超声引导经皮穿刺微波消融治疗原发性肝癌患者的症状群研究
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摘要
目的探讨超声引导经皮穿刺微波消融(UPMWA)治疗原发性肝癌患者的症状种类、发生率、症状严重程度及对日常生活干扰程度,并分析症状群种类及群内症状相关性。方法采用方便抽样法选择接受UPMWA治疗的151例原发性肝癌患者,采用M.D安德森症状评估量表中文版(MDASI-C)、原发性肝癌特异性症状模块(TSM-PLC)对肝癌患者进行问卷调查。以Cronbach’sα系数评估症状群信度,采用最大方差正交旋转因子分析和Cronbach’sα系数探索症状间相互关系并确定症状群。结果共回收有效问卷120份,共经历19个症状,症状评分最高的3个症状为疼痛、疲乏和口干,症状发生程度及对日常生活的干扰程度均为轻度,干扰以情绪、一般活动和行走为主。聚集为4个症状群,内部一致性信度Cronbach’sα分别为0.61、0.70、0.70和0.78,总方差贡献率60.27%,分别为疼痛症状群(疼痛、疲乏和气短)、病感症状群(黄疸、麻木、悲伤、瘙痒和健忘)、消融相关症状群(发热、体重减轻、呕吐、食欲下降和腹胀)、消化系统症状群(腹泻、睡眠不安、苦恼、恶心、口干和昏昏欲睡)。结论 UPMWA治疗肝癌患者所经历症状程度评分最高的3个症状分别为疼痛、疲乏和口干,对日常生活干扰程度均为轻度,但症状有普遍性且发生率高。
Objective To investigate the type, incidence, severity of symptoms and the interference to daily life in heprimary hepatic carcinoma patients following ultrasound-guided percutaneous microwave ablation(UPMWA), and further explore the symptom clusters and the relationship among them. Method By convenience sampling, 151 patients of primary hepatic carcinoma were included in the analysis, who were assessed by questionnaires of the Chinese version of the M.D Anderson symptom inventory(MDASI-C) and the symptom module specific for primary liver cancer(TSMPLC). Cronbach's α was applied to evaluate the reliability of symptom clusters, in addition, the interaction between varimax rotation in factor analysis and Cronbach's α was analyzed to determine the symptom clusters. Result A total of 120 valid questionnaires were returned, which indicated that there covered 19 symptoms, among which the highest scored symptoms were pain, fatigue and dry mouth, all symptoms were mild, with minor interference to daily life, involving emotion, general activities, and walking. The symptoms, which were grouped as 4 clusters with Cronbach's α being 0.61,0.70, 0.70 and 0.78, respectively, and the total variance contribution rate being 60.27%, were pain symptom clusters(pain, fatigue and dyspnea), disease-feeling symptom clusters(jaundice, numbness, sad, pruritis and amnesia), ablation-related symptom clusters(fever, weight loss, vomiting, poor appetite and abdominal distension), and gastrointestinal symptom clusters(diarrhea, uneasy sleep, upset, nausea, dry mouth and somnolence). Conclusion The top three scored symptoms experienced by primary hepatic carcinoma patients who received ultrasound-guided microwave ablation are pain, fatigue and dry mouth, which pose minimal interference to daily life, while these symptoms are common and of relatively high incidence.
Objective To investigate the type, incidence, severity of symptoms and the interference to daily life in heprimary hepatic carcinoma patients following ultrasound-guided percutaneous microwave ablation(UPMWA), and further explore the symptom clusters and the relationship among them. Method By convenience sampling, 151 patients of primary hepatic carcinoma were included in the analysis, who were assessed by questionnaires of the Chinese version of the M.D Anderson symptom inventory(MDASI-C) and the symptom module specific for primary liver cancer(TSMPLC). Cronbach's α was applied to evaluate the reliability of symptom clusters, in addition, the interaction between varimax rotation in factor analysis and Cronbach's α was analyzed to determine the symptom clusters. Result A total of 120 valid questionnaires were returned, which indicated that there covered 19 symptoms, among which the highest scored symptoms were pain, fatigue and dry mouth, all symptoms were mild, with minor interference to daily life, involving emotion, general activities, and walking. The symptoms, which were grouped as 4 clusters with Cronbach's α being 0.61,0.70, 0.70 and 0.78, respectively, and the total variance contribution rate being 60.27%, were pain symptom clusters(pain, fatigue and dyspnea), disease-feeling symptom clusters(jaundice, numbness, sad, pruritis and amnesia), ablation-related symptom clusters(fever, weight loss, vomiting, poor appetite and abdominal distension), and gastrointestinal symptom clusters(diarrhea, uneasy sleep, upset, nausea, dry mouth and somnolence). Conclusion The top three scored symptoms experienced by primary hepatic carcinoma patients who received ultrasound-guided microwave ablation are pain, fatigue and dry mouth, which pose minimal interference to daily life, while these symptoms are common and of relatively high incidence.
引文
[1]梁萍,董宝玮.肝癌微波消融治疗合理选择与评价[J].中国实用外科杂志, 2008, 28(8):615-618.
[2] Liang P, Yu J, Yu XL, et al. Percutaneous cooled-tip microwave ablation under ultrasound guidance for primary liver cancer:a multicentre analysis of 1363 treatment-naive lesions in 1007 patients in China[J]. Gut, 2012, 61(7):1100-1101.
[3] Kim HJ, McGuire DB, Tulman L, et al. Symptom clusters:concept analysis and clinical implications for cancer nursing[J]. Cancer Nurs, 2005, 28(4):270-282.
[4] Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients:the M.D. Anderson symptom inventory[J]. Cancer, 2000, 89(7):1634-1646.
[5] Wang XS, Wang Y, Guo H, et al. Chinese version of M.D.anderson symptom inventory-validation and application of symptom measurement in cancer patients[J]. Cancer, 2004,101(8):1890-1901.
[6] Serlin RC, Mendoza TR, Nakamura Y, et al. When is cancer pain mild, moderate or severe? grading pain severity by its interference with function[J]. Pain, 1995, 61(2):277-284.
[7]曹文婷. TACE肝癌患者症状、症状群及生活质量的纵向研究[D].上海:第二军医大学, 2012.
[8] Kim HJ, Barsevick AM, Tulman L, et al. Treatment-related symptom clusters in breast cancer:a secondary analysis[J].J Pain Symptom Manage, 2008, 36(5):468-479.
[9]张雪花,张潆化,梁萍.超声引导下微波消融治疗肝癌246例并发症分析[J].解放军医学院学报, 2015, 36(9):883-885.
[10]杨小平,王维利,张淼.肿瘤患者癌因性疲乏可控性影响因素的研究进展[J].中华护理杂志, 2013, 48(11):1039-1041.
[11]梁萍,董宝玮.超声引导微波凝固治疗肝癌[M].北京:人民军医出版社, 2003:123.
[12] Prue G, Rankin J, Allen J, et al. Cancer-related fatigue:a critical appraisal[J]. Eur J Cancer, 2006, 42(7):846-863.
[13] Kurzrock R. The role of cytokines in cancer-related fatigue[J]. Cancer, 2001, 92(6 Suppl):1684-1688.
[14]田银生,张华清,朱宇.住院肝癌患者112例心理特征及相关因素调查[J].中国临床康复, 2006, 10(10):16-18.
[15]姜春林,匡铭.肝癌热消融治疗引起免疫增强机制的研究进展[J].中国病理生理志, 2011, 27(5):1020-1024.
[16]张磊,钱国军.原发性肝癌热消融治疗的方法与评价[J].肝胆外科杂志, 2011, 19(1):73-75.
[17]刘洁.肝病患者的营养状况及血清Ghrelin、Leptin、IGF-1、TNF-α的检测及临床意义[D].天津:天津医科大学,2015.
[2] Liang P, Yu J, Yu XL, et al. Percutaneous cooled-tip microwave ablation under ultrasound guidance for primary liver cancer:a multicentre analysis of 1363 treatment-naive lesions in 1007 patients in China[J]. Gut, 2012, 61(7):1100-1101.
[3] Kim HJ, McGuire DB, Tulman L, et al. Symptom clusters:concept analysis and clinical implications for cancer nursing[J]. Cancer Nurs, 2005, 28(4):270-282.
[4] Cleeland CS, Mendoza TR, Wang XS, et al. Assessing symptom distress in cancer patients:the M.D. Anderson symptom inventory[J]. Cancer, 2000, 89(7):1634-1646.
[5] Wang XS, Wang Y, Guo H, et al. Chinese version of M.D.anderson symptom inventory-validation and application of symptom measurement in cancer patients[J]. Cancer, 2004,101(8):1890-1901.
[6] Serlin RC, Mendoza TR, Nakamura Y, et al. When is cancer pain mild, moderate or severe? grading pain severity by its interference with function[J]. Pain, 1995, 61(2):277-284.
[7]曹文婷. TACE肝癌患者症状、症状群及生活质量的纵向研究[D].上海:第二军医大学, 2012.
[8] Kim HJ, Barsevick AM, Tulman L, et al. Treatment-related symptom clusters in breast cancer:a secondary analysis[J].J Pain Symptom Manage, 2008, 36(5):468-479.
[9]张雪花,张潆化,梁萍.超声引导下微波消融治疗肝癌246例并发症分析[J].解放军医学院学报, 2015, 36(9):883-885.
[10]杨小平,王维利,张淼.肿瘤患者癌因性疲乏可控性影响因素的研究进展[J].中华护理杂志, 2013, 48(11):1039-1041.
[11]梁萍,董宝玮.超声引导微波凝固治疗肝癌[M].北京:人民军医出版社, 2003:123.
[12] Prue G, Rankin J, Allen J, et al. Cancer-related fatigue:a critical appraisal[J]. Eur J Cancer, 2006, 42(7):846-863.
[13] Kurzrock R. The role of cytokines in cancer-related fatigue[J]. Cancer, 2001, 92(6 Suppl):1684-1688.
[14]田银生,张华清,朱宇.住院肝癌患者112例心理特征及相关因素调查[J].中国临床康复, 2006, 10(10):16-18.
[15]姜春林,匡铭.肝癌热消融治疗引起免疫增强机制的研究进展[J].中国病理生理志, 2011, 27(5):1020-1024.
[16]张磊,钱国军.原发性肝癌热消融治疗的方法与评价[J].肝胆外科杂志, 2011, 19(1):73-75.
[17]刘洁.肝病患者的营养状况及血清Ghrelin、Leptin、IGF-1、TNF-α的检测及临床意义[D].天津:天津医科大学,2015.