终末期患者宁养服务前生活质量的临床分析

Quality of Life of Terminal Patients in Wuhan Hospice

目的:描述和比较终末期患者与其他生存时间较长的患者接受宁养服务前生活质量(quality of life,QOL)的差异。方法:按建立宁养关系后接受宁养服务时间的长短将宁养患者分为生存时间短于2周的终末组,生存时间长于2周的对照组,其中1634例患者接受宁养服务前完成疼痛评分、总QOL评分和QOL的12项指标的全面评估,回顾性分析终末组201例和对照组1433例患者疼痛评分和QOL的差异。疼痛评分和QOL状况分别用NRS量表和中国QOL量表,第一次家访时由患者自我评估。结果:统计学结果表明两组患者的性别分布、中位年龄、原发肿瘤分布及合并远处转移的发生率均无明显差异,一般情况是均衡的;接受宁养服务前终末期患者与对照组相比:疼痛评分明显较高,均值分别为6.8和6.3,有明显统计学差异(P<0.001);总QOL评分明显较低,均值分别为27.9和31.4,有明显统计学差异(P<0.001);QOL的12项指标中,躯体方面的不适更明显;心理方面除自身对疾病的认识无差异外,精神和对治疗的态度等指标明显较差;而社会人际关系方面两组无明显差异。结论:宁养患者需要身、心、灵等方面的全人照护,终末期患者身、心、灵等方面的损害更加严重,需要更强的宁养服务照护。

Objective: To describe and compare the quality of life(QOL) difference between the terminal patients and other survival longer patients when they are newly admitted hospice.Methods: A representative sample of 1643 hospice patients were surveyed and classified as terminal patients group(n=201) and contrast patients group(n=1433) according to hospice service time.Pain score and QOL were collected at the patient home when hospice staff first visited patients.The patients self-measured by numerical rating scale(NRS) and Chinese-QOL instrument respectively.Among the questionnaires they completed were pain score and 12 scales of Chinese-QOL,the global QOL was the sum of the 12 scales score.Results: The demography difference of two group patients was no significant.Compared with the contrast group patients,the pain score was more serious and global QOL was lower for the terminal patients.There were significantly different,respectively.Among their scales of Chinese-QOL,the terminal patients had a significantly bad physical well-being than those who survival longer patients.About psychological well-being,the mood and the attitude to treatment were bad for terminal patients,but the difference of attitude to cancer was no significant.There were no significantly different about the support from family and social between the terminal patients group and contrast patients group.Conclusion: Because of the pain and QOL states,the terminal patients need more hospice home care.