中晚期肺癌患者姑息性表现发展轨迹研究

Development trajectory of palliative performance in middle-and late-stage lung cancer patients

目的分析中晚期肺癌患者姑息性表现发展轨迹及其影响因素,为患者终末期护理提供指导。方法选取初诊后接受手术治疗的中晚期肺癌患者为调查对象,分别于术前(T1)、首次化疗周期前(T2)、首次化疗周期1~3 d(T3)、首次化疗周期中期(T4)、首次化疗周期结束(T5)和术后3个月(T6)6个时间点调查其姑息性表现。潜变量增长曲线混合模型分析其姑息性表现发展轨迹。结果中晚期肺癌患者T1时姑息性表现水平为(35.00±6.86)%,T2时(31.05±9.09)%,T3时(29.11±11.47)%,T4时30.00(10.00,50.00)%,T5时30.00(10.00,50.00)%,T6时20.00(10.00,50.00)%。中晚期肺癌患者姑息性表现发展曲线分为改善组(41.13%)、恶化组(22.58%)和严重恶化组(36.29%)。多分类logistic回归分析显示,年龄、TNM分期、人格分型和自我管理是肺癌患者姑息性表现类别的影响因素(均P<0.05)。结论中晚期肺癌患者姑息性表现整体呈随时间恶化发展趋势,根据不同时间点姑息性表现特征可分为改善组、恶化组和严重恶化组3个发展轨迹类别,高龄、情绪不稳定人格和低自我管理水平是中晚期肺癌患者姑息性表现的危险因素,应结合不同姑息性表现发展轨迹中晚期肺癌患者进行针对性干预,为其提供更优质的癌症护理。

Objective To analyze the development trajectory and its influencing factors of palliative performance in middle-and late-stage lung cancer patients,so as to provide a reference for terminal care.Methods The initial diagnosed middle-and late-stage lung cancer patients undergoing surgery were selected,and their palliative performance were investigated by using the Palliative Performance Scale(PPS)at six time points,one day before the surgery(T1),one to three days before the first circle chemotherapy(T2),one to three days of the first circle chemotherapy(T3),the middle stage of the first circle chemotherapy(T4),one to three days after the first circle chemotherapy(T5),and three months after the surgery(T6).The Latent Growth Curve Mixture Model was used to analyze the development trajectory of palliative performance.Results The PPS level of the middle-and late-stage lung cancer patients was(35.00±6.86)%at T1,(31.05±9.09)%at T2,(29.11±11.47)%at T3,30.00(10.00,50.00)%at T4,30.00(10.00,50.00)%at T5,and 20.00(10.00,50.00)%at T6.The development curve of the participants′palliative perfor-mance was divided into an improvement group(41.13%),a deterioration group(22.58%)and a severe deterioration group(36.29%).Multinomial logistic regression analysis showed that,age,TNM stage,personality classification,and self-management were significant influencing factors of palliative performance in lung cancer patients(all P<0.05).Conclusion The overall palliative performance of middle-and late-stage lung cancer patients shows a trend of deterioration over time.According to the characte-ristics of PPS at different time points,they can be divided into three trajectory categories:improvement group,deterioration group,and severe deterioration group.Advanced age,unstable emotional personality,and low self-management are risk factors of their palliative performance.Targeted intervention should be conducted according to different development trajectories of palliative performance in middle-and late-stage lung cancer patients,so as to provide them high quality cancer care.