骨肿瘤患者术后生活质量和疼痛的影响因素及应对措施

Factors influencing postoperative quality of life and pain and the solutions in patients with bone tumors

目的探讨骨肿瘤患者术后生活质量和疼痛的影响因素及应对措施。方法选取2015年1月至2018年1月间西安市第九医院收治的经影像学及手术病理确诊的113例骨肿瘤患者,采用生活质量测定量表(QIQ-C30.3.0)和视觉模拟评分(VAS)评估患者术后生活质量和疼痛情况,将预后影响因素各变量采用比例风险回归模型(Cox)评估。结果113例患者中总健康状况、各项生活质量(躯体、角色、认知和社会功能)指标评分均处于中、下水平,情感功能处于中、上水平,多数患者症状表现(乏力、疼痛和睡眠障碍)多处于中、重水平,呼吸困难、恶心呕吐、便秘和腹泻则相对较轻。多因素Cox比例风险回归发现,总体健康、功能状态(躯体、角色、情感、认知和社会功能)及症状与性别无相关性,总体健康、功能状态与年龄(年龄越大,总体健康与功能状态越差)呈负相关;除腹泻外,其他症状与年龄呈负相关,文化程度与总体健康、功能状态及症状(除腹泻外)均呈正相关,总体健康、功能状态与不同治疗阶段呈负相关。113例患者术后疼痛完全缓解、部分缓解与稳定97例,总有效率为85.8%,无效16例(14.2%)。单因素分析显示,年龄、DS分期、骨病分级、BMPC、Hb、Alb、β2-MG、Cr和LDH均是影响患者疼痛的因素(P<0.05)。多因素Cox回归分析显示,年龄、DS分期、Alb、β2-MG和Cr是影响患者疼痛的危险因素(P<0.05)。结论影响骨肿瘤患者的疼痛、总健康状况及生活质量的危险因素较多,制定干预方案需综合考虑。

Objective To investigate the factors influencing postoperative quality of life and pain and the solutions in patients with bone tumors.Methods A total of 113 patients with bone tumors diagnosed by imaging and surgery were collected at Xi’an No.9 Hospital from January 2015 to January 2018.The quality of life was evaluated by quality of life scale(QIQ-C30.3.0),and the pain was evaluated by visual analog score(VAS).The variables of prognostic factors were evaluated by proportional risk regression model(Cox)regression model.Results The scores of quality of life including physical,role,cognitive and social functions were moderate or low.The scores of emotional function were moderate or high.The symptoms of most patients including fatigue,pain and sleep disorder were moderate or severe.However,symptoms including dyspnea,nausea and vomiting,constipation and diarrhea were relatively mild.Multivariate Cox proportional risk regression showed that the overall health,functional status including physical,role,cognitive and social functions and symptoms were not associated with gender.The overall health and functional status were negatively associated with age.Symptoms except diarrhea were negatively associated with age.Education level was positively associated with overall health,functional status and symptoms except diarrhea.The overall health and functional status were negatively associated with different stages of treatment.Complete remission,partial remission and stable disease were achieved in 97 patients.The overall efficacy rate was 85.8%.Univariate analysis revealed that age,DS stage,bone disease grade,BMPC,Hb,Alb,β2-MG,Cr and LDH were factors influencing pain in patients with bone tumors(all P<0.05).Multivariate Cox regression showed that age,DS stage,Alb,β2-MG and Cr were independent risk factors for pain in patients with bone tumors(all P<0.05).Conclusion There are many risk factors influencing pain,overall health status and quality of life in patients with bone tumors.When treatment decisions are made,these factors should be taken into consideration.