肺癌化疗患者疲乏-负性情绪-疼痛-睡眠障碍症状群及其影响因素
|
摘要
目的探讨肺癌化疗患者疲乏-负性情绪-疼痛-睡眠障碍症状群及其影响因素。方法 2017年9-12月,便利抽样法抽取湖南省五所三级甲等医院住院治疗的肺癌化疗患者220名为研究对象。采用一般资料调查表、数字疼痛量表、简易疲乏量表、医用焦虑抑郁量表和匹兹堡睡眠质量指数量表对其进行调查,同时收集其化疗期间血液检测结果。采用聚类分析对疲乏-负性情绪-疼痛-睡眠障碍症状群进行分组,多元线性逐步回归分析筛选其影响因素。结果通过聚类分析得出,肺癌化疗患者疲乏-负性情绪-疼痛-睡眠障碍症状群分为重度和轻度两个症状组,其中化疗周期、患病时长、白细胞、血小板和谷丙转氨酶水平是其主要影响因素(均P<0.05)。结论化疗周期、患病时长、血小板、白细胞和谷丙转氨酶与症状群严重程度密切相关。医护人员对于化疗周期短、患病时间较长及白细胞、血小板和谷丙转氨酶异常的患者应加强观察,及时评估,并采取针对性的预防及症状管理措施。
Objective To analyze the symptom cluster of fatigue,anxiety,pain and sleeping disorder in patients with lung cancer underwent chemotherapy and to explore its influencing factors.Methods From September to December 2017, 220 lung cancer patients hospitalized from five hospitals in Hunan Province were selected by convenience sampling method.General information questionnaire,digital pain scale,simple fatigue scale,medical anxiety and depression scale and Pittsburgh Sleep Quality Index scale were used for investigatiuon,and blood test results during chemotherapy were collected.Cluster analysis was used to group the symptoms of fatigue-anxiety-pain-sleep disorder,and multiple linear stepwise regression analysis was used to screen the influencing factors.Results Cluster analysis showed that the symptoms of fatigue-anxiety-pain-sleep disorder in lung cancer patients were divided into two groups:severe and mild symptoms.The main influencing factors were chemotherapy cycle, duration of illness, leucocyte, platelet and alanine aminotransferase levels(all P<0.05).Conclusions Chemotherapy cycle,the duration of disease,platelet,white blood cell and ALT are closely related to the severity of symptom group.It is suggested that the medical workers should strengthen the observation of patients with short chemotherapy cycle,long duration of disease,leukocytes,platelets and ALT,and put forward targeted measures for prevention and symptom management measures.
Objective To analyze the symptom cluster of fatigue,anxiety,pain and sleeping disorder in patients with lung cancer underwent chemotherapy and to explore its influencing factors.Methods From September to December 2017, 220 lung cancer patients hospitalized from five hospitals in Hunan Province were selected by convenience sampling method.General information questionnaire,digital pain scale,simple fatigue scale,medical anxiety and depression scale and Pittsburgh Sleep Quality Index scale were used for investigatiuon,and blood test results during chemotherapy were collected.Cluster analysis was used to group the symptoms of fatigue-anxiety-pain-sleep disorder,and multiple linear stepwise regression analysis was used to screen the influencing factors.Results Cluster analysis showed that the symptoms of fatigue-anxiety-pain-sleep disorder in lung cancer patients were divided into two groups:severe and mild symptoms.The main influencing factors were chemotherapy cycle, duration of illness, leucocyte, platelet and alanine aminotransferase levels(all P<0.05).Conclusions Chemotherapy cycle,the duration of disease,platelet,white blood cell and ALT are closely related to the severity of symptom group.It is suggested that the medical workers should strengthen the observation of patients with short chemotherapy cycle,long duration of disease,leukocytes,platelets and ALT,and put forward targeted measures for prevention and symptom management measures.
引文
[1] CHEN W Q,SUN K X,ZHENG R S,et al.Report of cancer incidence and mortality in different areas of China,2014[J].Chin J Cancer Res,2018,30(1):1-12.
[2] FERGUSON T S,TULLOCH-REID M K,CUNNINGHAM-MYRIE C A,et al.Chronic disease in the Caribbean:strategies to respond to the public health challenge in the region.What can we learn from Jamaica’s experience?[J].West Indian Med J,2011,60(4):397-411.
[3] 顾岩,付秀华.肺癌化疗的研究进展[J].国际呼吸杂志,2007,27(23):1818-1821.
[4] PADILLA G,ROPKA M E.Quality of life and chemotherapy-induced neutropenia[J].Cancer Nurs,2005,28(3):167-171.
[5] 李楠楠,陈芬荣,朱惠瑛,等.肺癌患者化疗前后症状群的调查研究[J].解放军护理杂志,2017,34(23):34-38.
[6] LOWERY A E,KREBS P,COUPS E J,et al.Impact of symptom burden in post-surgical non-small cell lung cancer survivors[J].Support Care Cancer,2014,22(1):173-180.
[7] LIN S,CHEN Y,YANG L,et al.Pain,fatigue,disturbed sleep and distress comprised a symptom cluster that related to quality of life and functional status of lung cancer surgery patients[J].J Clin Nurs,2013,22(9-10):1281-1290.
[8] 薄纯露.肺癌放疗患者症状群及其与自我感受负担、生活质量作用模型初步构建[D].济南:山东大学,2018.
[9] 倪圆圆.理性情绪行为疗法在非小细胞肺癌化疗患者疼痛-疲乏-睡眠障碍症状群中的应用[D].吉林:吉林大学,2017.
[10]张作记.行为医学量表手册[M].北京:中华医学电子音像出版社,2005:485-489.
[11]MENDOZA T R,WANG X S,CLEELAND C S,et al.The rapid assessment of fatigue severity in cancer patients :use of the Brief Fatigue Inventory[J].Cancer,1999,85(5):1186-1196.
[12]BUYSSE D J,REYNOLDS C F 3RD,MONK T H,et al.The Pittsburgh Sleep Quality Index:a new instrument for psychiatric practice and research[J].Psychiatry Res,1989,28(2):193-213.
[13]ZIGMOND A S,SNAITH R P.The hospital anxiety and depression scale (HADS)[J].Acta Psychiatrica Scandinavica,1983,67(6):361-370.
[14]叶维菲,徐俊冕.“综合性医院焦虑抑郁量表”在综合性医院病人中的应用与评价[J].中华行为医学与脑科学杂志,1993,2(3):17-19.
[15]刘威.晚期非小细胞肺癌患者化疗前后睡眠及生活质量变化及相互关系的研究[D].昆明:昆明医科大学,2018.
[16]张天燕,杨娟丽,张健,等.癌症患者生存质量影响因素分析[J].中华肿瘤防治杂志,2013,20(3):166-171.
[17]林双兰,周建荣,赵良辉,等.肺癌患者常见症状群及与生存质量的相关性研究[J].重庆医科大学学报,2013,38(7):683-686.
[18]陈迪,张红梅,刘纬华.肺癌患者癌因性疲乏与希望水平的相关性[J].解放军护理杂志,2017,34(19):17-20,25.
[19]钟晓莉,赵彩云,赵天霞,等.圆桌认知疗法对肺癌化疗患者焦虑和抑郁情绪的干预效果[J].解放军护理杂志,2018,35(2):30-33,38.
[20]姚静静,陈如男,刘砚燕,等.癌症适应概念及其理论的研究进展[J].解放军护理杂志,2012,29(2A):23-27.
[21]BOWER J E.Cancer-related fatigue—mechanisms,risk factors,and treatments[J].Nat Rev Clin Oncol,2014,11(10):597-609.
[22]CLEVENGER L,SCHREPF A,CHRISTENSEN D,et al.Sleep disturbance,cytokines,and fatigue in women with ovarian cancer[J].Brain Behav Immun,2012,26(7):1037-1044.
[23]范奎,代良敏,伍振峰,等.放化疗所致骨髓抑制的研究进展[J].中华中医药杂志,2017,32(1):210-214.
[24]张石革.抗肿瘤药所致不良反应的防治与合理应用原则[J].中国医院用药评价与分析,2014,114(12):1060-1063.
[25]谢铮铮,梁瑶,孙路路.抗肿瘤药物肝毒性评价及在肝功能受损患者中的剂量调整[J].中国临床药理学杂志,2016,32(23):2203-2205.
[26]杨树勤.中国医学百科全书[M].上海:上海科学技术出版社,1985:158-159.
[2] FERGUSON T S,TULLOCH-REID M K,CUNNINGHAM-MYRIE C A,et al.Chronic disease in the Caribbean:strategies to respond to the public health challenge in the region.What can we learn from Jamaica’s experience?[J].West Indian Med J,2011,60(4):397-411.
[3] 顾岩,付秀华.肺癌化疗的研究进展[J].国际呼吸杂志,2007,27(23):1818-1821.
[4] PADILLA G,ROPKA M E.Quality of life and chemotherapy-induced neutropenia[J].Cancer Nurs,2005,28(3):167-171.
[5] 李楠楠,陈芬荣,朱惠瑛,等.肺癌患者化疗前后症状群的调查研究[J].解放军护理杂志,2017,34(23):34-38.
[6] LOWERY A E,KREBS P,COUPS E J,et al.Impact of symptom burden in post-surgical non-small cell lung cancer survivors[J].Support Care Cancer,2014,22(1):173-180.
[7] LIN S,CHEN Y,YANG L,et al.Pain,fatigue,disturbed sleep and distress comprised a symptom cluster that related to quality of life and functional status of lung cancer surgery patients[J].J Clin Nurs,2013,22(9-10):1281-1290.
[8] 薄纯露.肺癌放疗患者症状群及其与自我感受负担、生活质量作用模型初步构建[D].济南:山东大学,2018.
[9] 倪圆圆.理性情绪行为疗法在非小细胞肺癌化疗患者疼痛-疲乏-睡眠障碍症状群中的应用[D].吉林:吉林大学,2017.
[10]张作记.行为医学量表手册[M].北京:中华医学电子音像出版社,2005:485-489.
[11]MENDOZA T R,WANG X S,CLEELAND C S,et al.The rapid assessment of fatigue severity in cancer patients :use of the Brief Fatigue Inventory[J].Cancer,1999,85(5):1186-1196.
[12]BUYSSE D J,REYNOLDS C F 3RD,MONK T H,et al.The Pittsburgh Sleep Quality Index:a new instrument for psychiatric practice and research[J].Psychiatry Res,1989,28(2):193-213.
[13]ZIGMOND A S,SNAITH R P.The hospital anxiety and depression scale (HADS)[J].Acta Psychiatrica Scandinavica,1983,67(6):361-370.
[14]叶维菲,徐俊冕.“综合性医院焦虑抑郁量表”在综合性医院病人中的应用与评价[J].中华行为医学与脑科学杂志,1993,2(3):17-19.
[15]刘威.晚期非小细胞肺癌患者化疗前后睡眠及生活质量变化及相互关系的研究[D].昆明:昆明医科大学,2018.
[16]张天燕,杨娟丽,张健,等.癌症患者生存质量影响因素分析[J].中华肿瘤防治杂志,2013,20(3):166-171.
[17]林双兰,周建荣,赵良辉,等.肺癌患者常见症状群及与生存质量的相关性研究[J].重庆医科大学学报,2013,38(7):683-686.
[18]陈迪,张红梅,刘纬华.肺癌患者癌因性疲乏与希望水平的相关性[J].解放军护理杂志,2017,34(19):17-20,25.
[19]钟晓莉,赵彩云,赵天霞,等.圆桌认知疗法对肺癌化疗患者焦虑和抑郁情绪的干预效果[J].解放军护理杂志,2018,35(2):30-33,38.
[20]姚静静,陈如男,刘砚燕,等.癌症适应概念及其理论的研究进展[J].解放军护理杂志,2012,29(2A):23-27.
[21]BOWER J E.Cancer-related fatigue—mechanisms,risk factors,and treatments[J].Nat Rev Clin Oncol,2014,11(10):597-609.
[22]CLEVENGER L,SCHREPF A,CHRISTENSEN D,et al.Sleep disturbance,cytokines,and fatigue in women with ovarian cancer[J].Brain Behav Immun,2012,26(7):1037-1044.
[23]范奎,代良敏,伍振峰,等.放化疗所致骨髓抑制的研究进展[J].中华中医药杂志,2017,32(1):210-214.
[24]张石革.抗肿瘤药所致不良反应的防治与合理应用原则[J].中国医院用药评价与分析,2014,114(12):1060-1063.
[25]谢铮铮,梁瑶,孙路路.抗肿瘤药物肝毒性评价及在肝功能受损患者中的剂量调整[J].中国临床药理学杂志,2016,32(23):2203-2205.
[26]杨树勤.中国医学百科全书[M].上海:上海科学技术出版社,1985:158-159.