重症监护室过渡期老年肿瘤患者生活质量及其影响因素

Quality of life in elderly tumor patients transitioning out of intensive care unit and its influencing factors

目的分析重症监护室(ICU)转出的老年肿瘤患者过渡期生活质量及影响因素。方法回顾性分析2021年6月至2023年2月新疆医科大学附属肿瘤医院ICU治疗的240例老年肿瘤患者临床资料,患者均处于ICU转出过渡期,将健康状况调查简表(SF-36)评分<50分患者纳为观察组(n=70),SF-36得分≥50分患者纳为对照组(n=170)。采用体力状况(ZPS)评分评价患者的一般情况与健康状态,采用微型营养评估量表(MNA)评估患者的营养状况,采用抑郁自评量表(SDS)和焦虑自评量表(SAS)评价患者心理状况,采用视觉模拟评分(VAS)评价患者的疼痛程度。采用SPSS 20.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、U检验、χ^(2)检验及方差分析。采用多因素logistic回归分析ICU转出过渡期老年肿瘤患者生活质量的影响因素。结果观察组患者SF-36评分[(41.15±5.74)和(68.88±7.43)分]及医护服务满意度[(83.43±8.87)和(94.65±9.46)分]明显低于对照组,差异均有统计学意义(P<0.05)。观察组年龄76~85岁、患慢性疾病>3种、重度抑郁、重度焦虑、中度疼痛、行手术治疗、ICU入住时间>5 d比例及体力状况评分明显高于对照组,血小板水平及MNA评分明显低于对照组(P<0.05)。多因素logistic回归分析提示,中度疼痛(OR=2.964,95%CI 2.004~7.964)、ICU入住时间>5 d(OR=5.750,95%CI 2.442~7.975)为老年肿瘤患者ICU转出过渡期生活质量下降的危险因素,MNA评分(OR=0.973,95%CI 0.955~0.991)为其保护因素(P<0.05)。结论老年肿瘤患者ICU转出过渡期存在生活质量降低情况,医护人员应密切关注患者病情变化及心理变化,根据患者生活质量状况实施处理措施,以此促进患者身体的恢复。

Objective To analyze the quality of life and its influencing factors in the elderly tumor patients transitioning out of the intensive care unit(ICU).Methods A retrospective analysis was conducted of the clinical data of 240 elderly tumor patients in ICU of Affiliated Tumor Hospital of Xinjiang Medical University between June 2021 and February 2023.All patients were in the transition period of ICU transfer.The patients with a score<50 on 36-item short-form health survey(SF-36)were included in the observation group(n=70),and those with a SF-36 score≥50 in the control group(n=170).The physical status(ZPS)score was used to evaluate the patient′s general condition and health status,the mini-nutritional assessment scale(MNA)to evaluate the patients′nutritional status,the self-rating depression scale(SDS)and self-rating anxiety scale(SAS)to evaluate the patients′psychological status,and visual analogue scale(VAS)to evaluate pain level.SPSS 20.0 was used for statistical analysis.Data comparison between two groups was performed using t-test orχ^(2)test,depending on the data type.Multivariate logistic regression analysis was used to analyze the influencing factors on the quality of life of the elderly tumor patients transitioning out of ICU.Results The SF-36 scores and medical service satisfaction in the observation group were significantly lower than those in the control group[(41.15±5.74)vs(68.88±7.43)points;(83.43±8.87)vs 9(4.65±9.46)points]with statistically significant differences(P<0.05 for both).The proportions of patients aged 76-85 years,chronic diseases>3 types,severe depression,severe anxiety,moderate pain,surgical treatment and ICU stay>5 d,and ZPS scores in the observation group were significantly higher than those in the control group,but the levels of white blood cell and platelet count and MNA scores were significantly lower than those in control group(P<0.05 for all).Multivariate Logistic regression analysis indicated that moderate pain(OR=2.964,95%CI 2.004-7.964)and ICU stay>5 d(OR=5.750,95%CI 2.442-7.975)were the risk factors of the decline in the quality of life in the elderly tumor patients transitioning out of ICU,while MNA score(OR=0.973,95%CI 0.955-0.991)was the protective factor(P<0.05).Conclusion The quality of life declines in the elderly tumor patients transitioning out of ICU.Medical staff should closely monitor the patients for changes in condition and their psychological state and implement the treatment measures based on their quality of life to promote their physical recovery.