原发性肝癌经导管动脉化疗栓塞术后患者症状困扰特点及其影响因素

Characteristics of symptom distress and its infl uencing factors in patients with primary liver cancer after transcatheter arterial chemoembolization

目的 探讨原发性肝癌（肝癌）经导管动脉化疗栓塞（TACE）术后患者症状困扰特点及其影响因素。方法 根据自愿原则通过便利抽样法调查2012年1月至2013年1月在中山大学附属第三医院肝胆外科行TACE术后3d的108例肝癌患者。其中男94例，女14例；年龄26～72岁，中位年龄51岁。所有患者调查前均签署知情同意书，符合医学伦理学规定。采用横断面研究和问卷调查的方法。问卷调查采用一般情况调查表、M．D．安德森症状评估量表（MDASI）、社会支持评定量表（SSS）、医学应对方式问卷（MCMQ）。症状困扰的影响因素分析采用多重线性回归分析。结果患者治疗期间MDASI症状分量表评分为（3．0±1．6）分，症状严重程度属轻度。症状对患者生活困扰分量表评分为（3．4±1．7）分，症状困扰程度亦属轻度。患者的工作受症状困扰最严重，其次为情绪、生活乐趣、一般活动、与他人关系、行走。困扰患者的最常见症状依次为发热、胃部不适、腹胀、皮肤黄染、体重减轻。患者的社会支持总评分为（42．2±6．7）分，为中等水平；社会支持的利用度评分为（7．9±2．2）分。患者的面对、回避、屈服3个维度评分分别为（2．5±0．5）、（2．4±0．5）、（2．0±0．6）分，较常采用的应对方式为面对和回避。大专及以上文化程度、患病后不在职、主观支持水平低、屈服应对的患者症状困扰程度较高（RR=0．320，0．254，0．569，0．217；P〈0．05）。结论 肝癌TACE术后患者存在轻度的症状困扰，大专及以上文化程度、患病后不在职、主观支持水平低、屈服应对的患者症状困扰程度较高。

Objective To study the characteristics of symptom distress and its influencing factors in patients with primary liver cancer after transcatheter arterial chemoembolization （TACE）. Methods A total of 108 patients with primary liver cancer receiving TACE in Department of Hepatobiliary Surgery, the Third Affiliated Hospital of Sun Yat-sen University from January 2012 to January 2013 were voluntarily enrolled in this study on the 3^rd day after operation by convenience sampling method. There were 94 males and 14 females with age ranging from 26 to 72 years old and median age of 51 years old. The informed consents of all patients were obtained and the ethics committee approval was received. Cross-sectional study and questionnaire survey were used in the research. The questionnaire survey included questionnaire of general information, M.D.Anderson Symptom Inventory （MDASI）, Social Support Measuring Questionnaire （SSS） and Medical Coping Modes Questionnaire （MCMQ）. Multiple linear regression analysis was used to identify factors influencing the symptom distress. Results The mean score of MDASI symptom subscale of patients during therapy was 3.0±1.6 with a mild degree of symptom distress. The score of MDASI life distress subscale of patients was 3.4±1.7, also with a mild degree of symptom distress. Work was most influenced by the symptoms, followed by emotion, joy of life, common activity, relation with others and walks. Fever, discomfort of stomach, abdominal distention, icteric skins and weight loss were common symptoms in sequence which distressed patients. The total score of social support was 42.2＋6.7 which was at the middle level, and the sore of use of social support was 7.9±2.2. The score of 3 dimensions facing, avoiding, surrender were 2.5±0.5, 2.4＋±0.5, 2.0±0.6 respectively. Facing and avoiding were the common coping modes. Patients who had college educational degree or above, no job after being ill, low level of subjective support, surrender coping mode were more distressed by symptoms than the other patients （RR=0.320, 0.254, 0.569, 0.217; P〈0.05）. Conclusions Patients with primary liver cancer have mild symptom distress after TACE, and patients with college educational degree or above, no job after being ill, low level of subjective support, surrender coping mode are more distressed by symptoms than the other patients.