晚期肺癌患者疼痛危象发生现状及影响因素研究

doi:10.3761/j.issn.0254-1769.2024.11.010

摘要/Abstract

摘要：

目的调查晚期肺癌患者疼痛危象的现状，并分析其影响因素。方法采用便利抽样法，于2023年8月—11月选取郑州市某三级甲等医院呼吸内科6个病区318例晚期肺癌患者为调查对象。应用疼痛数字评定量表、领悟社会支持量表、焦虑自评量表、抑郁自评量表进行调查，采用Logistic回归分析晚期肺癌患者疼痛危象的影响因素。结果调查的318例晚期肺癌患者中，102例患者发生了疼痛危象，发生率为32.08%。年龄大、高水平社会支持是疼痛危象的保护因素，发生骨转移、焦虑、轻中度抑郁是疼痛危象的危险因素。结论晚期肺癌患者疼痛危象发生率高，护理人员应重点关注年龄小、发生骨转移、社会支持水平低、焦虑水平高、轻中度抑郁水平的晚期肺癌患者，并及时采取干预措施，减少疼痛危象的发生。

关键词: 肺癌, 疼痛危象, 癌痛, 问卷调查, 护理

Abstract:

Objective To investigate the status quo of pain crisis in advanced lung cancer patients and analyze its influencing factors. Methods From August to November 2023，318 patients with advanced lung cancer were selected from 6 wards of respiratory department of a tertiary A hospital in Zhengzhou. The Numerical Rating Scale，Perceptive Social Support Scale，Self-rating Anxiety Scale and Self-rating Depression Scale were used to investigate the influencing factors of pain crisis in advanced lung cancer patients by Logistic regression. Results Among 318 patients with advanced lung cancer，102 patients had painful crisis，with the incidence rate of 32.08%. Older age and high level of social support were protective factors for pain crisis，and bone metastasis，anxiety and mild to moderate depression were risk factors for pain crisis. Conclusion The incidence of pain crisis was high in advanced lung cancer patients. Medical staff should pay attention to those with younger age，bone metastasis，low level of social support，high level of anxiety and mild to moderate level of depression，and take timely intervention measures to reduce the occurrence of pain crisis.

Key words: Lung Cancer, Pain Crisis, Cancer Pain, Questionnaire, Nursing Care

豆丽园, 蒋秋玲, 申文佳, 李晓萍, 戚新新. 晚期肺癌患者疼痛危象发生现状及影响因素研究[J]. 中华护理杂志, 2024, 59(11): 1353-1359.

DOU Liyuan, JIANG Qiuling, SHEN Wenjia, LI Xiaoping, QI Xinxin. Status quo and influencing factors of pain crisis in advanced lung cancer patients[J]. Chinese Journal of Nursing, 2024, 59(11): 1353-1359.

图/表 3

表1 晚期肺癌患者疼痛危象的单因素分析[n=318，例（百分比，%）]

Table 1 Univariate analysis of pain crisis in patients with advanced lung cancer[n=318，cases（percentage，%）]

表2 自变量赋值方式

Table 2 Assignment methods of argument variables

表3 晚期肺癌患者疼痛危象的Logistic回归分析结果（n=318）

Table 3 Logistic regression analysis results of pain crisis in patients with advanced lung cancer（n=318）

参考文献 28

[1]	Evenepoel M, Haenen V, De Baerdemaecker T, et al. Pain prevalence during cancer treatment:a systematic review and meta-analysis[J]. J Pain Symptom Manag, 2022, 63(3):e317-e335.
[2]	丁群芳, 黄静, 江子芳, 等. 癌症疼痛规范化管理信息平台的构建及应用[J]. 中华护理杂志, 2020, 55(3):387-391. DOI
	Ding QF, Huang J, Jiang ZF, et al. Effect assessment of an information platform for standardized nursing management of cancer pain[J]. Chin J Nurs, 2020, 55(3):387-391. DOI
[3]	雒晓燕, 崔仁善, 许秀梅, 等. 基于“互联网+”的护理干预对癌症患者疼痛影响的Meta分析[J]. 中华护理杂志, 2023, 58(9):1056-1062. DOI
	Luo XY, Cui RS, Xu XM, et al. Effectiveness of “Internet+” nursing intervention model on pain in cancer patients:a meta-analysis[J]. Chin J Nurs, 2023, 58(9):1056-1062.
[4]	中国临床肿瘤学会肿瘤支持与康复治疗专家委员会, 中国抗癌协会肿瘤康复与姑息治疗专家委员会, 中华医学会麻醉学分会, 等. 癌痛管理中疼痛危象理念的形成与管理方案专家建议[J]. 中华医学杂志, 2023, 103(21):1591-1595.
	Chinese Society of Clinical Oncology-Supportive Care and Rehabilitation Committee,China Anti-Cancer Association-the Committee of Rehabilitation and Palliative Care,Chinese Society of Anesthesiology, et al. Expert recommendations on the formation of pain crisis concept and management plan in cancer pain management[J]. Natl Med J China, 2023, 103(21):1591-1595.
[5]	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249.
[6]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4):378-380.
	Ni P, Chen JL, Liu N. The sample size estimation in quantitative nursing research[J]. Chin J Nurs, 2010, 45(4):378-380.
[7]	Dahlem NW, Zimet GD, Walker RR. The multidimensional scale of Perceived Social Support:a confirmation study[J]. J Clin Psychol, 1991, 47(6):756-761. DOI PMID
[8]	姜乾金. 领悟社会支持量表[J]. 中国行为医学科学, 2001, 10(10):41-43.
	Jiang QJ. Perceived Social Support Scale[J]. Chin Behav Med Sci, 2001, 10(10):41-43.
[9]	Zung WW. A rating instrument for anxiety disorders[J]. Psychosomatics, 1971, 12(6):371-379. DOI PMID
[10]	戴晓阳. 常用心理评估量表手册[M]. 北京: 人民军医出版社, 2010:170-172.
	Dai XY. Handbook of commonly used psychological assessment scales[M]. Beijing: People’s Military Medical Press, 2010:170-172.
[11]	孙雪洁, 姚洁林, 王慧如, 等. 整合式心理干预联合阶段性认知行为护理对肺癌化疗患者癌因性疲乏、心理弹性与情绪的影响[J]. 护理实践与研究, 2023, 20(20):3130-3135.
	Sun XJ, Yao JL, Wang HR, et al. Effects of integrated psychological intervention combined with staged cognitive behavioral nursing on cancer-related fatigue,psychological resilience and emotion in patients undergoing chemotherapy for lung cancer[J]. Nurs Pract Res, 2023, 20(20):3130-3135.
[12]	Zung WW. A self-rating depression scale[J]. Arch Gen Psychiatry, 1965,12:63-70.
[13]	晁林林, 钟土秀, 李伟兴, 等. 盐酸羟考酮缓释片联合阿米替林对重度癌症疼痛伴抑郁患者的疗效观察[J]. 中国现代药物应用, 2020, 14(18):203-205.
	Chao LL, Zhong TX, Li WX, et al. Observation on the curative effect of oxycodone hydrochloride sustained-release tablets combined with amitriptyline on patients with severe cancer pain and depression[J]. Chin J Mod Drug Appl, 2020, 14(18):203-205.
[14]	王稳, 樊碧发. 癌痛发生机制的研究进展[J]. 中国疼痛医学杂志, 2021, 27(8):616-618.
	Wang W, Fan BF. Research progress on the mechanism of cancer pain[J]. Chin J Pain Med, 2021, 27(8):616-618.
[15]	Achaliwie F, Wakefield AB, Mackintosh-Franklin C. Does education improve nurses’ knowledge,attitudes,skills,and practice in relation to pain management? An integrative review[J]. Pain Manag Nurs, 2023, 24(3):273-279.
[16]	王润珠, 纪木火, 杨建军, 等. 胸腔镜术后慢性疼痛患者的危险因素及恢复质量[J]. 医学研究生学报, 2022, 35(2):161-164.
	Wang RZ, Ji MH, Yang JJ, et al. Risk factors and recovery quality of patients with chronic postsurgical pain after thoracoscopy[J]. J Med Postgrad, 2022, 35(2):161-164.
[17]	Hoag JA, Karst J, Bingen K, et al. Distracting through procedural pain and distress using virtual reality and guided imagery in pediatric,adolescent,and young adult patients:randomized controlled trial[J]. J Med Internet Res, 2022, 24(4):e30260.
[18]	Azizoddin DR, DeForge SM, Baltazar A, et al. Development and pre-pilot testing of STAMP+CBT:an mHealth app combining pain cognitive behavioral therapy and opioid support for pa-tients with advanced cancer and pain[J]. Support Care Cancer, 2024, 32(2):123. DOI PMID
[19]	Tsao MN, Barnes EA, Chow E. Multiple bone metastases:what the palliative care specialist should know about the potential,limitations and practical aspects of radiation therapy[J]. Ann Palliat Med, 2020, 9(3):1307-1313. DOI PMID
[20]	Niu YJ, Lin YT, Pang HL, et al. Risk factors for bone metastasis in patients with primary lung cancer:a systematic review[J]. Medicine, 2019, 98(3):e14084.
[21]	Geerling JI, van der Linden YM, Raijmakers NJH, et al. Randomized controlled study of pain education in patients receiving radiotherapy for painful bone metastases[J]. Radiother Oncol, 2023,185:109687.
[22]	Fisher HM, Winger JG, Miller SN, et al. Relationship between social support,physical symptoms,and depression in women with breast cancer and pain[J]. Support Care Cancer, 2021, 29(9):5513-5521.
[23]	Cui CX, Liu HY, Yue N, et al. Research progress on the mechanism of chronic neuropathic pain[J]. IBRO Neurosci Rep, 2023, 14:80-85.
[24]	Smolev ET, Rolf L, Zhu E, et al. “pill pushers and CBD oil”-a thematic analysis of social media interactions about pain after traumatic brachial plexus injury[J]. J Hand Surg Glob Online, 2021, 3(1):36-40.
[25]	卢海彬, 张屹, 孙真诚, 等. 肺癌根治术后患者焦虑情绪对疼痛症状及应激反应的影响[J]. 国际精神病学杂志, 2023, 50(6):1522-1524.
	Lu HB, Zhang Y, Sun ZC, et al. The influence of anxiety on pain and stress response in lung cancer patients after radical surgery[J]. J Int Psychiatry, 2023, 50(6):1522-1524.
[26]	Deng C, Xie YJ, Liu Y, et al. Aromatherapy plus music therapy improve pain intensity and anxiety scores in patients with breast cancer during perioperative periods:a randomized controlled trial[J]. Clin Breast Cancer, 2022, 22(2):115-120.
[27]	黄巧荣, 杨连招, 陈玲, 等. 聚焦解决模式对HIV感染者/AIDS患者焦虑、抑郁影响的Meta分析[J]. 中华护理杂志, 2023, 58(22):2792-2800. DOI
	Huang QR, Yang LZ, Chen L, et al. Effect of solution-focused brief therapy on anxiety and depression in patients with HIV/AIDS:a meta-analysis[J]. Chin J Nurs, 2023, 58(22):2792-2800.
[28]	孙倩倩, 叶红芳, 杨莉. 接纳与承诺疗法对乳腺癌患者干预效果的Meta分析[J]. 中华护理杂志, 2022, 57(9):1070-1078. DOI
	Sun QQ, Ye HF, Yang L. Effectiveness of acceptance and commitment therapy on breast cancer patients:a Meta-analysis[J]. Chin J Nurs, 2022, 57(9):1070-1078.