心理痛苦温度计在胸部恶性肿瘤放疗前患者中的应用价值

Diagnostic Value of Psychological Distress Thermometer in Patients with Chest Malignant Tumors Before Radiotherapy

目的探讨心理痛苦温度计在胸部恶性肿瘤患者放疗前心理痛苦中的临床诊断价值及其相关危险因素。方法选取2018年5月至2019年5月于新乡医学院第三附属医院放疗科就诊的胸部恶性肿瘤患者作为研究对象,以医院焦虑抑郁量表(HADS)为金标准对患者进行心理痛苦诊断,使用中文版心理痛苦温度计(DT)对所有患者进行评分。分析DT对心理痛苦患者的诊断效能及心理痛苦发生的危险因素。结果入组对象145例,以HADS为金标准,符合诊断标准的患者63例,不符合82例。DT筛选心理痛苦患者的受试者操作特征(ROC)曲线下面积为0.947,DT为4分时约登指数最大为0.746,此时灵敏度和特异度分别为86.00%、88.60%(P<0.001)。以4分为界,DT<4分患者88例,DT≥4分患者57例。单因素分析显示DT≥4分患者的高龄、男性、低学历、体力劳动、低收入、医疗自费、未成年子女及病程≥1 a比率高于DT<4分患者(均P<0.05)。Logistic多因素回归分析显示体力劳动、医疗自费、低学历、育有未成年子女、低收入及病程≥1 a是心理痛苦发病的独立危险因素(均P<0.05)。心理痛苦问题列表显示前10位的因素为担心复发(87.92%),疲乏(73.37%),疼痛(61.93%),睡眠(50.37%),恐惧(45.75%),经济问题(42.75%),进食(37.85%),无时间精力做家务(32.25%),无时间精力照顾老人和小孩(28.79%),身体活动受限(20.32%)。结论DT对胸部恶性肿瘤放疗前患者心理痛苦具有较好的诊断效能,发病危险因素包括医疗自费、低学历、育有未成年子女等,心理痛苦因素包括担心复发、疲乏、疼痛等,临床护理中可据此给予有效措施进行预防和治疗。

Objective To explore the clinical diagnostic value of psychological pain thermometer in patients with chest malignant tumors before radiotherapy and its related risk factors.Methods From May 2018 to May 2019,patients with malignant thoracic tumors were selected as the subjects.The hospital anxiety and depression scale(HADS)was used as the gold standard to assess the psychological distress of patients.The Chinese version of psychological distress thermometer(DT)was used to score all patients.To analyze the diagnostic efficacy of DT in patients with psychological distress and the risk factors of psychological distress.Results One hundred and forty-five patients were enrolled in the study,with HADS as the gold standard,63 patients met the diagnostic criteria,and 82 patients did not.The area under receiver operating characteristic(ROC)curve of DT screening for patients with mental distress was 0.947,and the maximum Youden index was 0.746 when DT was 4 points.The sensitivity and specificity were 86.00%and 88.60%respectively(P<0.001).According to 4 points,88 patients with DT<4 points and 57 patients with DT≥4 points.Univariate analysis showed that the 1-year rate of elderly,male,low educational background,manual labor,low income,medical expenses,minor children and course of disease of DT≥4 points were higher than those of DT<4 points(all P<0.05).Logistic multivariate regression analysis showed that physical labor,medical expenses,low educational background,having minor children,low income and 1 year of course were independent risk factors for the onset of psychological distress(all P<0.05).The list of psychological distress problems showed that the top 10 related factors were fear of relapse(87.92%),fatigue(73.37%),pain(61.93%),sleep(50.37%),fear(45.75%),economic problems(42.75%),eating(37.85%),lack of time and energy to do housework(32.25%),lack of time and energy to care for the elderly and children(28.79%),limited physical activity(20.32%).Conclusion Psychological distress thermometer has a good diagnostic effect on psychological pain of patients with chest malignant tumors.Risk factors include medical expenses,low education,having minor children and so on.Psychological pain factors include fear of recurrence,fatigue,pain and so on.Effective measures can be taken to prevent and treat psychological pain in clinical nursing.