老年直肠癌永久性结肠造口患者生存质量、心理精神调查分析

A clinical survey of quality of life and psychological status in elderly patients with rectal cancer after permanent colostomy

目的探讨老年直肠癌永久性结肠造口患者术后生存质量及精神心理状况。方法采用生存质量核心问卷(QLQ-C30)及症状自评量表(SCL-90),对64例老年直肠癌永久性结肠造口患者分别于术前、术后1、3、6个月进行问卷调查,并对QLQ-C30评分与SCL-90评分进行相关性分析。结果完整参加本次调查的患者共60例。术后1个月QOL-C30量表中总体健康、功能领域(生理功能、角色功能、情感功能、认知功能、社会功能)评分显著低于术前,术后3、6个月有明显改善(P<0.05);术后1、3、6个月症状领域及症状子条目评分显著高于术前(P<0.05);术后1个月SCL-90量表总评分、焦虑、抑郁、躯体化评分显著高于术前,术后3、6个月躯体化评分显著升高,焦虑、抑郁及总评分显著降低(P<0.05);SCL-90量表总评分、焦虑、抑郁、躯体化评分与QLQ-C30量表中总体健康、功能量表评分呈显著负相关性,且能够显著影响情绪功能及总体健康(P<0.05)。结论老年直肠癌永久性结肠造口患者术后具有明显的心理精神异常,且直接影响生存质量,早期针对心理护理有利于提高患者的生存质量。

Objective To analyze the quality of life and psychological status of elderly patients with rectal cancer after perma- nent colostomy. Methods Quality of life questionnaire-core 30 （ QLQ-C30 ） and Symptom checklist 90 （ SCL-90 ） were tested by self- report questionnaire in 64 elderly patients with rectal cancer before and after permanent colostomy in the first,third and sixth month af- ter the operation. The correlation between QLQ-C30 scores and SCL-90 scores were analyzed. Results There were 60 patients comple- ting the survey. The scores of overall health, functional scales （ physiological function, role function, affective function, cognitive func- tion, and social function） of QOL-C30 scale after one month of operation were significantly lower than before operation. All the scores were improved greatly in the third and sixth month after operation （P 〈 0. 05 ）. The scores of symptom areas and symptom sub-entries in the first, third and sixth month after operation were significantly higher than before operation （ P 〈 0. 05 ）. The total score, the scores of anxiety, depression and somatization of SCL-90 in the first month after operation were signifcantly higher than before operation （ P 〈 0. 05 ）. The somatization score in the third and sixth month after operation were significantly increased,while the total score, the scores of anxiety and depression were significantly decreased （ P 〈 0. 05 ）. The Pearson correlation analysis showed that the total score, the scores of anxiety, depression and somatization in the SCL-90 were negatively correlated with the overall health, functional scales in the QLQ-C30. The psychological status negatively affected emotional function and general health （ P 〈 0.05 ）. Conclusion Elderly patients with rectal cancer after permanent colostomy have obviously psychological abnormality, which affects the quality of life significantly. The targeted mental nursing can improve the quality of life.