肝臟移植後病人症狀困擾程度與不確定感之相關性探討

肝臟移植手術是以健康的肝臟植入病人體內，取代其原本功能衰竭的肝臟，以改善肝臟功能狀況。病人於移植術後需接受免疫抑制藥物治療以預防排斥反應，免疫抑制過程的副作用可能引發身體各系統產生不適的症狀困擾，可能使病人產生不確定感。本研究目的為探討肝臟移植後病人的症狀困擾發生頻率及困擾程度與不確定感程度的相關性，研究為採橫斷性研究設計，方便取樣，以台灣中部某醫學中心，肝臟移植手術之病人為收案對象，收取樣本數為80人。 研究結果顯示肝臟移植術後病人不確定感平均分數56.34(SD=16.85)，呈現中等不確定感程度。症狀困擾發生頻率平均分數9.3(SD=7.00)；困擾程度平均分9.7(SD=7.69)，呈現低程度的症狀困擾發生頻率及困擾程度。相關性分析結果呈現症狀困擾與不確定感呈現顯著相關，症狀困擾頻率愈高者、困擾程度愈嚴重者其不確定感程度愈高。症狀困擾會因婚姻狀態及移植前疾病診斷不同而呈現顯著差異。不確定感會因年齡、保險狀態、移植後工作狀況及宗教信仰不同而呈現顯著差異。 研究結果能增進臨床護理人員對肝臟移植術後病人症狀困擾與不確定感的了解，作為未來臨床護理照顧指引及護理研究之參考，以提升肝臟移植術後照護品質。

Liver transplantation is the replacement of a diseased liver with some or all of a healthy liver from another person to improve recipient’s liver function. After a liver transplantation, recipient need to take immunosuppressive management for prevent graft rejection. The consequences of immunosuppression on multiple organ systems are becoming increasingly evident and often symptom distress and uncertainty develop because of the side effects of immunosuppressive drugs. The purpose of this study was to investigate the relationship between symptom distress and uncertainty in recipient after liver transplantation. This cross-sectional study design was conducted with a purposive sampling. The research instruments include background data form, Michel’s Uncertainty in illness Scale Chinese Version and symptom distress scale. Eighty subjects were recruited from a medical center of middle Taiwan.The average score of the recipient’s uncertainty was 56.34(SD = 16.85), showing a moderate degree of uncertainty. The average frequency of symptom distress was 9.3(SD = 7.00)and the average degree of symptom distress was 9.7(SD = 7.69)which showing a low frequency and degree of symptom distress. The correlation analysis showed the frequency and degree of symptom distress correlated with uncertainty significantly, the higher frequency and degree of symptom distress, the higher degree of uncertainty. The score of symptom distress for marital status and pre-transplant disease diagnosis in recipients were different significantly. The score of uncertainty for age, insured status, post-transplant occupation and religious beliefs in recipients were different significantly. The results of this study can help nurse recognize recipient’s symptom distress and uncertainty, to serve as a reference for nursing clinical guideline and research for improve the quality of care for post liver transplantation.