinal study aims to investigate the changes in quality of life, anxiety and depression in patients with LVADs at a medical center in northern Taiwan, preoperatively, one month, and six months postoperatively. The study also examines the influencing factors of quality of life after surgery. From February 2021 to August 2023, a total of 11 patients receiving LVADs were enrolled in the study at a medical center in Taipei. Questionnaires were used to assess quality of life, anxiety, and depression preoperatively, one month and six months postoperatively. Quality of life was measured using the EuroQol Five-Dimension Five-Level Scale (EQ-5D-5L), anxiety was assessed using the Generalized Anxiety Disorder Scale (GAD-7), and depression was measured using the Patient Health Questionnaire (PHQ-9). Nonparametric Friedman tests and Wilcoxon signed-rank tests were employed to examine the differences in EQ-5D, GAD-7, and PHQ-9 scores preoperatively, one month and six months postoperatively. Stepwise regression analysis was used to identify predictors of quality of life.Results: The quality of life in LVAD patients improved nearly significantly at six months postoperatively compared to one month postoperatively (p = .096), and there was an improvement in depression scores at six months postoperatively compared to preoperative scores (p = .046). However, there were no significant differences in anxiety scores among preoperative, one month postoperative, and six months postoperative assessments. The significant predictors affecting quality of life were the number of readmissions after discharge and followed by depression at six months postoperatively.Conclusion: In patients of heart failure with LVAD, there was an improvement in depression at six months postoperatively. The implantation of LVADs aims not only to extend life but also to improve the quality of life. Firstly, fewer re-hospitalization and depression after discharge predicted better quality of life. Therefore, in clinical practice, minimizing readmissions after discharge is crucial for predicting better quality of life, highlighting the importance of informing patients about the risks of readmission. Healthcare professionals should also take care to reduce preventable complications to enhance quality of life. Secondly, psychological assessments are recommended both before and after LVAD implantation, ensuring comprehensive care for patients' physical, mental, and spiritual well-being to achieve satisfactory quality of life.左心室輔助器生活品質焦慮憂鬱left ventricular assist device (LVAD)quality of lifeanxietydepression學術論文