【作者】 赵燕；

【导师】 曹枫林；

【作者基本信息】 山东大学 ， 护理（专业学位）， 2018， 硕士

【摘要】 目的:基于甲状腺癌术前患者对焦虑、抑郁、疲乏、压力和创伤后成长的体验状况,通过潜在类别分析方法鉴别患者应激反应类型;比较不同应激反应类型的甲状腺癌患者在围手术期的生活质量水平。方法:本研究从2017年5月至2017年11月,在山东省某三级甲等医院选取190名拟接受手术治疗的甲状腺癌住院患者,在入院时(T1)和出院前(T2)两个时间点进行问卷调查。采用一般资料问卷、患者健康问卷(PatientHealth Questionaire,PHQ-9)、广泛性焦虑量表(Generalised Anxiety Disorder Questionaire,GAD-7)、压力知觉量表(Perceived Stress Scale 4-item,PSS-4)、简易疲乏量表(Brief Fatigue Inventory,BFI)、简易创伤后成长量表(The Short Form of the Posttraumatic Growth Inventory,PTGI-SF)和癌症患者生活功能指数量表(The Functional Living Index-Cancer,FLIC)测量研究对象的一般情况、抑郁、焦虑、压力、疲乏和创伤后成长的体验状况及其生活质量。采用描述性分析、独立样本t检验、配对样本t检验、方差分析和χ2检验、潜在类别分析(Latent Class Analysis,LCA)和混合效应模型等进行数据分析。结果:1.T1阶段,170名甲状腺癌症患者生活质量FLIC总分为122.54±20.35;躯体健康能力得分为51.26±9.77;心理健康能力得分为30.58±6.68;癌症负担得分为16.33±3.77;社交健康得分为11.66±2.99;恶心得分为12.75±2.]4。抑郁得分为5.52±5.31,抑郁阳性率为52.9%。焦虑得分为6.45±5.48,焦虑阳性率为59.4%。压力得分为6.08±2.41,其中高于均分有43.5%。疲乏得分为4.49±2.30,高于均分有51.8%。创伤后成长得分27.76±13.45,高于均分有57.6%。2.T2阶段,接受随访的85名甲状腺癌患者FLIC总分显著低于T1阶段FLIC得分(t=3.289,P=0.001);在T2阶段的躯体健康能力得分显著低于T1阶段得分(t=2.977,P=0.004);T2阶段癌症负担得分显著低于T1阶段的得分(t=3.665,P<0.001);恶心得分T2阶段显著低于T1阶段(t=2.827,P=0.006)。3.根据焦虑、抑郁、疲乏、压力和创伤后成长得分采用潜在类别分析方法将170个样本分为三类:“高困扰低成长组(类别1)”、“中困扰高成长组(类别2)”和“低困扰中成长组(类别3)”。类别1患者的抑郁、压力、疲乏得分显著高于类别2、类别3的得分。类别2患者抑郁、焦虑、压力、疲乏显著高于类别3;创伤后成长得分显著高于类别3、类别1。4.在T1阶段,类别3的躯体健康能力得分和FLIC总分显著高于类别2和类别1的得分;类别3的心理健康和癌症负担得分均显著高于类别2和类别1的得分;类别3的社交健康和恶心显著高于类别1。在T2阶段,类别3的躯体健康能力、心理健康得分和FLIC总分均显著高于类别1和类别2的得分;类别3的癌症负担得分显著高于类别2,社交健康显著高于类别1。结论:1.甲状腺癌患者体验的负性应激反应水平较高,而创伤后成长水平较低。2.甲状腺癌患者围手术期生活质量低,且手术后患者生活质量总分及躯体健康能力、癌症造成的负担及恶心三个维度较手术前有所下降。3.甲状腺癌患者治疗中多种负性应激反应和正性变化-创伤后成长通过潜在类别分析方法得到三个应激反应类别,分别是:“高困扰低成长组”、“中困扰高成长组”和“低困扰中成长组”。不同类别的甲状腺癌患者在不同时间点生活质量得分有差异,通过潜在类别分析可以预测甲状腺癌患者的生活质量。更多还原

【Abstract】 Objective:To identify thyroid cancer patients’ stress response types by the latent class analysis based on the experience of anxiety,depression,fatigue,stress and post-traumatic growth.To compare the quality of life among different types during perioperative period.Methods:The study recruited 190 thyroid cancer inpatients prepared for operation from May 2017 to November 2017 at two time points:on admission(T1),before discharge(T2).A questionnaire survey was carried out to investigate the general condition,anxiety,depression,fatigue,stress,post-traumatic growth and their quality of life.Survey tools include general information questionnaire,the Patient Health Questionaire(PHQ-9),the Generalised Anxiety Disorder Questionaire(GAD-7),the 4-item Perceived Stress Scale(PSS-4),the Brief Fatigue Inventory(BFI),the Short Form of the Posttraumatic Growth Inventory(PTGI-SF),the Functional Living Index-Cancer(FLIC).SPSS22.0 statistical software was used to analyze data,statistical methods include:descriptive analysis,independent sample t-test and paired sample t test,analysis of variance,chi-square,latent class analysis,and mixed effects model.Results:1.In the T1 stage,the FLIC total score of 170 thyroid cancer patients was 122.54± 20.35;the physical health score was 51.26 ± 9.77;the mental health score was 30.58 ± 6.68;the cancer burden score was 16.33 ± 3.77;the social health score was 11.66±2.99;the nausea score was 12.75 ± 2.14.The depression score was 5.52 ± 5.31,and the positive rate of depression was 52.9%.The average score of anxiety was 6.45± 5.48,the positive rate was 59.4%.The pressure score was 6.08 ± 2.41,with the patients above the average score of 43.5%.The fatigue score was 4.49±2.30,with the patients above the average score of 51.8%,the score of posttraumatic growth was 27.76±13.45,with the patients above the average score of 57.6%.2.In the T2 stage,FLIC total score of 85 patients with thyroid cancer was significantly lower than that in T1 stage(t=3.289,P=0.001).The physical health score of T2 was significantly lower than that of T1(t=2.977,P=0.004).The score of cancer burden in T2 was significantly lower than that of T1(t=3.665,P<0.001).The T2 stage of nausea was significantly lower than T1(t=2.827,P=0.006).3.The 170 samples are divided into three types according to the anxiety,depression,fatigue,stress and posttraumatic growth,respectively named "high distress low growth group(group 1)","moderate distress high growth group(group 2)" and "low distress and moderate growth(group 3)".Depression,stress and fatigue were significantly higher in group 1 than in group 2 and group 3;anxiety,depression,stress and fatigue in group 2 were significantly higher than group 3.Post-traumatic growth score in group 1 was significantly higher than group 2 and group 3.4.In the T1 stage,the physical health score and FLIC total scores of group 3 were significantly higher than that of group 2 and group 1;mental health and cancer burden in group 3 were significantly higher than group 2 and group 1;social health and nausea in group 3 were significantly higher than group 1.In the T2 stage,the physical health,mental health score and FLIC total score of group 3 were significantly higher than group 1 and group 2.The cancer burden of group 3 was significantly higher than group 2,and social health was significantly higher than group 1.Conclusion:1.The incidence of negative symptoms of thyroid cancer patients is high,and the symptoms of patients are severe,while the post-traumatic growth level is low.2.Quality of life of thyroid cancer patients during perioperative period is low,and the patient’s quality of life,physical health,cancer burden and nausea scores after the operation ability,the burden of cancer and nausea were lower than the preoperation period.3.Three types thyroid cancer were identified based on negative symptoms and positive change-posttraumatic growth:"high distress low growth group","moderate distress high growth group" and "low distress and moderate growth".The three types of thyroid cancer patients have significant difference in quality of life at different time points,and the quality of life of thyroid cancer patients can be predicted through the analysis of potential categories.更多还原