围手术期肺癌患者症状群与生活质量相关性的纵向研究

doi:10.3761/j.issn.0254-1769.2020.11.006

摘要/Abstract

摘要：

目的调查肺癌患者在围手术期不同时间点的症状群和生活质量,并分析两者的相关性,为临床护士动态管理其症状群及改善其生活质量提供依据。方法便利选取2019年1月—9月就诊于合肥市某三级甲等医院胸外科行手术治疗的217例肺癌患者为调查对象。在患者入院当天、术后2~4 d和术后1个月,采用一般资料调查表、中文版安德森症状评估量表-肺癌模块及肺癌患者生活质量评估量表进行调查。结果入院当天肺癌患者存在呼吸道症状群、疼痛-疲乏-睡眠障碍症状群、心理情感症状群及神经系统症状群,共4个症状群;术后2~4 d和术后1个月患者增加了消化道症状群,共5个症状群,各时间点群内症状组成不同。肺癌患者围手术期不同时间点生活质量总分及各维度得分（除社会与家庭状况维度）比较,差异有统计学意义（P<0.001）。入院当天,呼吸道症状群严重程度得分与患者生活质量总分及各维度得分均呈负相关（P<0.01）;术后2~4 d,呼吸道及疼痛-疲乏-睡眠障碍症状群严重程度得分均与患者生活质量总分呈负相关（P<0.05）;术后1个月,5个症状群严重程度得分均与患者生活质量总分呈负相关（P<0.01）。结论肺癌患者围手术期存在多个稳定的症状群,且症状群严重程度得分与生活质量得分负性相关。医护人员应对围手术期肺癌患者症状群进行有效的动态管理以提升其生活质量。

关键词: 围手术期护理, 肺肿瘤, 症状和体征, 生活质量, 纵向研究

Abstract:

Objective To investigate symptom clusters and quality of life（QOL） in patients with lung cancer during perioperation at different time points,and to analyze the correlation between 2 variables,so as to provide a basis for guiding clinical dynamic management of symptom clusters and improving patients’ QOL. Methods From January to September 2019,a longitudinal study was conducted among 217 lung cancer patients during perioperation from a thoracic department at a tertiary first-class hospital in Hefei City,Anhui Province. Patients were investigated by a demographic questionnaire,Chinese Version of M.D. Anderson Symptom Inventory-Lung cancer（MDASI-L） and Chinese version of Functional Assessment of Cancer Therapy-Lung scale（FACT-L） on the first day of admission,2~4 days post-operation,and 1 month post-operation. Symptom clusters were extracted by the knowledge-based complex systems’ entropy partition method,and the correlations between symptom clusters and QOL were analyzed by Spearman correlation analysis. Results At the first day of admission,4 symptom clusters（respiratory,pain-fatigue-sleep disturbance,psychosomatic,and neurological） were found in all the respondents;at 2~4 days post-operation and 1 month post-operation patients had increased gastrointestinal symptom cluster,and there were totally 5 symptom clusters. The symptoms included in the corresponding symptom clusters differed significantly over the treatment time. At different time points,the differences in QOL scores and all dimension scores（except social/family well-being） of lung cancer patients were statistically significant（P<0.001）. At the first day of admission,severity scores of the respiratory symptom cluster was negatively correlated with QOL scores and all dimension scores of patients（P<0.01）. At 2~4 days post-operation,severity scores of respiratory and pain-fatigue-sleep disturbance symptom clusters in patients were negatively correlated with QOL scores（P<0.05）. At 1 month post-operation,severity scores of 5 symptom clusters of patients were negatively correlated with QOL scores（P<0.01）. Conclusion Lung cancer patients have multiple stable symptom clusters during chemotherapy which is negatively correlated with their quality of life. Dynamic management of symptom clusters by medical staff is expected to improve the quality of life of lung cancer patients during perioperation.

Key words: Perioperative Nursing Care, Lung Neoplasms, Signs and Symptoms, Quality of Life, Longitudinal Studies

李京京,吕晓晴,刘杉杉,汪冰清,童欢欢,夏丽莉,宋永霞,洪静芳. 围手术期肺癌患者症状群与生活质量相关性的纵向研究[J]. 中华护理杂志, 2020, 55(11): 1635-1641.

LI Jingjing,LÜ Xiaoqing,LIU Shanshan,WANG Bingqing,TONG Huanhuan,XIA Lili,SONG Yongxia,HONG Jingfang. A longitudinal study on the correlations between symptom clusters and quality of life in patients with lung cancer during perioperation[J]. Chinese Journal of Nursing, 2020, 55(11): 1635-1641.

图/表 4

表1 调查对象的一般资料（n=217）

Table 1 General information of respondents（n=217）

表2 肺癌患者围手术期不同时间点症状群情况（n=217）

Table 2 The perioperative symptom clusters of lung cancer patients among different time points（n=217）

表3 肺癌患者围手术期3个时间点生活质量评估量表各维度及总分比较（n=217,分,$\overline{x}±s$）

Table 3 Comparison of the perioperative quality of life scores of lung cancer patients at 3 different time points（n=217,scores,$\overline{x}±s$）

表4 肺癌患者围手术期3个时点症状群与生活质量的相关性（r值,n=217）

Table 4 Correlation between symptom clusters and the quality of life at 3 different time points in lung cancer patients during perioperation（r value,n=217）

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