骨肿瘤手术患者创伤后成长的调查研究

doi:10.3761/j.issn.0254-1769.2022.10.005

摘要/Abstract

摘要：

目的探究骨肿瘤患者术后30 d创伤后成长（post-traumatic growth,PTG）水平及变化规律,以及与手术创伤后应激（post-traumatic stress,PTS）的相关性。方法采用方便抽样,选取2019年11月—2020年12月在四川省某三级甲等医院骨科病房住院的骨肿瘤手术患者作为调查对象,进行前瞻性队列研究。队列划分依据为患者术后2 d的中文版事件影响量表修订版得分,≥26分纳入PTS较大组,<26分纳入PTS较小组,评估其术后2、15、30 d PTG的水平。结果最终纳入PTS较小组78例,PTS较大组64例,共142例。全部患者术后2、15、30 d的中文版创伤后成长问卷（Chinese version of the Post traumatic Growth Inventory,PTGI-C）得分差异无统计学意义（F=2.704,P=0.069）。PTS较小组患者术后2、15、30 d的PTGI-C得分为（34.95±25.60）、（31.96±22.20）、（37.77±25.32）分;PTS较大组患者术后各时间点得分分别为（53.48±17.70）、（48.78±21.47）、（50.84±22.80）分,两组各时间点的PTG水平差异有统计学意义（F=27.029, P<0.001）。多元线性回归结果提示,术后2 d PTS对术后30 d PTG影响有统计学意义（β=0.272,P<0.05）。结论术后30 d 内PTG的最低点在术后15 d,该时间点医护人员应及时识别PTG较低的危险人群,并进行针对性干预。手术事件引起的PTS越强,PTG水平越高,二者呈正相关。

关键词: 骨肿瘤, 创伤后成长, 创伤后应激, 队列研究, 护理

Abstract:

Objective To explore the post-traumatic growth（PTG） level and change of patients with bone neoplasms within 30 day after surgery,and the correlation with post-traumatic stress（PTS） after surgery. Methods A prospective cohort study was conducted by convenience sampling to select patients who met the criteria for inclusion and exclusion in the orthopedic ward of a tertiary hospital in Sichuan Province. The cohort was divided based on the scores of the revised version of Chinese translation of the Impact of Event Scale-Revised for patients 2 days after surgery. Patients whose scores were≥26 points would be included in the larger PTS group,and <26 points would be included in the smaller PTS group. Their PTG levels were assessed at 2nd day,15th day,and 30th day after surgery. Results In the end,a total of 142 cases were included. 78 cases were included in the smaller PTS group and 64 cases in the larger PTS group. The differences in PTGI-C scores of all patients at 2 d,15d and 30 d after surgery were no statistically significant. The PTGI-C scores of the patients in the smaller group of PTS were 34.95±25.60,31.96±22.20,and 37.77±25.32 at 2 d,15 d,and 30 d after the operation（F=2.704,P=0.069）. The scores of the patients in the larger PTS group at each time point after the operation were 53.48±17.70,48.78±21.47 and 50.84±22.80 points（F=27.029,P<0.001）. The difference in PTG levels between the 2 groups at each time point was statistically significant. Multiple linear regression results suggest that postoperative 2 d PTS has a statistically significant effect on postoperative 30 d PTG（β=0.272,P<0.05）. Conclusion The lowest point of PTG within 30 days after surgery is 15 days after surgery. Therefore,at this time,medical staff should promptly identify people at risk of reduced PTG and carry out targeted interventions. When the PTS caused by the surgical event gets stronger,the PTG level will be higher. There is a positive correlation between them.

Key words: Bone Neoplasms, Post-Traumatic Growth, Post-Traumatic Stress, Cohort Study, Nursing Care

刘颖, 陈佳丽, 宁宁, 屠重棋, 陈咏梅, 李佩芳, 郑小凤, 李剑霞, 李凤兰. 骨肿瘤手术患者创伤后成长的调查研究[J]. 中华护理杂志, 2022, 57(10): 1184-1189.

LIU Ying, CHEN Jiali, NING Ning, TU Chongqi, CHEN Yongmei, LI Peifang, ZHENG Xiaofeng, LI Jianxia, LI Fenglan. Study on the relationship between post-traumatic stress and post-traumatic growth in patients with bone neoplasms surgery[J]. Chinese Journal of Nursing, 2022, 57(10): 1184-1189.

图/表 3

表1 两组一般资料比较

Table 1 General data analysis table of the two groups of research subjects

表2 两组术后不同时间点中文版创伤后成长量表得分情况（分,$\bar{x}\pm s$）

Table 2 PTGI-C score of two groups of patients at different time points after surgery（score;$\bar{x}\pm s$）

表3 术后30 d中文版创伤后成长量表得分的多元线性回归结果

Table 3 Multi-Linear Regression Results for 30 d PTGI-C Scores After Surgery

参考文献 23

[1]	Niu X, Xu H, Inwards CY, et al. Primary bone tumors:epidemiologic comparison of 9200 patients treated at Beijing jishui- tan hospital,Beijing,China,with 1 0165 patients at mayo clinic,rochester,minnesota[J]. Arch Pathol Lab Med, 2015, 139(9):1149-55. DOI URL
[2]	刘巍峰, 郝林, 牛晓辉, 等. 人工全肘关节置换在骨肿瘤中的临床效果[J]. 中华骨科杂志, 2020, 40(13):828-839.
	Liu WF, Hao L, Niu XH, et al. The clinical effect of artificial total elbow joint replacement in bone neoplasms[J]. Chin J Orthop, 2020, 40(13):828-839.
[3]	江宁宁. 基于行为转变理论的护理在骨肿瘤化疗患者中的应用[J]. 中华现代护理杂志, 2019, 25(28):3673-3676.
	Jiang NN. Application of nursing based on the theory of behavior change in patients with bone neoplasms chemotherapy[J]. Chin J Mod Nurs, 2019, 25(28):3673-3676.
[4]	Marziliano A, Tuman M, Moyer A. The relationship between post-traumatic stress and post-traumatic growth in cancer patients and survivors:a systematic review and meta-analysis[J]. Psychooncology, 2020, 29(4):604-616. DOI PMID
[5]	Tedeschi RG, Calhoun LG. The Postraumatic Growth Inventory:measuring the positive legacy of trauma[J]. J Trauma Stress, 1996, 9(3):455-471. PMID
[6]	Aderhold C, Morawa E, Paslakis G, et al. Protective factors of depressive symptoms in adult cancer patients:the role of sense of coherence and posttraumatic growth in different time spans since diagnosis[J]. J Psychosoc Oncol, 2019:1-20.
[7]	Calhoun LG, Tedeschi RG. Handbook of post traumatic growth[M]. New York: Routledge, 2006,81-99.
[8]	Shand LK, Cowlishaw S, Brooker JE, et al. Correlates of post-traumatic stress symptoms and growth in cancer patients:a systematic review and meta-analysis[J]. Psychooncology, 2015, 24(6):624-34. DOI URL
[9]	Smith SK, Samsa G, Ganz PA, et al. Is there a relationship between posttraumatic stress and growth after a lymphoma diagnosis?[J]. Psychooncology, 2014, 23(3):315-321. DOI URL
[10]	Turner JK, Hutchinson A, Wilson C. Correlates of post-traumatic growth following childhood and adolescent cancer:a systematic review and meta-analysis[J]. Psychooncology, 2018, 27(4):1100-1109 DOI URL
[11]	Anderson WJ, Doyle LA. Updates from the 2020 World Health Organization classification of soft tissue and bone tumours[J]. Histopathology, 2021, 78(5):644-657. DOI PMID
[12]	叶盈, 杨可, 傅静. 丧亲事件对丧亲者的影响及相关因素分析[J]. 中国全科医学, 2018, 21(29):3611-3615. DOI
	Ye Y, Yang K, Fu J. The impact of bereavement on the bereavement and analysis of related factors[J]. Chin Gen Pract, 2018, 21(29):3611-3615.
[13]	汪际, 陈瑶, 王艳波, 等. 创伤后成长评定量表的修订及信效度分析[J]. 护理学杂志, 2011, 7(14):26-28.
	Wang J, Chen Y, Wang YB, et al. Revision and reliability and validity analysis of Post-Traumatic Growth Assessment Scale[J]. J Nurs Sci, 2011, 7(14):26-28.
[14]	Groarke A, Curtis R, Groarke JM, et al. Post-traumatic growth in breast cancer:how and when do distress and stress contribute?[J]. Psychooncology, 2017, 26(7):967-974. DOI URL
[15]	Horowitz M, Wilner N, Alvarez W. Impact of Event Scale:a measure of subjective stress[J]. Psychosom Med, 1979, 41:209-218. PMID
[16]	郭素然, 辛自强, 耿柳娜. 事件影响量表修订版的信度和效度分析[J]. 中国临床心理学杂志, 2007, 15(1):15-17.
	Guo SR, Xin ZQ, Geng LN. Reliability and validity analysis of the revised version of the Event Impact Scale[J]. Chin J Clin Psychol, 2007, 15(1):15-17.
[17]	Wang L, Chen S, Liu P, et al. Posttraumatic growth in patients with malignant bone tumor:relationships with psychological adjustment[J]. Asian Pac J Cancer Prev, 2018, 19(10):2831-2838.
[18]	李甄, 张亚平, 张盈. 恶性骨肿瘤青少年患者截肢后真实体验的质性研究[J]. 中华现代护理杂志, 2020, 26(13):1747-1751.
	Li Z, Zhang YP, Zhang Y. Real experience of malignant bone tumor adolescents and young adults with amputation: a qualitative research[J]. Chin J Mod Nurs, 2020, 26(13):1747-1751.
[19]	林琪, 曾莉, 任君红. ICU患者家属创伤后成长体验的质性研究[J]. 中华护理杂志, 2021, 56(3):347-353.
	Lin Q, Zeng L, Ren JH. A qualitative study on the post-traumatic growth experience of family members of ICU patients[J]. Chin J Nurs, 2021, 56(3):347-353.
[20]	闵理, 陈春雨, 段宏, 等. 骨水泥型同种异体骨复合人工关节治疗股骨近端肿瘤的长期随访[J]. 北京大学学报(医学版), 2016, 48(3):562-567.
	Min L, Chen CY, Duan H, et al. Long-term follow-up of cement-type allograft composite artificial joint for the treatment of proximal femoral tumors[J]. J Peking Univ(Health Sci), 2016, 48(3):562-567.
[21]	Tomich PL, Helgeson VS. Posttraumatic growth following cancer:links to quality of life[J]. J Trauma Stress, 2012, 25(5):567-573. DOI URL
[22]	陈杰灵, 伍新春, 安媛媛. 创伤后成长的促进:基本原理与主要方法[J]. 北京师范大学学报(社会科学版), 2015(6):114-122.
	Chen JL, Wu XC, An YY. The promotion of post-traumatic growth:basic principles and main methods[J]. J Beijing Normal Univ(Social Sci), 2015(6):114-122.
[23]	莫阔, 唐棠, 陈珑, 等. 肿瘤患者创伤后成长与情感情绪调节和自我效能的关系[J]. 中华护理杂志, 2013, 48(4):334-336.
	Mo K, Tang T, Chen L, et al. The relationships among posttraumatic growth,affect and emotion regulation and self-efficacy in cancer patients[J]. Chin J Nurs, 2013, 48(4):334-336.