喉癌患者术后焦虑程度与营养状况及免疫指标的相关性分析
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摘要
目的探讨喉癌患者焦虑情绪与术后营养状况及免疫指标的相关性,为改善喉癌患者预后提供相关参考。方法选取遂宁市中心医院耳鼻咽喉科2014年1月～2018年6月收治的经手术治疗且术后病理确诊的103例喉癌患者作为研究对象;全部患者分别于术前1天和术后12天应用营养风险筛查量表2002(NRS2002)进行营养状况评价,同时收集患者空腹外周静脉血进行相关免疫指标检测;采用焦虑症状自评量表(SAS)在术后24小时内对喉切除术患者进行焦虑测评,并依据SAS评分筛选出焦虑症状者85例,并进一步分为轻度焦虑组15例、中度焦虑组29例和重度焦虑组41例。比较术前及术后不同焦虑程度的患者营养状况及免疫指标水平。结果术后有焦虑症状85例,阳性检出率为82.52%。其中轻度焦虑15例(17.65%)、中度焦虑29例(34.12%)、重度焦虑41例(48.24%)。术后营养不良检出率为86.41%。术后3组不同焦虑程度喉癌患者的体质量指数(BMI)和血清白蛋白(ALB)水平分别较手术前均有下降,随着焦虑程度的加重,术后患者的BMI和ALB水平均呈下降趋势。术后中度焦虑和重度焦虑组CD4~+、CD8~+、NK细胞及IgG、IgM和IgA水平较术前均有下降,随着焦虑程度的加重,术后患者的CD4~+、CD8~+、NK细胞及IgG、IgM和IgA水平水平均呈下降趋势。结论喉癌患者术后焦虑程度与营养状况及免疫指标关系密切,焦虑程度越高患者术后营养状况及免疫指标水平越差。
OBJECTIVE To explore the correlation between anxiety and postoperative nutritional status,immune indexes in patients with laryngeal cancer, and to provide reference for improvi ng the prog nosis of patients with laryngeal cancer. METHODS 103 patients with lar yngeal cancer who had been operated on and pathologically confirmed after operation were selected as the subjects of study from January 2014 to June 2018 in the Department of Otolaryngology of Suining Central Hospital. Fasting peripheral venous blood was tested for related immune indicators. Self-rating anxiety scale(SAS) was used to assess the anxiety of laryngectomy patients within 24 hours after operation, and 85 patients with anxiety symptoms were screened out according to SAS score, and further divided into 15 mild anxiety group, 29 moderate anxiety group and 41 severe anxiety group. Nutritional status and immune indexes of patients with different anxiety levels before and after operation were compared. RESULTS Positive rate of anxiety symptoms was 82.52%. Among them, 15(17.65%) had mild anxiety, 29(34.12%) had moderate anxiety and 41(48.24%) had severe anxiety. Postoperative malnutrition detection rate was 86.41%. The levels of BMI and ALB in three groups of laryngeal cancer patients with different anxiety levels after operation were lower than those before operation. With the aggravation of anxiety level, the levels of BMI and ALB in patients after operation showed a downward trend. The levels of CD4~+, CD8~+, NK cells, IgG, IgM and IgA in moderate and severe anxiety group decreased compared with those before operation. With the aggravation of anxiety, the levels of CD4~+, CD8~+, NK cells, IgG, IgM and IgA decreased after operation. CONCLUSION The postoperative anxiety of laryngeal cancer patients is closely related to nutritional status and immune indicators. The higher the degree of anxiety, the worse the nutritional status and immune indicators.
OBJECTIVE To explore the correlation between anxiety and postoperative nutritional status,immune indexes in patients with laryngeal cancer, and to provide reference for improvi ng the prog nosis of patients with laryngeal cancer. METHODS 103 patients with lar yngeal cancer who had been operated on and pathologically confirmed after operation were selected as the subjects of study from January 2014 to June 2018 in the Department of Otolaryngology of Suining Central Hospital. Fasting peripheral venous blood was tested for related immune indicators. Self-rating anxiety scale(SAS) was used to assess the anxiety of laryngectomy patients within 24 hours after operation, and 85 patients with anxiety symptoms were screened out according to SAS score, and further divided into 15 mild anxiety group, 29 moderate anxiety group and 41 severe anxiety group. Nutritional status and immune indexes of patients with different anxiety levels before and after operation were compared. RESULTS Positive rate of anxiety symptoms was 82.52%. Among them, 15(17.65%) had mild anxiety, 29(34.12%) had moderate anxiety and 41(48.24%) had severe anxiety. Postoperative malnutrition detection rate was 86.41%. The levels of BMI and ALB in three groups of laryngeal cancer patients with different anxiety levels after operation were lower than those before operation. With the aggravation of anxiety level, the levels of BMI and ALB in patients after operation showed a downward trend. The levels of CD4~+, CD8~+, NK cells, IgG, IgM and IgA in moderate and severe anxiety group decreased compared with those before operation. With the aggravation of anxiety, the levels of CD4~+, CD8~+, NK cells, IgG, IgM and IgA decreased after operation. CONCLUSION The postoperative anxiety of laryngeal cancer patients is closely related to nutritional status and immune indicators. The higher the degree of anxiety, the worse the nutritional status and immune indicators.
引文
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[7]赵莹莹,马晓宇.音乐疗法联合心理干预对喉癌术后气管切开患者焦虑及疼痛状态的影响.山西医药杂志,2017,46(13):1631-1633.
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[12]金磊,丁可.联合护理干预对喉癌患者术后生活质量的影响.中华灾害救援医学,2018,6(1):39-42.
[13]卫琦琼.喉癌气管切开患者住院期间真实体验的质性研究.安徽卫生职业技术学院学报,2018,17(2):140-142.
[14]郑雪松,汪蓉,李爱霞.喉癌患者术后营养风险评估与生存质量的关系.西部中医药,2017,30(7):83-85.
[15]曾玲,周建平.不同肠内营养制剂对喉癌术后患者的影响.西南国防医药,2017,27(12):1333-1335.
[16]刘嘉,骆峻,曾庆琪.恶性肿瘤患者心理因素与社会支持的研究进展.中国肿瘤外科杂志,2017,9(5):331-333.
[17]李菊芳,刘瑞云.康复期老年恶性肿瘤患者生命质量影响因素的调查分析.肿瘤研究与临床,2017,29(9):623-627.
[18]Johansson M,Ryden A,Finizia C.Mental adjustment to cancer and its relation to anxiety,depression,HRQL and survival in patients with laryngeal cancer-a longitudinal study.BMC Cancer,2011,11:283
[2]Moser EC,Meunier F.Cancer survivorship:a positive side-effect of more successful cancer treatment.EJC Suppl,2014,12(1):1-4.
[3]谭辉,郝永丽,王海洋,等.系统康复护理对喉癌患者围手术期心理状态及术后恢复的干预研究.肿瘤预防与治疗,2018,31(2):112-116.
[4]杜灵彬,毛伟敏,陈万青,等.中国2003-2007年喉癌发病率和死亡率分析.中华流行病学杂志,2012,33(4):395-398.
[5]于洮,刘海莹,孙梦婷.喉癌部分喉切除术后患者的营养风险筛查及营养支持.中西医结合护理(中英文),2018,4(5):27-29.
[6]何科,韦春银,许坚.喉癌患者营养不良状况及免疫肠内营养支持治疗的研究进展.广西医学,2017,39(6):874-876.
[7]赵莹莹,马晓宇.音乐疗法联合心理干预对喉癌术后气管切开患者焦虑及疼痛状态的影响.山西医药杂志,2017,46(13):1631-1633.
[8]李素芳,路平,杨乐.心理干预对喉癌患者治疗过程中精神状态的影响.中国实用神经疾病杂志,2016,19(23):139-141.
[9]李素芳.老年喉癌患者术后焦虑程度与营养状况及免疫指标的关系.中国老年学杂志,2015,35(8):2077-2079.
[10]Gourin CG,Couch ME,Johnson JT.Effect of weight loss on short-term outcomes and costs of care after head and neck cancer surgery.Ann Otol Rhinol Laryngol,2014,123(2):101-110.
[11]郭静,黎娜,范杨,等.早期肠内营养支持对喉癌术后患者营养状况的改善作用.肠外与肠内营养,2014,21(3):132-134.
[12]金磊,丁可.联合护理干预对喉癌患者术后生活质量的影响.中华灾害救援医学,2018,6(1):39-42.
[13]卫琦琼.喉癌气管切开患者住院期间真实体验的质性研究.安徽卫生职业技术学院学报,2018,17(2):140-142.
[14]郑雪松,汪蓉,李爱霞.喉癌患者术后营养风险评估与生存质量的关系.西部中医药,2017,30(7):83-85.
[15]曾玲,周建平.不同肠内营养制剂对喉癌术后患者的影响.西南国防医药,2017,27(12):1333-1335.
[16]刘嘉,骆峻,曾庆琪.恶性肿瘤患者心理因素与社会支持的研究进展.中国肿瘤外科杂志,2017,9(5):331-333.
[17]李菊芳,刘瑞云.康复期老年恶性肿瘤患者生命质量影响因素的调查分析.肿瘤研究与临床,2017,29(9):623-627.
[18]Johansson M,Ryden A,Finizia C.Mental adjustment to cancer and its relation to anxiety,depression,HRQL and survival in patients with laryngeal cancer-a longitudinal study.BMC Cancer,2011,11:283