异基因造血干细胞移植患者生活质量变化轨迹及影响因素研究

目的 探讨异基因造血干细胞移植患者3年内的生活质量变化轨迹及影响因素。方法 采用便利抽样法,选取2016年7月—2017年10月于苏州市某三级甲等医院行异基因造血干细胞移植的患者作为调查对象,在患者移植前（入仓前1~2 d）、移植后1个月、3个月、半年、1年、1年半及3年时采用一般资料调查表及癌症治疗功能评价-骨髓移植测评量表进行调查。 结果 异基因造血干细胞移植患者的癌症治疗功能评价-骨髓移植测评量表总分在移植后1个月时降至最低,此后呈逐渐上升趋势,半年时基本恢复至移植前水平,3年时总分显著高于移植前,差异具有统计学意义（P<0.05）。生理健康、功能健全及干细胞移植3个维度得分与癌症治疗功能评价-骨髓移植测评量表总分变化轨迹一致,呈波动上升型;情绪稳定维度在移植前得分最低,随移植时间延长逐渐上升;社交/家庭健全维度移植前得分与移植后各时间点得分比较,差异无统计学意义（P>0.05）。多元线性回归分析结果显示,影响患者移植后3年时生活质量的主要因素为居住地（t=3.175,P=0.002）、家庭人均月收入（t=3.320,P=0.001）、移植相关并发症（t=-6.955,P<0.001）及患者是否回归工作/学习（t=2.706,P=0.008）。 结论 异基因造血干细胞移植患者总体生活质量呈波动上升趋势,癌症治疗功能评价-骨髓移植测评量表5个维度间的恢复时间及变化轨迹存在差异。至移植后3年时,居住地为农村、家庭人均月收入较低、患有移植相关并发症及尚未回归工作/学习的患者生活质量更差。护理人员可根据患者生活质量变化轨迹动态调整护理措施,为其提供更为精准的延续性护理。

Research on the changing trajectory and influencing factors of quality of life in patients with allogeneic hematopoietic stem cell transplantation

Objective To investigate the changing trajectory of quality of life and its influencing factors in allogeneic hematopoietic stem cell transplantation（allo-HSCT）patients within 3 years. Methods The convenience sampling method was used to select patients who received allo-HSCT from July 2016 to October 2017 in a tertiary hospital of Suzhou City as the research subjects. The general data table and Functional Assessment of Cancer Treatment-Bone Marrow Transplant（FACT-BMT） were adopted to investigate the quality of life of patients at different time points（1~2 days before transplantation,1 month,3 months,6 months,1 year,1.5 years and 3 years after transplantation）. Results The quality of life of patients with allo-HSCT was the worst at 1 month after transplantation,and then gradually increased and basically returned to pre-transplant level at 6 months after transplantation. The quality of life of patients 3 years after transplantation was significantly higher than pre-transplant patients,with statistically significant differences（P<0.05）. The trajectories of physiological health,functional integrity and stem cell transplantation were consistent with the trajectory of the total score of quality of life,showing a fluctuating upward pattern. The score of emotional stability dimension was the lowest before transplantation and gradually increased over the transplantation time. There was no significant differences between the scores of social/family stability before transplantation and the scores of each time point（P>0.05）. Multiple linear regression analysis showed that the major factors affecting the quality of life of allo-HSCT patients at 3 years were residence（t=3.175,P=0.002）,average monthly household income（t=3.320,P=0.001）,transplanted complications（t=-6.955,P<0.001） and whether the patient returns to work/school（t=2.706,P=0.008）. Conclusion The overall quality of life of allo-HSCT patients showed a fluctuating upward trend. There were differences in the recovery time and the changing trajectory among the 5 dimensions affecting quality of life. Nurses can dynamically adjust the focus of nursing interventions according to the changing trajectory of quality of life,so as to provide patients with more precise continuous nursing support.