Avaliação da percepção da qualidade de vida e do estado psicológico de pacientes candidatos a transplante de fígado

Abstract

MARTINS, P. D. Assessment of the quality of life and psychological state of candidates listed for liver transplantation. 2008. 131 f. Dissertação -Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, 2008.The quality of life of patients with chronic liver diseases, especially liver cirrhosis, may be affected by factors such as the clinical outcome of the condition, the presence of medical complications, and occupational and social life restrictions. All these factors have a major impact on the patients' daily activities, as well as on their social and psychological development. Nowadays, liver transplantation (LT) is the main treatment for patients with advanced liver disease, with good survival rates. One of the aims of the transplant is to provide significant improvement in the patient's quality of life. Facing the diagnosis and the possibility of being submitted to LT may lead to important subjective difficulties that range from changes in the family dynamics to poor psychological support, leading to symptoms that may include anxiety, phobia, obsession and depression, at various levels. The patient's psychological state can be seriously affected during the various treatment stages. The aim of the present study was to identify the psychological state and assess the quality of life of patients with liver disease as a function of the etiology and severity of the illness, medical comorbidities and time elapsed since the subject was listed for transplant. The frequency of somatic complaints in candidates listed for LT at the Clinical Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (HCFMRP-USP) was also evaluated. Data collection was carried out at the HCFMRP-USP itself, where the patients were being clinically followed. The following instruments were employed for data collection: the World Health Organization scale for evaluation of the Quality of Life (WHOQoL-BREF), the Beck Depression Inventory (BDI), and the semi-structured interview. In the case of the BDI-13 analysis (Cognitive-affective subscale), patients with score higher than 10 were considered depressed. One hundred and twenty-one adult patients were included in the study, the majority of which were male, with stable union and aged between 41 and 60 years. Depression was diagnosed in 19% of the cases. In this population, depression was significantly related with a lower level of instruction, and it did not prevail in any etiological group, although it was present in the majority of the patients with the comorbidity ethylism. The percentage of patients with MELD (Model for End-stage Liver Disease) ≤ 15 was significantly higher in the group with depression. There was also a statistically significant difference between the complaint body appearance as defined in the BDI Somatic and Performance Complaints Subscale and liver cirrhosis by hepatitis C (including those patients presented with ethylism as comorbidity). The complaints fatigue and decreased sex drive were statistically...

uso de álcool antes e após o transplante hepático

“…O transplante é um tratamento complexo que permite que órgãos e/ou células sejam substituídos em partes ou em sua totalidade, de um doador e transferidos com sucesso para um receptor (Ferreira, Vieira, & Da Silveira, 2000). O primeiro transplante hepático (TH) O objetivo principal do transplante é proporcionar uma sobrevida ao paciente com doença crônica, favorecendo assim a sua qualidade de vida (Martins, 2008). No caso do TH, a indicação se dá para doenças avançadas do fígado em que outros tratamentos não surtem mais efeito, como doenças hepáticas progressivas, autoimunes, metabólicas e insuficiência hepática, nas quais as Doenças Hepáticas Alcoólicas (DHA) estão incluídas (Parolin et al, 2002).…”

O impacto da doença hepática e do transplante de fígado na qualidade de vida

“…Cirrose por hepatite B, C e por álcool somam juntos mais de 70% de todos os diagnósticos que levam pacientes a um estágio terminal da doença hepática e, consequentemente, à indicação de um transplante de fígado como única alternativa possível para a sobrevivência 5,[26][27][28] .…”

“…Estudos demostram que condições psicopatológicas como ansiedade e depressão são significativamente presentes em candidatos ao transplante de fígado 27,40,41,45 . Uma pesquisa realizada por Bianchi e col. 40 , com expressiva extensão amostral e rigor metodológico, mostrou que cerca 57% dos pacientes cirróticos em fila para transplante apresentaram sintomas depressivos, entre leves e muito severos.…”

“…Daí o crescente interesse de pesquisadores e de programas de saúde em tentar mensurar a contribuição desse tratamento para a vida do paciente 8,27 .…”