食管癌病人术后 3个月的症状群及相关因素研究

目的 探讨食管癌病人术后3个月所经历的症状群,并分析症状群与生活质量的相关性.方法 选取2017年6月至2019年2月在南通大学附属如皋医院胸外科手术的食管癌病人102例纳入研究.采用人口统计学和疾病特征问卷、中文版安德森症状评估量表(MDASI)、癌症治疗功能评价量表(FACT-G)、中文版心理弹性量表(CD-RISC)评估病人术后3个月症状发生情况和生活质量.采用探索性因子分析提取症状群;采用logistic回归和Pearson相关分析确定病人症状群预测因素及其与生活质量的关系.结果 有2例中途退出,最终共有100例病人全程参与.术后3个月病人最常见的四种症状是疲劳(63.0％),反流(51.0％),睡眠不安(47.0％)和食欲不振(45.0％),病人四大严重症状分别是疲劳(4.97±3.18)分,食欲不振(4.19±2.67)分,睡眠不安(4.08±2.75)分和反流(3.72±3.07)分.由此确定了4个症状群:吞咽困难-心理,放化疗不良反应,消化道重建和疲劳-睡眠.性别、食管癌分期和心理弹性水平是影响吞咽困难-心理症状群的重要因素(均P<0.05).性别、食管癌分期、心理弹性水平和手术+术后辅助放化疗是影响放化疗不良反应和疲劳-睡眠症状群的重要因素(均P<0.05).性别、食管癌分期、心理弹性水平和吻合位置是影响消化道重建症状群的重要因素(均P<0.05).前述4个症状群与生活质量之间具有显著的相关性(r=-0.499、-0.436、-0.311、-0.379,均P<0.05),其中吞咽困难-心理症状群相关性最大(r=-0.499,P<0.001).结论 应关注食管癌病人术后3个月的4个症状群:吞咽困难-心理,放化疗不良反应,消化道重建和疲劳-睡眠,在术后3个月应重视食管癌病人的症状管理.根据影响因素,包括性别,食管癌分期,心理弹性水平,手术或手术+术后辅助放化疗和吻合位置,实施个体化干预.

Symptom groups and related factors in patients with esophageal cancer at 3 months after operation

Objective To explore symptom clusters experienced by patients with esophageal cancer 3 months after surgery and toexamine whether symptom clusters are related to demographic, clinical and quality of life variables.Methods A convenience sampleof 102 esophageal cancer patients were were enrolled in the study, who underwent thoracic surgery in Rugao Hospital Affiliated to Nan.tong University between June 2017 and February 2019. Participants completed the demographic questionnaire, the M. D. AndersonSymptom Inventory (MDASI), the Functional Assessment of Cancer Therapy.General (FACT-G) and the Connor.Davidson Resilience Scale (CD-RISC) to evaluate the occurrence of symptom clusters and quality of life three months after surgery. Exploratory factor analy.sis was performed to extract symptom clusters, and stepwise regression and Pearson correlation analysis were applied to determine thepredictive factors for symptom clusters and their association with quality of life.Results There were 2 cases lost to follow-up. In total100 patients participated in the study. The four most common symptoms of patients at 3 months after surgery were fatigue (63.0%), re.gurgitation (51.0%), disturbed sleep (47.0%) and loss of appetite (45.0%). The most serious symptoms of the patients were fatigue(4.97±3.18) points], loss of appetite (4.19±2.67) points], disturbed sleep (4.08±2.75) points] and regurgitation (3.72±3.07) points].Therefore, four symptom clusters were identified: dysphagia-psychology, chemoradiotherapy side.effects, digestive tract reconstruction and fatigue-sleep. Gender, esophageal cancer staging and psychological resilience were important factors affecting the dysphagia-psy. chological symptom group (all P<0.05). Gender, esophageal cancer staging, psychological resilience and surgery plus postoperative ad.juvant radiotherapy and chemotherapy were important factors affecting adverse reactions to radiotherapy and chemotherapy and fatigue-sleep symptom groups (all P<0.05). Gender, esophageal cancer staging, psychological resilience and anastomosis position were impor. tant factors affecting the symptom group of digestive tract reconstruction (all P<0.05). There was a significant correlation between the 4 symptom groups and quality of life (r=.0.499, .0.436, .0.311, .0.379, respectively; all P<0.05), among which the correlation between dysphagia-psychological symptom group and quality of life was the closest (r=.0.499, P<0.001).Conclusions Nurses should pay moreattention to symptom management in esophageal cancer patients 3 months after surgery by focusing on four symptom clusters, includingdysphagia-psychology, side effects of radiotherapy and chemotherapy, digestive tract reconstruction and fatigue-sleep. It is necessary toimplement individualized nursing program depending on the influence factors including gender, stage of disease, psychological resil.ience, surgery plus postoperative adjuvant radiotherapy and chemotherapy and anastomotic position.