基于聚类分析的胃癌术后化疗患者症状群的分类研究

Identification of subtypes of symptom cluster in patients with gastric cancer undergoing chemotherapy: a cluster analysis

目的从胃癌术后化疗患者对疼痛-疲乏-睡眠障碍症状群的体验角度,分析该症状群患者可能的类型,并探讨不同类型症状群患者的影响因素及与生命质量的关系。方法采用一般资料调查表、数字疼痛评估表(NRS)、简易疲乏量表(BFI)、匹兹堡睡眠质量指数量表(PSQI)、卡诺夫斯基功能状态量表(KPS)、胃癌患者生命质量量表(QLICP-ST)对161例胃癌术后化疗患者进行调查,通过SPSS 22.0中的聚类分析方法进行分类,并根据分类结果分析其影响因素及与生命质量的关系。结果161例胃癌术后化疗患者可分为Ⅰ类(症状均低组)23例占14.3%,Ⅱ类(低疼痛、中疲乏组)43例占26.7%,Ⅲ类(低疼痛、高疲乏组)62例占38.5%,Ⅳ类(症状中高组)33例占20.5%。文化程度、化疗周期及KPS得分是胃癌术后化疗患者疼痛-疲乏-睡眠障碍症状群分类的主要影响因素(χ2=13.873、26.442,F=3.193,P <0.05或0.01)。其中文化程度较高,化疗处于后期,KPS评分较低患者更倾向于"症状中高组"。且"症状中高组"患者的生命质量总得分显著低于其余3组(F=10.552,P <0.01)。结论胃癌术后化疗患者基于疼痛-疲乏-睡眠障碍症状群的体验状况可分为4种不同类型,如医护人员有效甄别,并制定有针对性的干预措施,将更大程度地提高患者生命质量。

Objective To explore the possible types of patients with gastric cancer undergoing chemotherapy based on their experience with the symptom cluster of pain, fatigue, sleep disturbance. Methods Totally 161 gastric cancer patients were investigated by the demographic and clinical characteristics questionnaire, the Numeric Rating Scale (NRS), the Brief Fatigue Inventory (BFI), the Pittsburgh Sleep Quality Index (PSQI), Quality of Life Questionnaires (QLICP-ST). Cluster analysis using SPSS 22.0 version was performed to categorize patients. Results Four different types of patients were got through cluster analysis. Type Ⅰ patients showed all low symptoms (23 cases accounted for 14.3%), Type Ⅱ patients showed low pain and moderate fatigue (43 cases accounted for 26.7%), Type Ⅲ patients showed low pain and high fatigue (62 cases accounted for 38.5%), Type Ⅳ patients performed moderate-to-high on all symptoms (33 cases accounted for 20.5%). Their education status, chemotherapy cycle sand KPS score were the main factor influencing the classification of pain-fatigue-sleep disorder symptoms in patients with gastric cancer undergoing chemotherapy after operation (χ2=13.873, 26.442, F=3.193, P<0.05 or 0.01). Type Ⅳ tended to have higher education level, lower KPS score and later stage of chemotherapy. Furthermore, patients in moderate-to-high class had significantly lower quality of life score than all low class (F=10.552, P <0.01). Conclusion In this research, patients with gastric cancer undergoing chemotherapy were divided into 4 types based on their experience with the symptom cluster of pain, fatigue and sleep disturbance. It could provide basis for effectively screening and implementing measures for symptoms management.