肾移植受者自我管理现状及其相关影响因素研究

  目的  分析肾移植受者目前居家自我管理的现状，并探讨自我效能、焦虑、抑郁及自我管理支持对其的影响。  方法  采用便利抽样法选取2020年10月—2021年2月在北京市两家、长沙市一家三甲医院就诊的270例肾移植受者为研究对象。采用一般资料调查表、慢性病自我效能量表、医院焦虑抑郁量表、肾移植受者自我管理和自我管理支持量表进行问卷调查。  结果  共回收有效问卷265份，肾移植受者自我管理总分为95(84，103)分，各维度中，问题解决为35(30，40)分，伙伴关系为14(12，16)分，自我照顾行为为45(40，49)分。肾移植受者自我管理与其焦虑(r=-0.259，P＜0.01)、抑郁(r=-0.332，P＜0.01)呈负相关关系；与自我效能(r=0.399，P＜0.01)、自我管理支持(r=0.500，P＜0.01)呈正相关关系。多元线性逐步回归分析结果显示，年龄、居住地、移植术后时间、抑郁、自我效能和自我管理支持是肾移植受者自我管理的独立影响因素(均P＜0.05)。  结论  肾移植受者自我管理水平较好，但仍有半数患者处于中等水平。护理人员应重视肾移植受者的自我效能、负性情绪及自我管理支持对其自我管理行为的影响，可通过心理疏导、延续护理干预等方式，增加与患者的有益互动，以提高其自我管理水平。 

Analysis of related factors of self-management in kidney transplant recipients

  Objective  To analyze the current status of self-management at home of kidney transplant recipients and explore the effects of self-efficacy, anxiety, depression and self-management support to self-management.  Methods  Using the convenience sampling method, we selected 270 kidney transplant recipients (KTRs) in three class A tertiary hospitals (two hospitals in Beijing and one in Changsha) from October 2020 to February 2021 and administered the general data questionnaire, chronic disease self-efficacy scale, Hospital Anxiety and Depression Scale questionnaire, kidney transplant recipient self-management scale and self-management support scale.  Results  We collected 265 valid questionnaires, and the total score of self-management of KTRs was 95 (84, 103) points. For the dimensions, the scores were 35(30, 40) for the problem-solving subscale, 14 (12, 16) points for the partnership subscale and 45 (40, 49) points for the self-care behaviour subscale. Self-management of KTRs and their anxiety (r=-0.259, P < 0.01) and depression (r=-0.332, P < 0.01) were negatively correlated and showed a positive correlation with self-efficacy (r=0.399, P < 0.01) and self-management support (r=0.500, P < 0.01). The results of multiple linear stepwise regression analysis revealed that the age, residence, time after transplantation, depression, self-efficacy and self-management support were independent factors influencing self-management in KTRs (all P < 0.05).  Conclusion  The self-management level of renal transplant recipients is satisfactory, but half of the patients are still at a medium level. Nursing staff should pay attention to the KTRs' self-efficacy, negative emotions and self-management support on the influence of their self-management behaviour through psychological counselling, continuous nursing intervention and increased beneficial interaction with patients to improve the level of self-management.