肺癌患者围手术期癌因性疲乏轨迹及影响因素的纵向研究

Longitudinal study on the trajectory and influencing factors of cancer-related fatigue in patients with lung cancer during perioperative period

目的探讨肺癌患者围手术期癌因性疲乏的变化轨迹,并分析心理社会等因素对轨迹类别的预测作用。方法采用便利抽样法,于2020年12月至2021年5月选取山东第一医科大学第一附属医院(山东省千佛山医院)胸外科接受手术治疗的肺癌患者162例。于手术前(T0)收集患者的心理弹性量表和社会支持评定量表,并于术前(T0)、术后3 d(T1)、术后1周(T2)、术后2周(T3)、术后1个月(T4),调查患者的癌因性疲乏水平。使用潜类别增长模型识别轨迹类别,并采用Logistic回归分析探索其影响因素。结果本研究拟合出3条癌因性疲乏轨迹,分别为无疲乏组(31.7%)、疲乏上升组(36.0%)、持续疲乏组(32.3%);单因素分析显示,吸烟史(χ2=14.83,P<0.05)、BMI(χ2=29.67,P<0.05)、血红蛋白(F=4.57,P<0.05)、心理弹性(F=35.53,P<0.05)、社会支持(F=47.53,P<0.05)与癌因性疲乏轨迹类别有关;Logistic回归分析表明,吸烟史、超重/肥胖、心理弹性和社会支持是癌因性疲乏轨迹的预测因素(均P<0.05)。结论肺癌患者围手术期的癌因性疲乏存在不同变化轨迹,超重/肥胖、心理弹性越低的患者越有可能出现持续疲乏趋势;有吸烟史和社会支持越低的患者越有可能出现疲乏上升趋势。针对此类肺癌患者,医务人员应及时采取有效的干预措施改善其癌因性疲乏状况。

Objective To explore the changing track of cancer-related fatigue in patients with lung cancer during perioperative period and analyze its influencing factors.Methods From December 2020 to May 2021,162 eligible patients with lung cancer were selected in the First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital by convenient sampling method.Mental resilience and social support were investigated before operation(T0);and cancer-related fatigue was investigated before operation(T0),3 days after operation(T1),1 week after operation(T2),2 weeks after operation(T3)and 1 month after operation(T4),and Latent Class Growth Model was used to identify the track categories.Logistic regression analysis was used to analyze the influencing factors.Results Three cancer-related fatigue tracks were fitted in this study,which were no fatigue group(31.7%),increased fatigue group(36.0%)and sustained fatigue group(32.3%).Univariate analysis showed that smoking history(χ2=14.83,P<0.05),BMI(χ2=29.67,P<0.05),hemoglobin count(F=4.57,P<0.05),mental resilience(F=35.53,P<0.05),social support(F=47.53,P<0.05)were related to the track category of cancer-related fatigue.Logistic regression analysis showed that smoking history,over weight/obesity,resilience and social support were the predictors of cancer-related fatigue locus(P<0.05).Conclusions Perioperative cancer-related fatigue of patients with lung cancer has different change trajectories,patients with higher BMI and lower resilience are more likely to have a tendency of persistent fatigue.Patients with smoking history and lower social support are more likely to have an upward trend of fatigue.For this kind of lung cancer patients,medical staff should take timely and effective intervention measures to improve their cancer-related fatigue.