膀胱癌原位尿流改道术后患者生命质量及其影响因素研究
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摘要
目的:
以MOS SF-36量表和生命质量相关因素调查表为工具,探讨膀胱癌膀胱全切术后患者的健康相关生命质量及主要影响因素,为医生、护士选择和评价治疗、护理方案,进一步提高患者术后生命质量提供科学的理论依据。
方法:
2004年1月至2005年12月在昆明医学院第二附属医院病理确诊,接受膀胱全切术后的膀胱癌病例,符合纳入和排除标准的82例患者作为研究对象;按照尿流改道手术方式,分为2组,其中原位尿流改道术组为54例(实验组),非原位尿流改道术组(对照组)为28例。以SF-36量表和生命质量相关因素调查表为工具,采用面对面调查方式,分别对实验组与对照组术后第6个月、第1年和第2年的生命质量进行随访调查。采用SPSS 16.0软件包进行统计分析,数据呈正态分布的采用t检验,非正态的采用Wilcoxon检验。HRQOL(health-related quality of life,HRQOL)评分与其影响因素间的相关性采用多元逐步回归分析(Backward法)。以P<0.05为统计学显著性差异标准。
结果:
1.SF-36量表对膀胱全切术后患者HRQOL测评中,各维度的内部一致性Cronbach a系数范围是0.66～0.92,显示较好的内部一致性信度。重测信度在各个维度相关性均较好,分布范围在0.82～0.93之间,分半信度也达到了0.94。内容效度评价中,发现36条目与各自的维度相关,而与其他维度不相关(显著低于两个标准差或以上),集合试验和区分试验的成功率达100%。在结构效度的评价中,各维度与两个主成分的相关基本符合理论模型,且两个主成分的累计方差贡献率达到了64.7。
2.原位尿流改道术组和非原位尿流改道术两组间,平均年龄、临床分型比较无统计学意义,研究对象其他一般情况,具有可比性。
3.原位尿流改道患者术后第6个月至第2年间的社会功能和心理健康上的评分明显高于非原位尿流改道患者,手术1年以后多数原位尿流改道患者认为自己的身体健康,其总体健康评价评分高于非原位尿流改道患者。而非原位尿流改道患者术后生理健康恢复并不差于原位尿流改道。
4.共有13项因素对原位尿流改道术患者的HRQOL各维度评分有着不同程度的影响;控尿情况、回忆住院经历、出院后的身体不适、对疾病的了解程度、随访时间、年龄和学历是影响患者HRQOL较为重要的7个因素,分别与多个维度产生了不同程度的影响,其中控尿情况、回忆住院经历和出院后不适为最多的3个因素。发病原因、病理分级等因素对各维度得分均无影响。
结论:
1.SF-36量表应用于膀胱全切术后患者的HRQOL研究具有较好的信度和效度,对这一人群的HRQOL评价是可信并可行的。
2.原位尿流改道患者术后生命质量高于非尿流改道手术患者。
3.控尿情况、回忆住院经历、出院后的身体不适、对疾病的了解程度、随访时间、年龄和学历是影响患者HRQOL较为重要的7个因素,其中又以控尿情况、回忆住院经历和出院后不适为最多的3个影响因素。
4.生命质量评定及其影响因素的研究,为膀胱癌原位尿流改道术后患者实施有效的医疗、护理干预提供了重要的科学理论依据。
Objective:
To analyze the health-related quality of lif(eQOL)and principal influencing factors of orthotopic neobladder after cystectomy for bladder carcinoma according to the questionnaire of SF-36 table and quality of life correlation factor.This investigation aims was provided science bases of the selection about the clinician and nurses therapeutics and nursing programs,and the improving the patients′QOL.
Methods:
82 people,urinary bladder were ablated after they were diagnosed as bladder carcinoma by pathological diagnosis in the second hospital of Kunming Medical College between January 2004 and December 2005,who met the conditions of internalization and elimination were studied. They were divided into two groups according to urinary diversion,one is urinary diversion patients including 54 cases,the other is non- urinary diversion patients including 28 cases. The quality of life was investigated face to face after six months,one year and two years of operation according to the questionnaire of SF-36 table and quality of life correlation factor. Dates were analyzed by SPSS 16.0,t-test was used to analyzed dates emerging on normal distribution,Wilcoxon-test was used to analyze dates emerging on non-normal distribution. The correlations between HRQOL scores and its influencing factors were analyzed by Backward(p<0.05).
Results:
1.The HRQOL evaluation about the patients ablated the whole urinary bladder displayed that amplitude of the interior concordance Cronbach a coefficient among each dimensions was 0.66-0.92.The test-retestreliability,0.82-0.93,was good in correlation among each dimensions,the split-half reliability reached to 0.94.In Survey of Content Validity,36 items were founded to be related to their dimensions respectively,but not to others,the achievement ratio of aggregation test and discrimination test was 100%.In the evaluation about construct validity,the correlation between each dimensions and two main constituents was consistent with theoretical model,and the summary variance contribution ratio of two main constituents reached to 64.7.
2. The mean age and clinical classification ratio have no significant differences between urinary diversion and non-urinary diversion,and the object studied was comparability.
3. The scores about society action and mental health was more high in urinary diversion patients six months to two years after operation,majority urinary diversion patients thought they were healthy one year after operation,and the pant-healthy scores was more high than the non-urinary diversion patients. The recovery of physiological health did not fall behind the urinary diversion patients.
4. 13 factors can affect each dimensions scores of HRQOL in urinary diversion patients.7 important factors can affect multiple dimensions,there were controlling urination , recalling hospitalization experiences , indisposition after discharge ,understanding degree of morbidity,follow-up times,ages and educational backgrounds. Of the total,controlling urination,recalling hospitalization experiences and indisposition after discharge were maximum. The cause of morbility,histological grading and educational backgrounds could not affect the scores of each dimensions .
Conclusion:
1. SF-36 table,which was used to evaluate the HRQOL of Radical Cystectomy patientas,had good reliability and validity,so it was credible and valid to HRQOL of this crowds.
2. The quality of life in urinary diversion patients after operation were better than others.
3. 7 important factors can affect HRQOL,there were controlling urination,recalling hospitalization experiences , indisposition after discharge , understanding degree of morbidity,follow-up times,ages and educational backgrounds. controlling urination,recalling hospitalization experiences and indisposition after discharge were maximum.
4. Studying about evaluation of living quality and its related influencing factors can provide important scientific evidence for effectual nursing to urinary diversion patients.
以MOS SF-36量表和生命质量相关因素调查表为工具,探讨膀胱癌膀胱全切术后患者的健康相关生命质量及主要影响因素,为医生、护士选择和评价治疗、护理方案,进一步提高患者术后生命质量提供科学的理论依据。
方法:
2004年1月至2005年12月在昆明医学院第二附属医院病理确诊,接受膀胱全切术后的膀胱癌病例,符合纳入和排除标准的82例患者作为研究对象;按照尿流改道手术方式,分为2组,其中原位尿流改道术组为54例(实验组),非原位尿流改道术组(对照组)为28例。以SF-36量表和生命质量相关因素调查表为工具,采用面对面调查方式,分别对实验组与对照组术后第6个月、第1年和第2年的生命质量进行随访调查。采用SPSS 16.0软件包进行统计分析,数据呈正态分布的采用t检验,非正态的采用Wilcoxon检验。HRQOL(health-related quality of life,HRQOL)评分与其影响因素间的相关性采用多元逐步回归分析(Backward法)。以P<0.05为统计学显著性差异标准。
结果:
1.SF-36量表对膀胱全切术后患者HRQOL测评中,各维度的内部一致性Cronbach a系数范围是0.66～0.92,显示较好的内部一致性信度。重测信度在各个维度相关性均较好,分布范围在0.82～0.93之间,分半信度也达到了0.94。内容效度评价中,发现36条目与各自的维度相关,而与其他维度不相关(显著低于两个标准差或以上),集合试验和区分试验的成功率达100%。在结构效度的评价中,各维度与两个主成分的相关基本符合理论模型,且两个主成分的累计方差贡献率达到了64.7。
2.原位尿流改道术组和非原位尿流改道术两组间,平均年龄、临床分型比较无统计学意义,研究对象其他一般情况,具有可比性。
3.原位尿流改道患者术后第6个月至第2年间的社会功能和心理健康上的评分明显高于非原位尿流改道患者,手术1年以后多数原位尿流改道患者认为自己的身体健康,其总体健康评价评分高于非原位尿流改道患者。而非原位尿流改道患者术后生理健康恢复并不差于原位尿流改道。
4.共有13项因素对原位尿流改道术患者的HRQOL各维度评分有着不同程度的影响;控尿情况、回忆住院经历、出院后的身体不适、对疾病的了解程度、随访时间、年龄和学历是影响患者HRQOL较为重要的7个因素,分别与多个维度产生了不同程度的影响,其中控尿情况、回忆住院经历和出院后不适为最多的3个因素。发病原因、病理分级等因素对各维度得分均无影响。
结论:
1.SF-36量表应用于膀胱全切术后患者的HRQOL研究具有较好的信度和效度,对这一人群的HRQOL评价是可信并可行的。
2.原位尿流改道患者术后生命质量高于非尿流改道手术患者。
3.控尿情况、回忆住院经历、出院后的身体不适、对疾病的了解程度、随访时间、年龄和学历是影响患者HRQOL较为重要的7个因素,其中又以控尿情况、回忆住院经历和出院后不适为最多的3个影响因素。
4.生命质量评定及其影响因素的研究,为膀胱癌原位尿流改道术后患者实施有效的医疗、护理干预提供了重要的科学理论依据。
Objective:
To analyze the health-related quality of lif(eQOL)and principal influencing factors of orthotopic neobladder after cystectomy for bladder carcinoma according to the questionnaire of SF-36 table and quality of life correlation factor.This investigation aims was provided science bases of the selection about the clinician and nurses therapeutics and nursing programs,and the improving the patients′QOL.
Methods:
82 people,urinary bladder were ablated after they were diagnosed as bladder carcinoma by pathological diagnosis in the second hospital of Kunming Medical College between January 2004 and December 2005,who met the conditions of internalization and elimination were studied. They were divided into two groups according to urinary diversion,one is urinary diversion patients including 54 cases,the other is non- urinary diversion patients including 28 cases. The quality of life was investigated face to face after six months,one year and two years of operation according to the questionnaire of SF-36 table and quality of life correlation factor. Dates were analyzed by SPSS 16.0,t-test was used to analyzed dates emerging on normal distribution,Wilcoxon-test was used to analyze dates emerging on non-normal distribution. The correlations between HRQOL scores and its influencing factors were analyzed by Backward(p<0.05).
Results:
1.The HRQOL evaluation about the patients ablated the whole urinary bladder displayed that amplitude of the interior concordance Cronbach a coefficient among each dimensions was 0.66-0.92.The test-retestreliability,0.82-0.93,was good in correlation among each dimensions,the split-half reliability reached to 0.94.In Survey of Content Validity,36 items were founded to be related to their dimensions respectively,but not to others,the achievement ratio of aggregation test and discrimination test was 100%.In the evaluation about construct validity,the correlation between each dimensions and two main constituents was consistent with theoretical model,and the summary variance contribution ratio of two main constituents reached to 64.7.
2. The mean age and clinical classification ratio have no significant differences between urinary diversion and non-urinary diversion,and the object studied was comparability.
3. The scores about society action and mental health was more high in urinary diversion patients six months to two years after operation,majority urinary diversion patients thought they were healthy one year after operation,and the pant-healthy scores was more high than the non-urinary diversion patients. The recovery of physiological health did not fall behind the urinary diversion patients.
4. 13 factors can affect each dimensions scores of HRQOL in urinary diversion patients.7 important factors can affect multiple dimensions,there were controlling urination , recalling hospitalization experiences , indisposition after discharge ,understanding degree of morbidity,follow-up times,ages and educational backgrounds. Of the total,controlling urination,recalling hospitalization experiences and indisposition after discharge were maximum. The cause of morbility,histological grading and educational backgrounds could not affect the scores of each dimensions .
Conclusion:
1. SF-36 table,which was used to evaluate the HRQOL of Radical Cystectomy patientas,had good reliability and validity,so it was credible and valid to HRQOL of this crowds.
2. The quality of life in urinary diversion patients after operation were better than others.
3. 7 important factors can affect HRQOL,there were controlling urination,recalling hospitalization experiences , indisposition after discharge , understanding degree of morbidity,follow-up times,ages and educational backgrounds. controlling urination,recalling hospitalization experiences and indisposition after discharge were maximum.
4. Studying about evaluation of living quality and its related influencing factors can provide important scientific evidence for effectual nursing to urinary diversion patients.
引文
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2.虞颂庭,臧美孚,夏溟.尿路上皮肿瘤概论.见:吴阶平.吴阶平泌尿外科学[M],济南:山东科学技术出版社,2004,919-942.
3. Messing EM. Urothelial tumors of the urinary tract. In: Walsh PC,Retik AB,Vaughan ED Jr,Wein AJ, eds. Campbell's urology. 8th ed. Philadelphia(PA):W. B. Saunders,2002. 2732-2784.
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