【作者】 陈静；

【导师】 田利；

【作者基本信息】 苏州大学 ， 护理（专业学位）， 2024， 硕士

【摘要】 【研究目的】明确结直肠癌化疗患者的症状负担现状,分析症状负担的潜在影响因素;探究膳食炎症指数与结直肠癌化疗患者症状负担的关联性。【研究方法】于2023年2月至12月在苏州市两所三甲医院内连续纳入符合纳排标准的结直肠癌患者。采用横断面研究的方法,在患者住院化疗期间指导其填写一般资料调查表、中文版记忆症状评估量表和半定量中国食物频率调查问卷。一般资料调查表包括患者社会人口学资料、生活习惯、临床资料等,中文版记忆症状评估量表用于调查患者症状负担,半定量中国食物频率调查问卷用于调查患者的饮食数据。利用营养计算器软件计算每种膳食营养素或食物成分的日均摄入量,再利用公式计算出个体的膳食炎症指数得分。采用单因素分析以及多元逐步回归分析探究结直肠癌化疗患者的症状负担影响因素。将膳食炎症指数按照四分位数转变为分类变量,采用Spearman相关分析探讨结直肠癌化疗患者膳食炎症指数与症状负担的相关性,采用多元线性回归分析探究膳食炎症指数对症状负担的影响。【研究结果】1.本研究实际发放问卷371份,有效回收问卷360份,问卷有效回收率97%。纳入患者的平均年龄为60.60±10.47岁;男性患者居多(58.33%);绝大多数患者已婚(93.89%);居住方式方面,与家人同住的患者占比97.50%;文化程度上,以小学及以下居多(n=146,40.56%),大学及以上学历仅占比5.28%;几乎全部患者都采用医保付费(99.17%);41.94%的患者睡眠质量好,48.89%的患者睡眠时间≤6h;结肠癌患者居多(65.56%);肿瘤分期以Ⅲ期和Ⅳ期为主(n=306,85%);74.44%的患者化疗次数≤6次;32.22%的患者主诉频繁感知到压力。2.结直肠癌化疗患者的症状负担现状结直肠癌化疗患者的症状负担较重,症状发生率位于前五位的症状依次是疲乏(84.72%)、难以入睡(65.28%)、没有食欲(65.28%)、精神紧张(64.17%)和手脚感到麻木或刺痛(60.28%),发生频率位于前五位的症状依次是疲乏、没有食欲、手脚感到麻木或刺痛、难以入睡和恶心,严重程度位于前五位的症状依次是疲乏、没有食欲、手脚感到麻木或刺痛、昏昏欲睡和难以入睡,困扰程度位于前五位的症状依次是疲乏、没有食欲、难以入睡、手脚感到麻木或刺痛和昏昏欲睡。3.结直肠癌化疗患者症状负担的影响因素单因素分析及多元逐步回归分析结果显示,性别、医疗费用支付方式、压力感知水平、运动频率、平均夜间睡眠时间和化疗次数是结直肠癌化疗患者症状负担的影响因素。女性、医疗费用支付方式为自费、化疗次数较多(>12次)、运动频率低、夜间睡眠时间较少(≤6h)和频繁感知到压力的患者症状负担更高。4.膳食炎症指数与结直肠癌化疗患者的症状负担关联性分析Spearman相关分析结果显示,膳食炎症指数与结直肠癌化疗患者的症状负担呈正相关,结直肠癌化疗患者的膳食炎症指数越高,饮食越促炎,相反则饮食越抗炎,相较于饮食最抗炎组,饮食最促炎组患者的症状负担得分更高。在校正性别、医疗费用支付方式、平均夜间睡眠时间、压力感知、运动频率和化疗次数的影响后,多元线性回归结果表明,膳食炎症指数与症状负担间仍具有显著的正向关联性,膳食炎症指数是症状负担的正向影响因素。【研究结论】1.结直肠癌化疗患者的症状负担较重,疲乏、难以入睡、没有食欲、手脚感到麻木或刺痛、昏昏欲睡、精神紧张和恶心等症状发生率高,严重程度重,症状评估与管理时应重点关注。2.性别、医疗费用支付方式、压力感知水平、运动频率、平均夜间睡眠时间和化疗次数会影响结直肠癌化疗患者的症状负担水平。女性患者、医疗费用支付方式为自费、化疗次数较多(>12次)、缺乏运动、夜间睡眠时间较少(≤6h)以及频繁感知到压力的结直肠癌化疗患者的症状负担更高。3.膳食炎症指数与结直肠癌化疗患者的症状负担呈正相关,膳食炎症指数是症状负担的正向影响因素。结直肠癌化疗患者的膳食炎症指数越高,饮食越促炎,患者的症状负担也越高。更多还原

【Abstract】 【Objective】To clarify the status of symptom burden in patients with colorectal cancer undergoing chemotherapy,and analyze the potential influencing factors of symptom burden.To explore the association between dietary inflammation index and symptom burden in patients with colorectal cancer undergoing chemotherapy.【Methods】From February to December 2023,colorectal cancer patients meeting the exclusion criteria were continuously enrolled in two class A tertiary hospitals in in Suzhou.A cross-sectional study was used to guide the patients to fill in the general information questionnaire,the Chinese version of the Memory Symptom Assessment Scale and the semi-quantitative Chinese Food Frequency Questionnaire during chemotherapy.The general data questionnaire included patients’socio-demographic data,living habits,clinical data,etc.The Chinese version of the Memory Symptom Assessment Scale was used to investigate patients’symptom burden,and the semi-quantitative Chinese food frequency questionnaire was used to investigate patients’dietary data.The daily intakes of each dietary nutrient or food component were calculated using the nutrition calculator software,and the scores of individual dietary inflammation index were calculated using the formula.Single factor analysis and multiple step-by-step regression were used to analyze the influencing factors of symptom burden in patients with colorectal cancer chemotherapy,and to identify the population characteristics of patients with high symptom burden.The dietary inflammatory index was transformed into a categorical variable according to the quartile,and Spearman correlation analysis was used to investigate the correlation between dietary inflammatory index and symptom burden in patients with colorectal cancer chemotherapy,Multiple linear regression analysis was used to investigate the influence of dietary inflammation index on symptom burden.【Results】1.371 questionnaires were actually distributed in this study,and 360 questionnaires were effectively collected,with an effective recovery rate of 97%.The mean age of included patients was 60.60±10.47 years.Most of the patients were male(58.33%).Most of the patients were married(93.89%).In terms of living style,97.50%of patients lived with their families.In terms of education level,the majority were primary school or below(n=146,40.56%),and the university education or above accounted for only 5.28%;Almost all patients were paid by medical insurance(99.17%);41.94%of the patients had good sleep quality,48.89%of the patients slept less than 6h;The majority of patients with colon cancer(65.56%);The main tumor stages were stage III and stage IV(n=306,85%).74.44%of patients received chemotherapy≤6 times;32.22%of the patients complained that they often felt pressure.2.Status of symptom burden in patients with colorectal cancer undergoing chemotherapyPatients with colorectal cancer chemotherapy have a higher symptom burden,the top five symptoms in patients with colorectal cancer chemotherapy were fatigue(84.72%),have trouble falling asleep(65.28%),loss of appetite(65.28%),nervousness(64.17%),and numbness or tingling in the hands and feet(60.28%),the top five symptoms of frequency are fatigue,no appetite,numbness or tingling in the hands and feet,have trouble falling asleep and nausea,the severity of the top five symptoms are fatigue,no appetite,numbness or tingling in the hands and feet,lethargy and have trouble falling asleep,and the severity of the top five symptoms are fatigue,no appetite,have trouble falling asleep,and numbness or tingling and lethargy.3.Influencing factors of symptom burden in patients with colorectal cancer undergoing chemotherapyThe results of single factor analysis and multiple stepwise regression analysis showed that,Gender,payment method of medical expenses,perceived level of stress,frequency of exercise,average night sleep time and number of chemotherapies were the influencing factors of symptom burden in patients with colorectal cancer chemotherapy.Patients who were female,paid for medical expenses at their own expense,had higher symptom burden with more chemotherapy(>12 times),lower frequency of exercise,less sleep time at night(≤6h),and frequent perceived stress.4.Analysis of association between dietary inflammation index and symptom burden in patients with colorectal cancer undergoing chemotherapySpearman correlation analysis showed that the dietary inflammation index was positively correlated with the symptom burden of patients with colorectal cancer chemotherapy.The higher the dietary inflammation index of patients with colorectal cancer chemotherapy was,the more pro-inflammatory the diet was,and on the contrary,the more anti-inflammatory the diet was.Compared with the group with the most pro-inflammatory diet,the group with the most pro-inflammatory diet had a higher symptom burden score.After adjusting for the influence of gender,payment method of medical expenses,average night sleep time,stress perception,exercise frequency and chemotherapy frequency,the results of multiple linear regression showed that there was still a significant positive correlation between dietary inflammation index and symptom burden,and dietary inflammation index was a positive influencing factor of symptom burden.【Conclusion】1.Patients with colorectal cancer chemotherapy have a heavy burden of symptoms,fatigue,difficulty falling asleep,no appetite,numbness or tingling in the hands and feet,lethargy,nervousness and nausea,and other symptoms have a high incidence and severity,and should be paid attention to in symptom evaluation and management.2.Gender,payment method of medical expenses,perceived level of stress,frequency of exercise,average night sleep duration,and number of chemotherapy treatments influenced symptom burden in patients with colorectal cancer chemotherapy.Patients with colorectal cancer chemotherapy who were female,paid for medical expenses out of pocket,had more chemotherapy sessions(>12),were inactive,had less sleep at night(≤6h),and frequent perceived stress had a higher burden of symptoms.3.The dietary inflammatory index was positively correlated with the symptom burden in patients with colorectal cancer treated with chemotherapy,and the dietary inflammatory index was a positive factor influencing the symptom burden.The higher the dietary inflammatory index and pro-inflammatory diet of patients with colorectal cancer chemotherapy,the higher the patient’s symptom burden.更多还原