非小细胞肺癌患者术后睡眠质量及影响因素分析

doi:10.19983/j.issn.2096-8493.20230027

摘要/Abstract

摘要：

目的: 分析非小细胞肺癌患者术后1个月的睡眠质量状况及相关影响因素。方法: 采用便利抽样法对2022年1—2月在上海市肺科医院胸外科行胸腔镜肺癌根治手术后复查的163例非小细胞肺癌患者进行问卷调查(包括一般资料问卷及匹兹堡睡眠质量指数量表),收集问卷数据,使用单因素及多因素logistic回归模型分析患者睡眠质量的影响因素。结果: 剔除不符合要求的8份问卷,最终纳入155例患者作为研究对象。155例患者术后1个月内睡眠质量得分[中位数(四分位数)]为8.00(5.00,12.00)分,睡眠障碍发生率为56.8%(88例),以夜间咳嗽频率≥3次/周[44.5%(69例)]和夜间易醒≥3次/周[40.0%(62例)]为主要形式。多因素logistic回归分析显示:女性、疼痛和留置胸管时间>7d的患者更易发生术后睡眠障碍[OR(95%CI)分别为2.786(1.201~6.460)、4.731(1.881~11.898)、4.855(1.010~23.348),P值分别为0.017、0.001、0.049],而行肺段切除术的患者睡眠质量更好[OR(95%CI)=0.305(0.101~0.922),P=0.035]。结论: 非小细胞肺癌患者术后1个月内的睡眠质量较差,中老年女性患者、行肺叶切除术、留置胸管时间>7d、存在疼痛症状的患者睡眠质量更差,需给予高度关注。结合患者人口学特征及症状群制定个性化护理措施及健康教育方案,可降低术后睡眠障碍发生率和改善患者预后。

关键词: 癌,非小细胞肺, 手术后医护, 肺外科手术, 睡眠障碍, 疾病影响状态调查

Abstract:

Objective: To analyze the sleep quality status and influencing factors of non-small-cell lung cancer (NSCLC) patients within one month postoperative. Methods: The convenience sampling method was used for survey questionnaire (including general information questionnaire and Pittsburgh Sleep Quality Index (PSQI)) in 163 NSCLC patients who underwent thoracoscopic surgery from the Department of Thoracic Surgery of Shanghai Pulmonary Hospital, from January to February 2022. Univariate and multivariate logistic regressions were used to analyze the influencing factors of sleep quality in postoperative patients with NSCLC. Results: Excluding 8 questionnaires that did not meet the inclusion criteria, 155 patients were finally included as the study subjects in the analysis. The results revealed that the score (M(Q₁,Q₃)) of sleep quality was 8.00 (5.00, 12.00). The prevalence of sleep disturbances was 56.8% (88/155), mainly included frequent nighttime cough (>3 episodes per week)(44.5% (69/155)) and frequent nighttime awakeners (>3 episodes per week)(40.0% (62/155)). Multivariate logistic regression analysis revealed that female, postoperative pain, >7d retention of chest tube were more susceptible to cause sleep disturbance during the postoperative period (OR (95%CI)=2.786 (1.201-6.460), 4.731 (1.881-11.898), and 4.855 (1.010-23.348); P=0.017, 0.001 and 0.049, respectively). Lung segmentectomy appeared to be a protective factor associated with better sleep quality (OR (95%CI)=0.305 (0.101-0.922), P=0.035). Conclusion: Poor sleep quality was prevalent among participants with NSCLC patients within 1 month after surgery. Patients of middle-aged and older female received lobectomy, with >7d retention of chest tube, and suffered postoperative pain had poorer sleep quality, and they should be paid more attention. Individualized nursing measures and health education programs based on patients’ demography characteristics and symptom groups could reduce the incidence of postoperative sleep disorders and improve the prognosis of NSCLC patients.

Key words: Carcinoma, non-small-cell lung, Postoperative care, Pulmonary surgical procedures, Sleep disorders, Sickness impact profile

中图分类号:

R473.73

谌欣欣, 李玉梅, 杨英姿, 胡亚晨, 樊嘉欣. 非小细胞肺癌患者术后睡眠质量及影响因素分析[J]. 结核与肺部疾病杂志, 2023, 4(3): 203-209. doi: 10.19983/j.issn.2096-8493.20230027

Chen Xinxin, Li Yumei, Yang Yingzi, Hu Yachen, Fan Jiaxin. Analysis of postoperative sleep quality and influencing factors in patients with non-small cell lung cancer[J]. Journal of Tuberculosis and Lung Disease, 2023, 4(3): 203-209. doi: 10.19983/j.issn.2096-8493.20230027

图/表 4

表1

表2

表3

表4

非小细胞肺癌患者术后睡眠质量影响因素的多因素logistic回归分析

自变量	β值	s $x ˉ$ 值	Wald χ²值	OR (95%CI)值	P值
年龄(岁)
0~44				1.000
45~64	0.933	0.534	3.049	2.541(0.892~7.237)	0.081
≥65	-0.083	0.706	0.014	0.920(0.231~3.670)	0.906
女性	1.024	0.429	5.698	2.786(1.201~6.460)	0.017
文化程度
小学及以上				1.000
初中	-0.119	0.732	0.026	0.888(0.211~3.729)	0.871
高中/中专	-1.067	0.729	2.139	0.344(0.082~1.437)	0.144
大专及以上	-1.053	0.752	1.964	0.349(0.080~1.522)	0.161
油烟接触史
无				1.000
二手烟	0.882	0.544	2.628	2.415(0.832~7.010)	0.105
环境油烟	0.919	0.594	2.389	2.506(0.782~8.034)	0.122
手术方式
肺叶切除术				1.000
肺段切除术	-1.187	0.564	4.427	0.305(0.101~0.922)	0.035
其他	-0.243	0.496	0.240	0.784(0.297~2.072)	0.624
留置胸管时间>7d	1.580	0.801	3.888	4.855(1.010~23.348)	0.049
疼痛	1.554	0.471	10.906	4.731(1.881~11.898)	0.001
咳嗽	0.264	0.516	0.263	1.303(0.474~3.579)	0.608

表4

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维度	PSQI得分分布[例(构成比,%)]				PSQI得分 [分,M(Q₁,Q₃)]
维度	0分	1分	2分	3分	PSQI得分 [分,M(Q₁,Q₃)]
主观睡眠质量	23(14.8)	75(48.4)	46(29.7)	11(7.1)	1.00(1.00,2.00)
入睡时间	22(14.2)	54(34.8)	41(26.5)	38(24.5)	2.00(1.00,2.00)
睡眠时间	57(36.8)	35(22.6)	45(29.0)	18(11.6)	1.00(0.00,2.00)
睡眠效率	43(27.7)	36(23.3)	33(21.3)	43(27.7)	1.00(0.00,3.00)
睡眠障碍	4(2.6)	65(41.9)	66(42.6)	20(12.9)	2.00(1.00,2.00)
催眠药物	136(87.7)	3(2.0)	5(3.2)	11(7.1)	0.00(0.00,0.00)
日间功能障碍	28(18.1)	50(32.3)	49(31.5)	28(18.1)	1.00(1.00,2.00)

项目	非睡眠障碍组(67例)		睡眠障碍组(88例)		χ²值	P值
项目	例数	构成比/发生率(%)	例数	构成比/发生率(%)	χ²值	P值
年龄组(岁)					6.228	0.044
0~44	22	32.8	15	17.0
45~64	26	38.8	49	55.7
≥65	19	28.4	24	27.3
性别					6.575	0.010
男性	35	52.2	28	31.8
女性	32	47.8	60	68.2
体质量指数^a	23.98±3.14		23.46±2.92		t=1.053	0.294
文化程度					9.000	0.029
小学及以下	8	11.9	17	19.3
初中	11	16.4	28	31.8
高中/中专	18	26.9	20	22.7
大专及以上	30	44.8	23	26.1
家族史	16	23.9	19	21.6	0.114	0.736
合并症
慢性阻塞性肺疾病	2	3.0	10	11.4	3.739	0.053
糖尿病	8	11.9	7	8.0	0.691	0.406
高血压	23	34.3	24	27.3	0.896	0.344
吸烟史	24	35.8	24	27.3	1.300	0.254
油烟接触史					9.274	0.010
二手烟	30	44.8	39	44.3
环境油烟史	16	23.9	37	42.1
手术方式					7.416	0.025
肺叶切除术	36	53.7	60	68.2
肺段切除术	18	26.9	9	10.2
其他	13	19.4	19	21.6
留置胸管时间(d)					4.355	0.037
≤7	64	95.5	75	85.2
>7	3	4.5	13	14.8
疼痛	35	52.2	72	81.8	15.568	0.001
咳嗽	49	73.1	77	87.5	5.161	0.023

编码	变量	赋值
Y	睡眠障碍	无=0,有=1
X₁	年龄	0~44岁=1,45~64岁=2,≥65岁=3
X₂	性别	男性=1,女性=2
X₃	文化程度	小学及以下=1,初中=2,高中/中专=3,大专及以上=4
X₄	油烟接触史	无=1,二手烟=2,环境油烟=3
X₅	手术方式	肺叶切除术=1,肺段切除术=2,其他=3
X₆	留置胸管时间	≤7d=1,>7d=2
X₇	疼痛	无=0,有=1
X₈	咳嗽	无=0,有=1