连续性院外管理对喉癌患者术后生活质量的影响

目的 探讨连续性院外管理对喉癌患者术后生活质量的影响。 方法 选择2016年1月至2017年6月于宜宾市第二人民医院进行手术治疗的喉癌患者82例,采用分层随机化方法随机分为对照组38例和干预组44例,对照组给予常规性院外随访,干预组进行连续性院外管理,采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、成人希望特质量表(ADHS)、一般健康状况量表(SF-36)、癌症病人生活质量问卷(QLQ-C30)及癌症功能评价专用头颈量表(FACT-HN)评估患者生活质量,分析两组患者情绪、认知和生活质量的差异。 结果 出院6个月后对照组与干预组焦虑发生率分别为42.1%、15.9%,两组比较差异有统计学意义(χ2=6.933, P=0.013);对照组与干预组抑郁发生率分别为39.5%、9.1%,两组比较差异有统计学意义(χ2=10.573, P=0.001)。出院后6个月对照组与干预组SAS评分分别为(49.2±10.3)、(41.3±8.7)分,SDS评分分别为(47.4±9.2)、(40.5±7.0)分,ADHS评分分别为(27.1±7.8)、(34.7±6.9)分,两组比较差异均有统计学意义(t分别为3.77、3.85、4.68, P均<0.01)。在SF-36量表中,除一般健康状况(GH)和精力(VT)2个维度差异无统计学意义外,其余6个维度(生理机能、生理职能、躯体疼痛、社会功能、情感职能、精神健康)差异均有统计学意义,干预组高于对照组(t分别为2.31、2.54、4.15、2.66、3.59、2.59, P分别为0.02、0.01、<0.001、0.01、<0.001、0.01)。在QLQ-C30量表中,两组患者整体健康状况评分(t=2.42, P=0.02)、5个功能量表(躯体、认知、角色、情绪和社会)评分(t分别为3.06、3.95、2.27、2.23和0.01, P分别为<0.001、<0.001、0.03、0.03和0.01)和“失眠”和“食欲下降”2单项评分(t分别为2.69和2.33, P分别为0.01和0.02)差异有统计学意义。两组患者癌FACT-HN总分和3个维度(社会/家庭状况、情感状况和附加关注)差异有统计学意义(t分别为2.89、2.55、3.07和2.14, P分别为0.01、0.01、<0.001和0.04)。 结论 连续性院外管理能一定程度纠正喉癌患者心理问题,提高患者获得感和生存质量。

Effects of continuous out-of-hospital administration on the quality of life in patients with laryngeal cancer

Objective To discuss the effects of continuous out-of-hospital administration on the quality of life in patients with laryngeal cancer. Methods From January 2016 to June 2017, 82 patients with laryngeal cancer were selected from No.2 Hospital of Yibin and divided randomly into control and intervention groups using a stratified randomization method. Patients in the control and intervention groups underwent routine out-of-hospital follow-up and continuous out-of-hospital administration, respectively. Finally, the scores of the self-ranking anxiety scale(SAS), self-ranking depression scale(SDS), adult dispositional hope scale(ADHS), normal health status scale(SF-36), quality-of-life questionnaire for cancer patients(QLQ-C30), and functional assessment of cancer therapy-head and neck(FACT-HN)were evaluated and compared. Results The incidences of anxiety and depression were significantly different between the control and intervention groups(anxiety: 42.1% vs. 15.9% with χ2=6.933, P=0.013; depression: 39.5% vs. 9.1% with χ2=10.573, P=0.001). The scores of the SAS, SDS, and ADHS had significant differences in the two groups based on dependent t-tests(SAS: 49.2±10.3 vs. 41.3±8.7 with t=3.77, P<0.001; SDS: 47.4±9.2 vs. 40.5±7.0 with t=3.85, P<0.001; ADHS: 27.1±7.8 vs. 34.7±6.9 with t=4.68, P<0.001). In the SF-36 scale, besides general health and vitality, the other six dimensions including physical functioning, role-physical, bodily pain, social functioning, role-emotional, and mental health in the intervention group were significantly higher than those in the control group(t=2.31, 2.54, 4.15, 2.66, 3.59, and 2.59, respectively; P=0.02, =0.01, <0.001, =0.01, <0.001, and =0.01, respectively). In the QLQ-C30 scale, significant differences in overall health status, five functioning scales(including body, cognition, role, emotions, and social function), and two single items(including insomnia and anorexia)were observed between the two groups(overall health status: t=2.42, P=0.02; five functioning scales: t=3.06, 3.95, 2.27, 2.23, and 0.01, respectively; P<0.001, <0.001, =0.03, =0.03, and =0.01, respectively; two single items: t=2.69 and 2.33, respectively; P=0.01 and 0.02, respectively). The total scores of FACT-HN and three dimensions(including social/family status, emotional well-being, and additional attention)were significantly different between the two groups(FACT-HN scores: 110.3±12.2 vs. 118.6±13.6, t=2.89, P=0.01; three dimensions: t=2.55, 3.07, and 2.14, respectively, P=0.01, <0.01, and =0.04, respectively). Conclusion Continuous out-of-hospital administration has certain positive significance in correcting psychological problems and promotes a sense of gain and quality of life in patients with laryngeal cancer.