儿童活体肝移植中供者的生命质量和心理健康评估
인동활체간이식중공자적생명질량화심리건강평고
Quality of life and psychological outcome of donors in pediatric living donor liver transplantation
  • 万方数据
    中华消化外科杂志 중화소화외과잡지
    CHINESE JOURNAL OF DIGESTIVE SURGERY
    2013年 9期 681-687 ,共7页

    何康%陈小松%李齐根%徐宁%韩龙志%奚志峰%张建军%夏强

    하강%진소송%리제근%서저%한룡지%해지봉%장건군%하강

    肝移植,活体%生命质量%心理健康%供者 肝移植,活體%生命質量%心理健康%供者
    간이식,활체%생명질량%심리건강%공자
    Liver transplantation,living donor%Quality of life%Psychological health%Donor
    目的 探讨儿童活体肝移植中供者的术后生命质量和心理健康水平.方法 回顾性分析2006年10月至2012年12月上海交通大学医学院附属仁济医院收治的45例儿童活体肝移植中供者的临床资料.采用SF-36生命质量调查表和SCL-90症状自评量表,评估45例供者术后生命质量和心理健康情况.术后采用门诊复查方式进行随访,随访时间截止2013年5月.采用t检验或秩和检验分析供者性别、年龄、身高、体质量、体质指数、户口类型、医疗保险类型、供者手术时间、术中出血量和随访时间等因素对供者术后生命质量和心理健康的影响.结果 45例供者均施行了肝左外叶切除术,其手术时间为(302±103)min、术中出血量为(187±40)ml,供者术中均未输血.45例供者术后无手术相关并发症和死亡发生,全部康复出院,平均住院时间为(7±2)d.45例供者术后获得随访,中位随访时间为636 d(163 ～2413 d).供者术后行SF-36生命质量调查量表评估:其健康改变、一般健康、生理功能、生理职能、情感职能、社会功能、躯体疼痛、活力和精神健康9个方面得分分别为:(61±25)分、(55±17)分、(89±14)分、(80±26)分、(87±25)分、(66±20)分、(82±18)分、(63±14)分、(63±15)分.SCL-90症状自评量表评估:其躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对、恐怖、偏执和精神病性9个方面中位得分分别为:0.25分(0～1.58分)、0.20分(0～1.60分)、0.11分(0～0.89分)、0.15分(0～1.62分)、0.10分(0～ 1.00分)、0.17分(0 ～2.67分)、0分(0～1.00分)、0分(0～1.33分)和0分(0～0.80分)；其中2名供者在敌对症状上得分均为2.67分,怀疑存在敌对症状,其余供者在以上9个方面得分均＜2.5分.进一步分析影响供者术后生命质量和心理健康的因素,其结果显示:随访时间＜636 d的供者其一般健康状况要优于随访时间≥636 d的供者(t =-2.448,P＜0.05)；年龄＜34岁的供者比年龄≥34岁的供者具有更好的社会功能和精力(t=-2.180,-2.267,P＜0.05),且躯体化和恐怖症状更少(Z=3.106,2.537,P＜0.05).结论 儿童活体肝移植中供者术后生命质量、心理健康评估满意,供者的年龄和随访时间影响其术后生命质量和心理健康水平,这将为儿童活体肝移植供者的选择提供一定参考.
    목적 탐토인동활체간이식중공자적술후생명질량화심리건강수평.방법 회고성분석2006년10월지2012년12월상해교통대학의학원부속인제의원수치적45례인동활체간이식중공자적림상자료.채용SF-36생명질량조사표화SCL-90증상자평량표,평고45례공자술후생명질량화심리건강정황.술후채용문진복사방식진행수방,수방시간절지2013년5월.채용t검험혹질화검험분석공자성별、년령、신고、체질량、체질지수、호구류형、의료보험류형、공자수술시간、술중출혈량화수방시간등인소대공자술후생명질량화심리건강적영향.결과 45례공자균시행료간좌외협절제술,기수술시간위(302±103)min、술중출혈량위(187±40)ml,공자술중균미수혈.45례공자술후무수술상관병발증화사망발생,전부강복출원,평균주원시간위(7±2)d.45례공자술후획득수방,중위수방시간위636 d(163 ～2413 d).공자술후행SF-36생명질량조사량표평고:기건강개변、일반건강、생리공능、생리직능、정감직능、사회공능、구체동통、활력화정신건강9개방면득분분별위:(61±25)분、(55±17)분、(89±14)분、(80±26)분、(87±25)분、(66±20)분、(82±18)분、(63±14)분、(63±15)분.SCL-90증상자평량표평고:기구체화、강박증상、인제관계민감、억욱、초필、활대、공포、편집화정신병성9개방면중위득분분별위:0.25분(0～1.58분)、0.20분(0～1.60분)、0.11분(0～0.89분)、0.15분(0～1.62분)、0.10분(0～ 1.00분)、0.17분(0 ～2.67분)、0분(0～1.00분)、0분(0～1.33분)화0분(0～0.80분)；기중2명공자재활대증상상득분균위2.67분,부의존재활대증상,기여공자재이상9개방면득분균＜2.5분.진일보분석영향공자술후생명질량화심리건강적인소,기결과현시:수방시간＜636 d적공자기일반건강상황요우우수방시간≥636 d적공자(t =-2.448,P＜0.05)；년령＜34세적공자비년령≥34세적공자구유경호적사회공능화정력(t=-2.180,-2.267,P＜0.05),차구체화화공포증상경소(Z=3.106,2.537,P＜0.05).결론 인동활체간이식중공자술후생명질량、심리건강평고만의,공자적년령화수방시간영향기술후생명질량화심리건강수평,저장위인동활체간이식공자적선택제공일정삼고.
    Objective To evaluate the quality of life and psychological outcome of donors in pediatric living donor liver transplantation (LDLT).Methods The clinical data of 45 pediatric LDLT donors who were admitted to the Renji Hospital of Shanghai Jiaotong University from October 2006 to December 2012 were retrospectively analyzed.The quality of life and psychological outcome were evaluated using the Study Short Form-36 (SF-36) and the Symptom Checklist-90 (SCL-90) respectively.The donors were followed up at the out-patient department till May 2013.The influence of gender,age,height,body weight,body mass index,types of Hukou and medical insurences,operation time for donors,volume of intraoperative blood loss and time for follow-up on the quality of life and psychological outcome of donors were analyzed using the t test or analysis of variance.Results All the 45 donors received left lateral lobectomy.The operation time and volume of intraoperative blood loss were (302 ± 103 minutes and (187 ± 40) ml,respectively,and no one received blood transfusion.No complications and death occurred with the mean duration of hospital stay of (7 ± 2) days.All the donors were followed up with the mean time of 636 days (range,163-2413 days).The scores of change of health,general health perception,physical functioning,physical limitations,emotional limitations,social functioning,pain,vitality and mental health were 61 ±25,55 ± 17,89 ± 14,80 ±26,87 ±25,66 ±20,82 ± 18,63 ± 14,63 ± 15,respectively.The median scores of somatization,obsessive-compulsive,sensitivity,depression,anxiety,hostility,phobic anxiety,paranoid and psychoneuroticism were 0.25 (0-1.58),0.20 (0-1.60),0.11 (0-0.89),0.15(0-1.62),0.10 (0-1.00),0.17 (0-2.67),0 (0-1.00),0 (0-1.33) and0 (0-0.80),respectively.The scores of hostility were 2.67 in 2 donors,and the other patients had scores ＜ 2.5 in all the 9 aspects.The general health perception of patients whose follow-up time ＜ 636 days was significantly better than those whose follow-up time≥636 days (t =-2.448,P ＜ 0.05).Donors aged under 34 years had better social functioning and vitality and litter somatization and phobic anxiety when compared with those whose age ≥34 years (t =-2.180,-2.267,Z =3.106,2.537,P ＜ 0.05).Conclusions The postoperative quality of life and psychological outcome are favorable in donors in pediatic LDLT.The donors' age and follow-up time affect the SF-36 and SCL-90 scores to some extent,which might offer reference on donor selcection in pediatic LDLT.
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