中老年结直肠癌永久性造口患者心理痛苦现状及影响因素分析

目的 探讨行永久性造口的中老年结直肠癌患者心理痛苦现状，进一步分析其影响因素。 方法 选取我院收治的行永久性结肠造口的中老年结直肠癌患者560例，记录患者临床资料，采用心理痛苦温度计(distress thermometer,DT)和心理痛苦相关调查表(problem list,PL)评估心理痛苦程度，采用多元线性回归分析永久性结肠造口中老年结直肠癌患者心理痛苦的影响因素。 结果 560例中老年结直肠癌永久性造口患者，DT评分为（6.12±2.06）分，为中重度痛苦，心理痛苦症状阳性率为52.3%；PL量表评分中，交往问题得分(1.72±0.36)分最高，其次为身体问题(1.50±0.32)分，宗教/信仰问题得分(1.03±0.25)分最低；单因素分析结果显示，不同年龄组、文化程度、造口时间、医疗费用支付手段、家庭人均月收入、造口自我护理程度及是否合并抑郁、疼痛、睡眠障碍、造口并发症患者DT评分比较差异有统计学意义（P＜0.05），不同性别、婚姻状况、造口每日护理时间患者DT评分比较差异无统计学意义（P＞0.05）；多元线性回归分析结果显示，年龄（β=-3.122,P=0.006）、抑郁（β=2.380,P＜0.001）、睡眠障碍（β=1.189,P=0.012）、合并疼痛（β=2.676,P＜0.001）、造口并发症（β=3.352,P＜0.001）、家庭人均月收入（β=-2.067,P＜0.001）是心理痛苦的影响因素。 结论 老年结直肠癌永久性造口患者心理痛苦程度为中重度，其发生与家庭人均月收入、年龄、心理状况、睡眠状况及是否合并疼痛、造口并发症有关。

Current status and influencing factors of psychological distress in middle-aged and elderly patients with colorectal cancer undergoing permanent stoma

Objective To explore the current status of psychological distress in middle-aged and elderly patients with colorectal cancer(CRC) undergoing permanent stoma, and to further analyze its influencing factors.Methods A total of 560 middle-aged and elderly CRC patients undergoing permanent stoma who were diagnosed and treated in our hospital were enrolled in this study. Clinical data of patients were recorded. Distress thermometer(DT) and problem list(PL) were used to assess the degree of psychological distress. Multivariate linear regression was used to analyze the influencing factors of psychological distress in middle-aged and elderly CRC patients undergoing permanent stoma.Results A total of 560 middle-aged and elderly patients with permanent stoma of CRC had a DT score of（6.12±2.06), which was moderate to severe pain, and the positive rate of psychological pain symptoms was 52.3%. In the PL scale score, the score of communication problems (1.72±0.36) was the highest, followed by the score of physical problems(1.50±0.32), and religion/belief problems(1.03±0.25). Univariate analysis results showed that DT scores were different in patients with respect to different age groups, education level, time of stoma, means of payment for medical expenses, monthly household income, self-care degree of stoma, and presence or absence of depression, pain, sleep disorders, and stoma complications（P＜0.05). There was no significant difference in DT scores in patients of different genders, marital status, and daily nursing time for stoma（P＞0.05). The multiple linear regression analysis showed that age（β=-3.122, P=0.006), depression（β=2.380, P＜0.001), sleep disorders（β=1.189, P=0.012), combined pain（β=2.676, P＜0.001), ostomy complications（β=3.352, P＜0.001), family monthly income per capita（β=-2.067, P＜0.001) were the influencing factors of psychological distress.Conclusion The degree of psychological distress in elderly CRC patients undergoing permanent stoma is moderate to severe, and its occurrence is associated with the family's average monthly income, age, psychological status, sleep status, and presence of pain and stoma complications.