头颈部恶性肿瘤病人生存质量及其影响因素调查

Quality of life and its associated factors among patients with head and neck malignant tumor

[目的]了解头颈部恶性肿瘤病人术前、术后不同时段生存质量、肩颈功能、焦虑、疼痛变化情况,探讨影响生存质量的主要因素,为建立康复训练及指导提供理论依据。[方法]选取82例进行手术治疗的头颈部恶性肿瘤病人,采用华盛顿大学生生存质量问卷(UW-QOL)、Constant-Murley肩功能评定、焦虑自评量表(SAS)及WHO疼痛分级标准4个量表,分别于病人术前、术后1周、术后3个月进行问卷调查及评定,分析病人不同时段生存质量得分及其影响因素。[结果]头颈部恶性肿瘤病人术后各时间点生存质量、肩颈功能均低于术前,术后3个月仍未恢复到术前水平;生存质量单项条目中,语言、肩功能、活力、外貌评分比术前下降明显,性别、切口愈合等级是影响生存质量的主要因素;进行颈淋巴清扫术病人各时间点的肩颈功能评分均低于未进行颈淋巴清扫术的病人;术后1周病人疼痛评分及焦虑发生率最高;不同时点生活质量变化与肩颈功能、疼痛、焦虑变化具有相关性。[结论]头颈部恶性肿瘤病人术后生活质量明显降低。对肿瘤病人进行手术方案选择时,不仅要考虑手术治愈率,更要兼顾病人功能的修复与重建,有针对性地实施围术期护理、心理护理及康复训练,改善病人的社会功能状态,提高生活质量。

Objectives:To understand the status in different period including the changes of quality of life,shoulder and neck function,anxiety,pain changes of patients with head and neck malignant tumor before and after surgery treatment,and probe into the main factors affected the quality of life,in order to provide theoretical basis for establishing rehabilitation training and guidance.Methods:A total of 82 patients with head and neck malignant tumor treated by surgery were included in this study.University of Washington Quality of Life Scale(UW-QOL),The Constant-Murley score(CMS),Zung Self-rating Anxiety Scale(SAS),and WHO Pain Ladder were used to investigate the patients at the time before surgery,1 week and 3 months after the surgery.The quality of life scores in the different periods and its influencing factors were analyzed.Results:The postoperative scores of quality of life and shoulder and neck function of patients with head and neck malignant tumor at each time point were lower than those in preoperative,and the preoperative level was not recovered 3 months after the operation.In the single items of quality of life,the language,shoulder function,activity,and appearance scores were significantly lower than those before surgery.Gender and notch healing grade were the main factors affecting the quality of life.The shoulder and neck function among patients with neck lymph node dissection was lower than that in those without neck dissection.Anxiety score and pain score of patients at 1 week after operation were reported the highest.Changes in quality of life at different time points were correlated with shoulder and neck function,pain and anxiety.Conclusions:The quality of life of patients with head and neck cancer was significantly reduced after the operation.In the choice of surgical procedures for patients with cancer,not only the healing rate of surgery should be considered,but also the restoration and reconstruction of patients' function.Furthermore,the medical staff should take effective perioperative nursing,psychological nursing and rehabilitation training to help patients to promote functional rehabilitation and improve their quality of life.