摘要
目的:肾移植术后患者需要终身服用以免疫抑制剂为主的多种药物,但患者总体药物依从性不佳。计划行为理论认为个体的过去服药行为、主观规范等与服药依从性行为密切相关。本研究旨在探讨肾移植患者手术前后不同阶段的服药依从性行为变化情况及相关影响因素。方法:本研究为单中心前瞻性纵向研究,采用免疫抑制剂治疗依从性Basel评估量表(Basel Assessment of Adherence with Immunosuppressive Medication Scale,BAASIS)、用药信念量表、社会支持量表及生活质量量表对肾移植患者术前和术后1、6、12个月进行动态追踪随访。结果:共有300名肾移植患者完成动态追踪随访。术后1、6、12个月患者服药依从性好的百分比分别为97.60%、87.30%和84.30%。术后自我报告生活质量较好的患者服药依从性反而较低。调整一般人口学资料后,术前服药依从性低的患者术后出现药物不依从的风险是术前服药依从性好的患者的37.646倍;术后未使用服药提醒的患者术后出现药物不依从性的风险是使用服药提醒患者的2.467倍;术后服药顾虑多的患者出现药物不依从性的风险是顾虑少的患者的1.265倍。结论:肾移植患者服药依从性随时间呈现下降趋势,生活质量的改善可弱化服药依从性的行为,服药顾虑降低了服药依从性。术前服药行为对术后服药依从性有明显的预测作用,服药提醒是一种积极的服药行为保护因素。医务人员可以通过关注肾移植患者术前用药行为、服药信念和督促患者使用服药提醒等方式,实现对肾移植患者服药行为的科学干预。
Objective:After renal transplantation,patients need to take various immunosuppressant,but the drug compliance is poor.The theory of planned behavior suggests that the past medication behavior and subjective norms of individuals are closely related to medication compliance.This study aims to explore the change of medication compliance behavior and its influenting factors for renal transplantation patients at different stages.Methods:This study was a prospective longitudinal study.The Basel Assessment of Adherence with Immunosuppressive Medication Scale(BAASIS),Medication Belief Scale,Social Support Scale and Quality of Life Scale were used to dynamically follow up renal transplantation patients at pre-operation and 1-month,6-month,and 12-month after transplantation.Results:A total of 300 patients completed the whole follow-up.The percentage of patients with good medication compliance was 97.60%,87.30%and 84.30%at 1-month,6-month and 12-month after transplantation respectively.The life quality of the patients was decreased at 6 months after the operation,and the patients with better self-reported life quality had poor medication compliance.After adjusting for demographic data,the risk of medication incompliance in patients with poor medication compliance before operation was 37.646 times than those with good compliance.Patients who did not use medication reminders had high risk(odds ratio=2.467)of drug non-adherence.The risk of drug nonadherence in patients with more postoperative misgivings was 1.265 times compared with that in patients with less postoperative misgivings.Conclusion:The medication compliance decreases with the time of transplantation,but the medication compliance of patients with good self-reported life quality is poor.Medication concerns reduce the compliance behavior.Preoperative medication behavior has a significant predictive effect on postoperative behavior.Medication reminder is a protective factor for promoting compliance.Medical staff should pay more attention to preoperative medication belief,behaviors and reminder of using drug so as to provide precise intervention in the renal transplantation patients.
作者
杨国莉
刘佳
赵洪圉
严谨
吴小霞
YANG Guoli;LIU Jia;ZHAO Hongyu;YAN Jin;WU Xiaoxia(Department of Pulmonary and Critical Care Medicine,Third Xiangya Hospital,Central South University,Changsha 410013;Center of Organ Transplantation,Third Xiangya Hospital,Central South University,Changsha 410013;Xiangya Nursing School,Central South University,Changsha 410013;Transplantation Medicine Engineering Technology Research Center of National Health Commission,Changsha 410013;Department of Nursing,Third Xiangya Hospital,Central South University,Changsha 410013,China)
出处
《中南大学学报（医学版）》
CAS
CSCD
北大核心
2022年第6期762-770,共9页
Journal of Central South University ：Medical Science
基金
国家自然科学基金(71904209)。
关键词
肾移植
药物
依从性
纵向研究
renal transplantation
medication
compliance
longitudinal study
