乳腺癌术后化疗患者失志综合征变化轨迹及影响因素分析-现代医学

乳腺癌术后化疗患者失志综合征变化轨迹及影响因素分析

单位：1. 山西医科大学汾阳学院护理系, 山西汾阳 032200;
2. 山西省汾阳医院甲乳病区, 山西汾阳 032200

分类号：R473.73

出版年·卷·期（页码）：2024·52·第十一期（1721-1727）

摘要：

目的: 探讨乳腺癌术后化疗患者失志综合征变化轨迹及影响因素分析。方法: 采用便利抽样法，纳入山西省某三级甲等医院就诊的218例乳腺癌术后化疗患者为调查对象。采用一般资料调查表、失志量表中文版、社会限制量表、疾病获益感量表和中文版患者报告结局的经济毒性综合评分量表收集患者资料，于化疗前、第1次化疗后、第3次化疗后、第6次化疗后的4个时间点评估患者的失志综合征水平，应用增长混合模型识别失志综合征发展轨迹，并采用多元Logistic回归分析不同发展轨迹类别的影响因素。结果: 识别出乳腺癌术后化疗患者3种发展轨迹:高失志曲折下降组(14.7%)、中失志缓慢下降组(47.7%)和低失志持续上升组(37.6%)。多元Logistic回归分析显示，患者性格类型、家庭人均月收入、病理分期、合并症情况以及基线经济毒性、益处发现、社会限制是乳腺癌术后化疗患者失志综合征不同发展轨迹类别的影响因素(P<0.05)，与低失志持续上升组相比，有合并症、病理分期高、社会限制大、性格内向、益处发现水平低、家庭月收入水平低和经济毒性大的患者归于高失志曲折下降组的概率偏大。结论: 乳腺癌术后化疗患者失志综合征轨迹呈现相对稳定性特征，但存在显著的群体异质性。医护人员应关注不同种类患者失志综合征的波动变化，根据影响因素采取针对性干预措施，以降低患者的失志水平。

Objective: To explore the trajectory of changes and influencing factors of demoralization syndrome in postoperative chemotherapy patients with breast cancer. Methods: Using convenience sampling method, 218 postoperative chemotherapy patients for breast cancer in a tertiary class A hospital in Shanxi province were selected. Baseline data of patients were collected by the General Situation Survey Form, Demoralization Scale Mandarin Version, Social Constraints Scale, Benefit Finding Scales, Comprehensive Scores for Financial Toxicity Based on the Patient-Reported Outcome Measures, and the evaluation of the patients before chemotherapy, after the first chemotherapy, and after the end of the third chemotherapy to identify the trajectory of the demoralization syndrome, and multiple Logistic regression was used to analyze the predictors of different development trajectory categories. Results: Three developmental trajectories of loss of demoralization syndrome were identified in postoperative chemotherapy patients with breast cancer: high demoralization syndrome tortuously declining group(14.7%), medium demoralization syndrome slowly declining group(47.7%), and low demoralization syndrome continuously increasing group(37.6%). Multiple Logistic regression analysis showed that patient personality type, family per capita monthly income, pathological stage, concomorbidities, and baseline social constraints, benefit finding, financial inadequacy were the influencing factors for different developmental trajectory categories of postoperative chemotherapy patients for breast cancer (P<0.05)compared with low demoralization syndrome continuously increasing group, patients with comorbidities, high pathological stage, large social constraints, introverision, low benefit finding, low level of monthly family income and high economic toxicity were more likely to fall into the high demoralization syndrome tortuously declining group. Conclusion: The demoralization syndrome of postoperative chemotherapy patients for breast cancer is divided into three changing trajectories with population heterogeneity, and targeted intervention should be implemented according to the influencing factors.

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