老年晚期肺癌化学治疗患者睡眠质量的影响因素研究

doi:10.19983/j.issn.2096-8493.20230028

摘要/Abstract

摘要：

目的: 探讨影响老年晚期肺癌化学治疗(简称“化疗”)患者睡眠质量的因素,为临床实施精准化护理提供参考。方法: 采用患者一般资料调查表、匹兹堡睡眠质量指数(pittsburgh sleep quality index,PSQI)量表、酒精使用障碍筛查量表(alcohol use disorder idenitification test,AUDIT),横断面调查2022年10月至2023年1月上海市肺科医院肿瘤科收治的住院老年晚期肺癌化疗患者145例。以PSQI≥8为睡眠障碍切点,分析睡眠质量状况及其影响因素。结果: 老年晚期肺癌化疗患者的平均PSQI得分为(8.41±3.96)分,睡眠障碍发生率为51.03%(74/145)。其中女性的 PSQI 总分($\bar{x}±s$)、主观睡眠质量($\bar{x}±s$)、入睡时间[M(Q₁,Q₃)]、睡眠时间[M(Q₁,Q₃)]、催眠药物使用[M(Q₁,Q₃)]的得分分别为(10.78±3.11)、(1.65±0.48)、1.87(1.47,2,29)、1.78(1.31,2.28)、1.09(0.83,1.39)分,明显高于男性[(7.96±2.33)(1.13±0.33)、1.30(1.26,1.33)、1.22(0.89,1.52)、0.19(0.16,0.29)分],差异均有统计学意义(t=2.673、2.555;U=2.421、2.667、2.924;P=0.013、0.012,0.022、0.013、0.007)。有吸烟史者在睡眠时间($\bar{x}±s$)、催眠药物使用($\bar{x}±s$)2个维度得分分别为(1.67±0.48)(0.93±0.29)分,明显高于无吸烟史者[(1.22±0.39)(0.17±0.05)分],差异均有统计学意义(t=2.700、2.914;P=0.008、0.006)。有酒精依赖史者催眠药物使用维度得分[M(Q₁,Q₃)]为0.10(0.06,0.12)分,低于无酒精依赖史者[0.39(0.35,0.50)分],差异有统计学意义(U=2.616,P=0.010)。白细胞计数异常的患者在 PSQI总分[M(Q₁,Q₃)]和入睡时间($\bar{x}±s$)、睡眠障碍[M(Q₁,Q₃)]得分分别为 8.60(4.36,8.73)、(1.45±0.43)、1.30(0.65,1.40)分,高于白细胞计数正常的患者[6.88(3.56,7.12)、(0.94±0.28)、1.01(0.68,1.36)分],差异均有统计学意义(U=2.267,t=2.137,U=3.531;P=0.032、0.034、0.001)。血红蛋白异常、红细胞计数异常者日间功能障碍维度得分($\bar{x}±s$)分别为(1.25±0.36)(1.12±0.28)分)均高于正常者[(0.67±0.15)(0.76±0.18)分],差异均有统计学意义(t=-3.475,-2.120,P=0.01,0.036)。谷丙转氨酶异常、直接胆红素异常者催眠药物使用维度得分[M(Q₁,Q₃)]分别为0.36(0.24,0.49)、0.40(0.26、0.51)分,均高于正常者[0.01(0.00,0.01)、0.11(0.08,0.13)分],差异均有统计学意义(U=4.425、2.198;P=0.00、0.030)。结论: 老年晚期肺癌化疗患者睡眠障碍发生率较高,临床工作中需要密切关注其性别、烟酒史、日常活动能力、血常规及肝功能指标以制订精准护理方案。

关键词: 入睡和睡眠障碍, 肺肿瘤, 因素分析,统计学

Abstract:

Objective: To explore the influencing factors of sleep quality in elderly patients with advanced lung cancer undergoing chemotherapy, and to provide references for accurate nursing. Methods: A cross-sectional survey was conducted on 145 elderly patients with advanced lung cancer undergoing chemotherapy admitted to the Oncology Department of Shanghai Pulmonary Hospital from October 2022 to January 2023, using a patient general information questionnaire and the Pittsburgh sleep quality index (PSQI) scale and the Alcohol Use Disorder Identification Test (AUIDT) scale. PSQI≥8 was defined as the cutoff point for sleep disorders, the status of sleep quality and its influencing factors were analyze. Results: The average PSQI score of elderly patients with advanced lung cancer undergoing chemotherapy was (8.41±3.96), and the incidence of sleep disorders was 51.03% (74/145). The total PSQI score ($\bar{x}±s$) of female was (10.78±3.11), and the scores of subjective sleep quality ($\bar{x}±s$), time to sleep (M(Q₁,Q₃)), sleep duration (M(Q₁,Q₃)), and usage of hypnotic drugwere (M(Q₁,Q₃)) were (1.65±0.48), (1.87 (1.47,2.29), (1.78 (1.31,2.28)), and (1.09 (0.83,1.39)), respectively, which were significantly higher than those of men ((7.96±2.33), (1.13±0.33), (1.30 (1.26,1,33)), (1.22 (0.89,1.52)), and (0.19 (0.16,0.29)), respectively), the differences were statistically significant (t=2.673, 2.555, 2.421,U=2.667, and 2.924; P=0.013, 0.012, 0.022, 0.013, and 0.007, respectively). The scores of sleeping time ($\bar{x}±s$) and hypnotic drug usage ($\bar{x}±s$) in smokers were (1.67±0.48) and (0.93±0.29), respectively, which were significantly higher than those in non-smokers ((1.22±0.39) and (0.17±0.05), respectively), the differences were statistically significant (t=2.700 and 2.914; P=0.008 and 0.006, respectively). The score of hypnotic drug use (M(Q₁,Q₃)) dimension of those who with alcohol dependence history was (0.10 (0.06,0.12), which was significantly lower than that of those who without alcohol dependence history (0.39 (0.35,0.50)), (U=2.616, P=0.010). Patients with abnormal white blood cell counts had significantly higher total PSQI score (M(Q₁,Q₃)), sleep time ($\bar{x}±s$), and sleep disorder scores (M(Q₁,Q₃) compared to patients with normal white blood cell counts ((8.60 (4.36,8.73)vs. (6.88 (3.56,7.12), U=2.267, P=0.032; (1.45±0.43) vs. (0.94±0.28), t=2.137, P=0.034; and (1.30 (0.65,1.40)) vs. (1.01 (0.68,1.36), U=3.531,P=0.001, respectively). The daytime dysfunction ($\bar{x}±s$) dimension scores of individuals with abnormal hemoglobin and red blood cell count (1.25±0.36, 1.12±0.28) were higher than those of normal individuals (0.67±0.15, 0.76±0.18), and the differences were statistically significant (t=-3.475, -2.120; P=0.01, 0.036, respectively). The dimension score of hypnotic drug usage (M(Q₁,Q₃)) of patients with abnormal glutamic transaminase and direct bilirubin was higher than that of normal patients (0.36 (0.24,0.49) vs. 0.01 (0.00,0.01), 0.40 (0.26,0.51) vs. 0.11 (0.08,0.13), and the difference was statistically significant (U=4.425, 2.198; P=0.00, 0.030, respectively). Conclusion: The incidence of sleep disorders in elderly patients with advanced lung cancer undergoing chemotherapy is relatively high. In clinic, gender, smoking and alcohol history, daily activity ability, blood routine, and liver function indicators should be pay close attention to develop precise nursing plans.

Key words: Sleep initiation and maintenance disorders, Lung neoplasms, Factor analysis, statistical

中图分类号:

R473.73

樊盼玉, 李玉梅, 杨磊, 樊嘉欣. 老年晚期肺癌化学治疗患者睡眠质量的影响因素研究[J]. 结核与肺部疾病杂志, 2023, 4(3): 210-215. doi: 10.19983/j.issn.2096-8493.20230028

Fan Panyu, Li Yumei, Yang Lei, Fan Jiaxin. Study on influencing factors of sleep quality in elderly patients with advanced lung cancer undergoing chemotherapy[J]. Journal of Tuberculosis and Lung Disease, 2023, 4(3): 210-215. doi: 10.19983/j.issn.2096-8493.20230028

图/表 2

表1

表2

生化指标正常和异常者匹兹堡睡眠质量指数得分的比较 (分)

血生化指标	主观睡眠质量 ($bar{x}±s$) [M(Q₁,Q₃)]	入睡时间 ($bar{x}±s$) [M(Q₁,Q₃)]	睡眠时间 ($bar{x}±s$) [M(Q₁,Q₃)]	睡眠效率 ($bar{x}±s$)	睡眠障碍 ($bar{x}±s$) [M(Q₁,Q₃)]	催眠药物使用 [M(Q₁,Q₃)]/ ($bar{x}±s$)	日间功能障碍 ($bar{x}±s$)	匹兹堡睡眠质量指数总分 [M(Q₁,Q₃)]/ ($bar{x}±s$)
血红蛋白
正常	1.14±0.36	1.38±0.21	1.30±0.25	1.89±0.43	1.27±0.39	0.23 (0.14,0.28)	0.67±0.15	8.07 (5.22,10.34)
异常	1.34±0.23	1.42±0.33	1.32±0.43	2.11±0.57	1.36±0.38	0.39 (0.23,0.48)	1.25±0.36	9.00 (5.78,11.54)
统计检验值	t=-1.260	t=-0.219	t=0.093	t=-1.318	t=-1.026	U=1.148	t=-3.475	U=-1.468
P值	0.210	0.827	0.926	0.189	0.307	0.253	0.001	0.145
红细胞计数
正常	1.20 (0.65,1.30)	1.30 (0.69,1.31)	1.22±0.36	1.94±0.51	1.27±0.39	0.16±0.02	0.76±0.18	8.40±1.33
异常	1.20 (0.77,1.54)	1.44 (0.87,1.72)	1.36±0.26	2.04±0.53	1.36±0.39	0.42±0.12	1.12±0.28	8.41±2.19
统计检验值	U=0.141	U=0.936	t=0.951	t=-0.602	t=-1.007	t=1.918	t=-2.120	t=0.017
P值	0.888	0.351	0.343	0.548	0.316	0.057	0.036	0.987
白细胞计数
正常	1.10 (0.57,1.12)	0.94±0.28	1.13±0.24	1.81±0.39	1.01 (0.68,1.36)	0.01 (0.00,0.01)	0.81±0.21	6.88 (3.56,7.12)
异常	1.20 (0.63,1.26)	1.45±0.43	1.33±0.32	1.99±0.61	1.30 (0.65,1.40)	0.37 (0.23,0.46)	0.89±0.23	8.60 (4.36,8.73)
统计检验值	U=0.568	t=2.137	t=0.947	t=0.692	U=3.531	U=4.437	t=0.300	U=2.267
P值	0.575	0.034	0.345	0.490	0.001	0.000	0.765	0.032
血小板计数
正常	1.04±0.33	1.28 (0.63,1.24)	1.29±0.33	1.96±0.35	1.00 (0.56,1.11)	0.32±0.09	0.87±0.29	8.12 (4.08,8.15)
异常	1.25±0.24	1.42 (0.75,1.48)	1.40±0.42	1.98±0.49	1.31 (0.73,1.45)	0.40±0.05	0.96±0.22	8.47 (4.66,9.31)
统计检验值	t=1.045	U=0.799	t=-0.593	t=0.069	U=2.937	t=-0.417	t=-0.428	U=0.471
P值	0.298	0.429	0.554	0.945	0.005	0.677	0.669	0.640
谷丙转氨酶
正常	1.21±0.22	1.36±0.22	1.28±0.22	1.94±0.48	1.27±0.39	0.01 (0.00,0.01)	0.84±0.28	8.34±1.98
异常	1.27±0.11	1.40±0.42	1.64±0.32	2.36±0.62	1.31±0.37	0.36 (0.24,0.49)	1.36±0.33	9.27±2.88
统计检验值	t=-0.222	t=0.111	t=-1.360	t=-1.384	t=0.215	U=4.425	t=-1.687	t=-0.769
P值	0.825	0.912	0.176	0.169	0.830	0.000	0.094	0.457
直接胆红素
正常	1.20 (0.64,1.27)	1.31±0.27	1.20 (0.68,1.36)	1.91±0.57	1.29±0.30	0.11 (0.08,0.13)	0.87±0.21	8.00±1.13
异常	1.20 (0.76,1.50)	1.42±0.35	1.30 (0.71,1.43)	1.99±0.31	1.31±0.36	0.40 (0.26,0.51)	0.91±0.25	8.54±2.41
统计检验值	U=0.115	t=0.584	U=0.485	t=0.402	t=0.245	U=2.198	t=-0.216	t=0.696
P值	0.909	0.560	0.629	0.688	0.807	0.030	0.830	0.488

表2

参考文献 10

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临床特征	主观睡眠质量 ($\bar{x}±s$)	入睡时间 [M(Q₁,Q₃)]/ ($\bar{x}±s$)	睡眠时间 [M(Q₁,Q₃)]/ ($\bar{x}±s$)	睡眠效率 ($\bar{x}±s$)	睡眠障碍 ($\bar{x}±s$)	催眠药物使用 [M(Q₁,Q₃)]/ ($\bar{x}±s$)	日间功能障碍 ($\bar{x}±s$)/ [M(Q₁,Q₃)]	匹兹堡睡眠质量指数总分 ($\bar{x}±s$)/ [M(Q₁,Q₃)]
性别
男性	1.13±0.33	1.30 (1.26,1.33)	1.22 (0.89,1.52)	1.95±0.46	1.29±0.27	0.19 (0.16,0.29)	0.88±0.28	7.96±2.33
女性	1.65±0.48	1.87 (1.47,2.29)	1.78 (1.31,2.28)	2.09±0.58	1.39±0.38	1.09 (0.83,1.39)	0.91±0.24	10.78±3.11
统计检验值	t=2.555	U=2.421	U=2.667	t=0.611	t=0.936	U=2.924	t=0.159	t=2.673
P值	0.012	0.022	0.013	0.542	0.351	0.007	0.874	0.013
吸烟史
无	1.14±0.28	1.31 (1.24,1.89)	1.22±0.39	1.95±0.56	1.30±0.28	0.17±0.05	0.87 (0.47,0.92)	7.96 (4.38,8.76)
有	1.50±0.31	1.70 (1.53,2.49)	1.67±0.48	2.07±0.35	1.33±0.35	0.93±0.29	0.93 (0.64,1.20)	10.10 (6.65,12.30)
统计检验值	t=1.944	U=1.786	t=2.700	t=0.591	t=0.374	t=2.914	U=0.313	U=2.37
P值	0.054	0.085	0.008	0.555	0.709	0.006	0.754	0.023
酒精依赖史
无	1.19±0.31	1.38±0.33	1.28±0.31	1.97±0.56	1.28±0.29	0.39 (0.35,0.50)	0.86±0.21	8.38±1.97
有	1.31±0.33	1.45±0.37	1.41±0.21	2.01±0.47	1.38±0.39	0.10 (0.06,0.12)	0.89±0.22	8.52±2.01
统计检验值	t=-0.634	t=-0.362	t=-0.750	t=-0.169	t=-0.931	U=2.616	t=0.125	t=-0.167
P值	0.527	0.718	0.455	0.866	0.354	0.010	0.900	0.868

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