肺癌合并肺结核患者预感性悲伤影响因素分析

doi:10.19983/j.issn.2096-8493.20220053

摘要/Abstract

摘要：

目的:调查肺癌合并肺结核患者预感性悲伤现状,探究其影响因素。方法:选择武汉市肺科医院2020年6月1日至2021年12月31日收治的确诊为肺癌合并肺结核的88例患者作为研究对象。采用一般情况调查表、预感性悲伤量表、社会支持评定量表、医院焦虑抑郁量表及癌症治疗功能评价量表(中文版)对患者进行评估,对相关影响因素进行统计分析。结果:患者预感性悲伤量表总分为(58.27±6.45)分,社会支持评定量表、医院焦虑抑郁量表及癌症治疗功能评价量表(中文版)评分分别为(36.85±8.41)分、(10.22±5.78)分和(50.18±4.28)分。Pearson相关性分析显示,患者社会支持评定量表各维度(主观支持、客观支持、支持利用)得分[(17.76±4.85)分、(9.12±2.34)分、(8.68±1.22)分]及总分[(36.85±8.41)分]、癌症治疗功能评价量表(中文版)总分[(50.18±4.28)分]与预感性悲伤量表总分[(58.27±6.45)分]呈负相关(r=-0.435,P<0.001;r=-0.398,P=0.008;r=-0.520,P<0.001;r=-0.484,P<0.001;r=-0.476,P<0.001),医院焦虑抑郁量表总分[(10.22±5.78)分]与预感性悲伤量表总分[(58.27±6.45)分]呈正相关(r=0.590,P<0.001)。多元线性回归分析结果显示,文化程度在大专及以下、社会支持评定量表<(36.85±8.41)分、医院焦虑抑郁量表>(10.22±5.78)分、癌症治疗功能评价量表(中文版)<(50.18±4.28)分是发生预感性悲伤的主要因素(t=3.043,P=0.032;t=3.844,P=0.010;t=4.843,P=0.004;t=3.754,P=0.012)。结论:肺癌合并肺结核患者预感性悲伤处于中等以上水平,临床护理应对文化程度和社会支持度较低、焦虑抑郁情绪较重的患者提供心理干预,以减少预感性悲伤的出现。

关键词: 结核,肺, 肿瘤, 共病现象, 悲痛, 因素分析,统计学

Abstract:

Objective: To investigate the status of premonitory sadness in lung cancer patients complicated with pulmonary tuberculosis, and the influencing factors. Methods: A total of 88 lung cancer patients complicated with pulmonary tuberculosis admitted to Wuhan Pulmonary Hospital from June 1, 2020 to December 31, 2021 were selected as the subjects. The patients were evaluated by general condition questionnaire, the preparatory grief in advanced cancer patients (PGAC), social support rating scale (SSRS), and hospital anxiety and depression scale (HADS) and functional assessment of cancer therapy (Chinese version)(FACT-G), the relevant influencing factors were analyzed. Results: The total PGAC score was (58.27±6.45), SSRS score, HADS score and FACT-G score were (36.85±8.41), (10.22±5.78) and (50.18±4.28), respectively. Pearson correlation analysis showed that scores of social support (dimensions: 17.76±4.85, 9.12±2.34, 8.68±1.22; total score: 36.85±8.41, respectively) and quality of life (50.18±4.28) were significantly negatively correlated with total score (58.27±6.45) of PGAC dimensions (r=-0.435, P<0.001; r=-0.398, P=0.008; r=-0.520, P<0.001; r=-0.484, P<0.001; r=-0.476, P<0.001), and scores of anxiety and depression were significantly positively correlated with scores of PGAC and total scores of PGAC dimensions (r=0.590, P<0.001). Multiple linear regression analysis showed that educational level (junior college or below), social support (<36.85±8.41), anxiety and depression (>10.22±5.78), and quality of life (<50.18±4.28) were the main influencing factors of premonitory sadness (t=3.043, P=0.032; t=3.844, P=0.010; t=4.843, P=0.004; t=3.754, P=0.012). Conclusion: The premonitory sadness of lung cancer patients complicated with pulmonary tuberculosis is above medium level. Clinical nursing should provide psychological intervention to patients with low educational level and social support and heavy anxiety and depression, so as to reduce the occurrence of premonitory sadness.

Key words: Tuberculosis,pulmonary, Neoplasms, Comorbidity, Grief, Factor analysis,statistical

中图分类号:

R473.73
R521

龚道敏, 朱凌, 田甜, 钟浈. 肺癌合并肺结核患者预感性悲伤影响因素分析[J]. 结核与肺部疾病杂志, 2022, 3(3): 193-197. doi: 10.19983/j.issn.2096-8493.20220053

GONG Dao-min, ZHU Ling, TIAN Tian, ZHONG Zhen. Analysis of influencing factors of premonitory sadness in lung cancer patients complicated with pulmonary tuberculosis[J]. Journal of Tuberculosis and Lung Disease, 2022, 3(3): 193-197. doi: 10.19983/j.issn.2096-8493.20220053

图/表 4

表1

表2

不同特征患者PGAC得分情况

因素	例数(构成比,%)	PGAC总分( $x ¯$ ±s)	t值	P值
性别			0.165	0.871
男性	46(52.3)	57.78±7.40
女性	42(47.7)	59.01±6.34
年龄组(岁)			2.289	0.032
<60	49(55.7)	56.18±8.44
≥60	39(44.3)	60.94±5.14
婚姻状况			1.563	0.126
已婚	77(87.5)	57.02±5.78
其他^a	11(12.5)	59.47±4.96
经济状况(元/月)			0.748	0.126
<10000	38(43.2)	59.89±5.14
>10000	50(56.8)	57.60±4.64
文化水平			2.895	0.012
大专以下	52(59.1)	60.62±4.85
大专及以上	36(40.9)	55.34±5.20
工作状况			0.374	0.709
在职	59(67.0)	57.68±5.24
其他^b	29(33.0)	59.88±5.62
基础疾病			1.400	0.166
有	30(34.1)	58.76±4.23
无	58(65.9)	56.46±5.16

表2

表3

表4

影响PGAC的多元线性回归分析

因素	B值	s $x ¯$ 值	β值	t值	P值
常数项	40.16	6.836	-	19.530	<0.001
年龄	4.942	2.874	0.156	2.644	0.067
文化程度	-5.532	3.456	-0.235	3.043	0.032
SSRS评分	-4.398	0.263	-0.241	3.844	0.010
HADS评分	5.506	1.453	0.128	4.843	0.004
FACT-G评分	-4.052	1.133	-0.337	3.754	0.012

表4

参考文献 16

[1]	李娜苗, 范亚莉, 赵瑞婧,等. 中国人群肺癌合并肺结核与单纯肺结核临床及影像学特征Meta分析. 安徽医药, 2020, 24(7):1278-1282. doi: 10.3969/j.issn.1009-6469.2020.07.002. doi: 10.3969/j.issn.1009-6469.2020.07.002
[2]	汪训豪, 申磊, 戴希勇. 肺癌合并肺结核52例外科治疗临床分析. 临床外科杂志, 2020, 28(7):647-649. doi: 10.3969/j.issn.1005-6483.2020.07.014. doi: 10.3969/j.issn.1005-6483.2020.07.014
[3]	蔡振颖, 王超, 朱亮,等. 贞芪扶正颗粒联合化疗治疗肺结核合并肺癌疗效观察. 现代中西医结合杂志, 2017, 26(36):4066-4069. doi: 10.3969/j.issn.1008-8849.2017.36.025. doi: 10.3969/j.issn.1008-8849.2017.36.025
[4]	高春燕. 力克肺疾、利福喷丁及莫西沙星联合治疗老年肺癌合并肺结核临床疗效及对患者生活质量评估量表评分与不良反应的影响. 陕西医学杂志, 2021, 50(10):1282-1284. doi: 10.3969/j.issn.1000-7377.2021.10.027. doi: 10.3969/j.issn.1000-7377.2021.10.027
[5]	陈海霞, 裴菊红, 南锐伶,等. 晚期胃癌患者预感性悲伤现状及其影响因素. 解放军护理杂志, 2021, 38(9):11-15. doi: 10.3969/j.issn.1008-9993.2021.09.003. doi: 10.3969/j.issn.1008-9993.2021.09.003
[6]	武妍, 赵国艳, 王艺. 局部宫颈癌晚期患者预感性悲伤与心理控制源相关性研究. 护理学报, 2019, 26(23):71-74. doi: 10.16460/j.issn1008-9969.2019.23.071. doi: 10.16460/j.issn1008-9969.2019.23.071
[7]	陈海霞, 裴菊红, 南锐伶,等. 预感性悲伤在晚期癌症患者中的研究进展. 现代肿瘤医学, 2022, 30(1):162-166. doi: 10.3969/j.issn.1672-4992.2022.01.036. doi: 10.3969/j.issn.1672-4992.2022.01.036
[8]	刘小利, 刘涛. 新版《肺结核诊断标准》解读. 中华灾害救援医学, 2018, 6(4):181-183. doi: 10.13919/j.issn.2095-6274.2018.04.001. doi: 10.13919/j.issn.2095-6274.2018.04.001
[9]	叶盈, 辛大君, 鲜莉,等. 晚期癌症患者预感性悲伤评估量表汉化及信效度评价. 西南医科大学学报, 2018, 41(3):268-272,276. doi: 10.3969/j.issn.2096-3351.2018.03.018. doi: 10.3969/j.issn.2096-3351.2018.03.018
[10]	肖水源. 《社会支持评定量表》的理论基础与研究应用. 临床精神医学杂志, 1994 (2): 98-100.
[11]	孙振晓, 刘化学, 焦林瑛,等. 医院焦虑抑郁量表的信度及效度研究. 中华临床医师杂志(电子版), 2017, 11(2):198-201. doi: 10.3877/cma.j.issn.1674-0785.2017.02.005. doi: 10.3877/cma.j.issn.1674-0785.2017.02.005
[12]	万崇华, 孟琼, 汤学良,等. 癌症患者生命质量测定量表FACT-G中文版评介. 实用肿瘤杂志, 2006, 21(1):77-80. doi: 10.3969/j.issn.1001-1692.2006.01.027. doi: 10.3969/j.issn.1001-1692.2006.01.027
[13]	郑小燕, 万春疆. 肺结核合并肺癌患者的临床特点及影响预后的相关因素分析. 实用癌症杂志, 2017, 32(4):590-592. doi: 10.3969/j.issn.1001-5930.2017.04.020. doi: 10.3969/j.issn.1001-5930.2017.04.020
[14]	Mystakidou K, Tsilika E, Parpa E, et al. Screening for preparatory grief in advanced cancer patients. Cancer Nurs, 2008, 31(4):326-332. doi: 10.1097/01.NCC.0000305749.50991.b1. doi: 10.1097/01.NCC.0000305749.50991.b1 pmid: 18600121
[15]	吴秋平, 徐栋, 吕超然,等. 乳腺癌患者术后焦虑、抑郁对生命质量的影响及社会支持的中介作用. 重庆医学, 2022, 51(2):326-330. doi: 10.3969/j.issn.1671-8348.2022.02.030. doi: 10.3969/j.issn.1671-8348.2022.02.030
[16]	丁晓芸, 刘华华, 冯威. 肺癌化疗患者焦虑和抑郁情绪管理的研究进展. 国际护理学杂志, 2021, 40(1):182-187. doi: 10.3760/cma.j.cn221370-20191106-00056. doi: 10.3760/cma.j.cn221370-20191106-00056

因素	自我意识		疾病调整		悲伤		愤怒		宗教安慰		总分
因素	r值	P值	r值	P值	r值	P值	r值	P值	r值	P值	r值	P值
主观支持	-0.337	0.007	-0.358	0.001	-0.291	0.019	-0.370	0.003	-0.365	0.005	-0.435	<0.001
客观支持	-0.365	0.015	-0.345	0.023	-0.388	0.020	-0.239	0.403	-0.423	0.005	-0.398	0.008
支持利用	-0.381	0.003	-0.373	0.012	-0.291	0.057	-0.409	0.002	-0.259	0.042	-0.520	<0.001
SSRS总分	-0.407	0.002	-0.364	0.005	-0.342	0.008	-0.427	<0.001	-0.395	0.003	-0.484	<0.001
HADS	0.435	0.003	0.357	0.020	0.621	<0.001	0.474	0.016	0.540	<0.001	0.590	<0.001
FACT-G	-0.264	0.034	-0.562	<0.001	-0.425	<0.001	-0.304	0.014	-0.288	0.028	-0.476	<0.001