乳腺癌患者睡眠及相关症状的轨迹研究

doi:10.3761/j.issn.0254-1769.2019.10.003

摘要/Abstract

摘要： 目的构建基于生态瞬时评估法的症状评估平台,并以该平台为依托,探究乳腺癌患者化疗期间睡眠状况与相关症状的变化轨迹及关联度。方法开发基于生态瞬时评估法的症状评估平台,以该平台为研究工具,采用自我监控法和便利取样法对60例乳腺癌患者化疗后1周的睡眠状况,以及疲乏、焦虑抑郁、恶心呕吐、疼痛症状进行持续监测,分析睡眠与症状变化趋势及相关性。结果乳腺癌患者化疗后1周内,睡眠状况与疲乏、焦虑抑郁、恶心呕吐、疼痛症状在第2天急剧加重,在第2~4天达到高峰,随后逐渐缓解;睡眠状况与症状、症状与症状之间均存在不同程度的关联,其中醒来次数与疲乏在化疗第1天和第7天（r=0.613,P<0.01;r=0.780,P<0.01）呈显著相关,睡眠质量（r=-0.439,P<0.05）和睡眠效率（r=-0.471,P<0.05）与化疗第2天的焦虑抑郁呈低度相关。结论乳腺癌患者化疗期间睡眠与相关症状均呈现先恶化后缓解的趋势,并且在不同时间存在不同程度的关联,也说明基于生态瞬时评估法的症状评估平台能够在一定程度上实现症状的精准化评估。

关键词: 乳腺肿瘤, 睡眠, 症状和体征, 生态瞬时评估法, 护理评估

Abstract: Objective To construct the Symptom Assessment Platform based on ecological momentary assessment and explore the trajectory and correlation of sleep and symptoms in breast cancer patients during chemotherapy by the platform.Methods We developed the Symptom Assessment Platform based on ecological momentary assessment and analyzed the correlation between sleep and fatigue,anxiety,depression,nausea,vomiting,pain in 60 breast cancer patients by self-monitoring and experience-sampling method.Results Sleep quality,sleep efficiency,number of wake-ups and fatigue,anxiety,depression,nausea,vomiting and pain in breast cancer patients aggravated sharply on the 2nd day,peaked on the 2nd to 4th day,then gradually improved. There were different degrees of correlation between sleep quality,number of wake-ups and symptoms. Number of wake-ups were significantly related to fatigue on day 1 and day 7 during chemotherapy（r=0.613,P<0.01;r=0.780,P<0.01）. Sleep quality（r=-0.439,P<0.05） and sleep efficiency（r=-0.471,P<0.05） were lowly related to anxiety and depression on day 2 during chemotherapy.Conclusion The symptoms of breast cancer patients showed trends which begin with clinical deterioration and turn to be relieved during chemotherapy,and there were different degrees of correlation at different times. The assessment of symptoms based on ecological momentary assessment might be a better way for cancer care.

Key words: Breast Neoplasms, Sleep, SYMPTOMS & SIGNS;, Ecological Momentary Assessment, Nursing Assessment

尚子妺, 吴静, 周洁. 乳腺癌患者睡眠及相关症状的轨迹研究[J]. 中华护理杂志, 2019, 54(10): 1456-1462.

SHANG Zimo, WU Jing, ZHOU Jie. A trajectory study of sleep and related symptoms in breast cancer patients based on ecological momentary assessment[J]. Chinese Journal of Nursing, 2019, 54(10): 1456-1462.

图/表 10

参考文献 27

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项目	例数	百分比（%）	项目	例数	百分比（%）
文化程度			癌症分期（期）
初中及以下	20	33.3	Ⅰ~Ⅱ	42	70.0
高中/中专	23	38.3	Ⅲ~Ⅳ	18	30.0
大专/本科	17	28.4	手术方式
婚姻状况			无	10	16.7
未婚	3	5.0	保乳术	9	15.0
已婚	53	88.3	根治术/改良根治术	14	23.3
离异/丧偶	4	6.7	单纯乳房切除术	27	45.0
职业			化疗方案
在职	21	35.1	EC-T/P^1）、TC/AC-T^2）	52	86.6
退休	27	45.0	DP/GP/PC^3）	8	13.4
个体	5	8.3	转移部位
其他	7	11.6	无	36	60.0
家庭人均收入（元）			淋巴转移	22	36.7
<3 000	8	13.4	其他	2	3.3
3 000~	27	45.0	合并症
>5 000	25	41.7	无	49	81.7
居住地			有	11	18.3
省城	42	70.0
地级市	5	8.3
城镇/农村	13	21.7

项目	例数	百分比（%）	项目	例数	百分比（%）
文化程度			癌症分期（期）
初中及以下	20	33.3	Ⅰ~Ⅱ	42	70.0
高中/中专	23	38.3	Ⅲ~Ⅳ	18	30.0
大专/本科	17	28.4	手术方式
婚姻状况			无	10	16.7
未婚	3	5.0	保乳术	9	15.0
已婚	53	88.3	根治术/改良根治术	14	23.3
离异/丧偶	4	6.7	单纯乳房切除术	27	45.0
职业			化疗方案
在职	21	35.1	EC-T/P^1）、TC/AC-T^2）	52	86.6
退休	27	45.0	DP/GP/PC^3）	8	13.4
个体	5	8.3	转移部位
其他	7	11.6	无	36	60.0
家庭人均收入（元）			淋巴转移	22	36.7
<3 000	8	13.4	其他	2	3.3
3 000~	27	45.0	合并症
>5 000	25	41.7	无	49	81.7
居住地			有	11	18.3
省城	42	70.0
地级市	5	8.3
城镇/农村	13	21.7

项目	焦虑抑郁			疼痛			恶心呕吐			疲乏
项目	回归系数	OR值	P值	回归系数	OR值	P值	回归系数	OR值	P值	回归系数	OR值	P值
睡眠效率	-0.024	0.977	0.173	-0.012	0.988	0.117	0.001	1.001	0.903	0.006	1.006	0.321
睡眠质量	-0.323	0.724	0.031	-0.040	0.961	0.760	-0.098	0.906	0.374	0.004	1.004	0.973
醒来次数	-0.009	0.991	0.951	-0.261	0.770	0.018	-0.420	0.657	0.025	0.327	1.387	0.008
焦虑抑郁	-	-	-	0.179	1.196	0.361	0.372	1.450	0.001	0.186	1.205	0.068
疼痛	0.983	2.672	0.001	-	-	-	-0.158	0.854	0.318	-0.108	0.897	0.515
恶心呕吐	0.045	1.046	0.801	-0.066	1.160	0.513	-	-	-	0.373	1.452	<0.001
疲乏	0.321	1.379	0.016	-0.389	0.678	0.010	0.542	1.720	<0.001	-	-	-

项目	焦虑抑郁			疼痛			恶心呕吐			疲乏
项目	回归系数	OR值	P值	回归系数	OR值	P值	回归系数	OR值	P值	回归系数	OR值	P值
睡眠效率	-0.024	0.977	0.173	-0.012	0.988	0.117	0.001	1.001	0.903	0.006	1.006	0.321
睡眠质量	-0.323	0.724	0.031	-0.040	0.961	0.760	-0.098	0.906	0.374	0.004	1.004	0.973
醒来次数	-0.009	0.991	0.951	-0.261	0.770	0.018	-0.420	0.657	0.025	0.327	1.387	0.008
焦虑抑郁	-	-	-	0.179	1.196	0.361	0.372	1.450	0.001	0.186	1.205	0.068
疼痛	0.983	2.672	0.001	-	-	-	-0.158	0.854	0.318	-0.108	0.897	0.515
恶心呕吐	0.045	1.046	0.801	-0.066	1.160	0.513	-	-	-	0.373	1.452	<0.001
疲乏	0.321	1.379	0.016	-0.389	0.678	0.010	0.542	1.720	<0.001	-	-	-

化疗时间	变量	回归系数	标准误	标准回归系数	t值	P值
第1天	疼痛	-0.055	0.356	-0.022	-0.154	0.878
	疲乏	-0.173	0.243	-0.122	-0.711	0.480
	焦虑抑郁	0.018	0.352	0.009	0.052	0.958
	恶心呕吐	-0.463	0.535	-0.120	-0.865	0.391
第2天	疼痛	-0.259	0.265	-0.125	-0.976	0.333
	疲乏	-0.005	0.217	-0.004	-0.021	0.983
	焦虑抑郁	-0.812	0.330	-0.439	-2.462	0.017
	恶心呕吐	0.255	0.326	0.130	0.782	0.438
第3天	疼痛	0.062	0.224	0.031	0.276	0.784
	疲乏	-0.162	0.143	-0.190	-1.130	0.263
	焦虑抑郁	-0.490	0.207	-0.370	-2.365	0.022
	恶心呕吐	-0.152	0.197	-0.115	-0.771	0.444
第4天	疼痛	-0.109	0.180	-0.086	-0.605	0.548
	疲乏	0.044	0.150	0.053	0.292	0.771
	焦虑抑郁	-0.315	0.244	-0.230	-1.287	0.204
	恶心呕吐	-0.251	0.183	-0.222	-1.376	0.175
第5天	疼痛	-0.077	0.235	-0.059	-0.330	0.743
	疲乏	0.043	0.172	0.055	0.253	0.801
	焦虑抑郁	-0.265	0.251	-0.216	-1.058	0.295
	恶心呕吐	-0.152	0.202	-0.134	-0.750	0.456
第6天	疼痛	0.181	0.309	0.104	0.583	0.562
	疲乏	-0.178	0.203	-0.191	-0.874	0.386
	焦虑抑郁	0.056	0.330	0.032	0.171	0.865
	恶心呕吐	-0.041	0.266	-0.026	-0.154	0.878
第7天	疼痛	0.212	0.362	0.116	0.587	0.560
	疲乏	0.077	0.246	0.072	0.311	0.757
	焦虑抑郁	-0.325	0.421	-0.160	-0.770	0.445
	恶心呕吐	0.130	0.351	0.066	0.372	0.712