晚期非小细胞肺癌患者症状群与生活质量的相关性研究

Correlation study on symptom clusters and quality of life in patients with advanced non-small cell lung cancer

目的 研究晚期非小细胞肺癌患者的症状和集群现象,并探讨症状群与生活质量的关系.方法 采用便利抽样法,选取2015年1月—2016年12月在南京市胸科医院确诊的晚期非小细胞肺癌患者150例为研究对象.收集患者的一般资料,采用安德森症状评估表（MDASI）和肺癌生活质量评估量表（FACT-L）调查患者的症状和生活质量;通过主成分分析提取肺癌的症状群,通过相关分析和多元回归分析探索症状群和生活质量之间的关系.结果 150例晚期非小细胞肺癌患者症状严重程度前3位为疲乏、食欲差及气短;症状频率前3位为疲乏、食欲差及苦恼.通过主成分分析提取了4个症状群,包括情感症状群、疲乏症状群、病感症状群和胃肠道症状群.4个症状群均与生活质量呈负相关（r值为-0.359^-0.721,P〈0.05）.多元线性回归分析发现,胃肠道症状群和疲乏症状群是晚期非小细胞肺癌患者生活质量主要的影响因素（R2=0.522,P〈0.05）.结论 晚期非小细胞肺癌患者受多个症状群困扰,护理人员应建立一个高效的症状管理模式,以提高患者生活质量.

Objective To explore the symptoms and clusters of patients with advanced non-small cell lung cancer （NSCLC）, and to discuss the correlation between their symptom clusters and quality of life. Methods A total of 150 patients who were diagnosed of advanced NSCLC in Nanjing Chest Hospital between January 2015 and December 2016 were selected by convenience sampling. The patients＇ basic information was collected, and their symptoms and quality of life were evaluated with M. D. Anderson symptom inventory （MDASI） and functional assessment of cancer therapy-lung （FACT-L）. The symptom clusters were extracted by principal component analysis, and the correlation between symptom clusters and the quality of life were then explored through correlation analysis and multivariate regression analysis.Results The top 3 symptoms in terms of severity in the 150 advanced NSCLC patients were fatigue, poor appetite and shortness of breath, while the top 3 symptoms in terms of frequency were fatigue, poor appetite and distress. Totally 4 symptom clusters were extracted by principal component analysis, including the emotional symptom cluster, the fatigue cluster, the illness perception cluster and the gastrointestinal tract cluster. The 4 symptom clusters were negatively correlated with the quality of life （r=-0.359--0.721,P〈0.05）. According to the multivariate regression analysis, the gastrointestinal tract and fatigue clusters were the main factors contributing to the life quality in advanced NSCLC patients （R2=0.522,P〈0.05）.Conclusions Advanced NSCLC patients were plagued with multiple symptom clusters. Therefore, nursing staff should build an efficient symptom management pattern to improve their quality of life.