肺癌患者心理问题的评估及其意义_中国呼吸与危重监护杂志

2018, 17(6): 582-587. doi:10.7507/1671-6205.201705031

肺癌患者心理问题的评估及其意义

喻慧 , 苏欣 , 施毅 ^△

南京大学医学院临床学院（南京军区南京总医院呼吸与危重症医学科）（江苏南京 210002）

收稿日期: 2017-05-17; 修回日期:2018-02-20;

通讯作者: 施毅, Email: shiyi56@126.com

△现在南京市青龙山精神病院

Evaluation and significance of psychological problems in patients with lung cancer

YU Hui , SU Xin , SHI Yi

Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing University, School of Medicine, Nanjing, Jiangshu 210002, P. R. China

Corresponding Author: SHI Yi, Email: shiyi56@126.com

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目的对住院肺癌患者的心理状况做初步评估，从而为临床干预提供理论支持。方法对符合条件的肺癌患者使用症状自评量表（SCL90）进行心理自评，再结合患者的人口学资料及躯体症状等信息进行综合分析。结果共有 239 例肺癌患者参与本次调查，其中男 161 例（67.4%），女 78 例（32.6%），平均年龄（60.7±9.9）岁。60 例初筛阳性，抑郁患病率 11.3%（27/239），焦虑患病率 4.2%（10/239），总的心理失调患病率 25.1%。知情、确诊时间越长、有癌症家族史、自主症状多、失眠、疲惫乏力、疼痛、呼吸困难症状或 KPS 评分低的肺癌患者，心理问题更严重。结论肺癌患者的心理问题较为严重，对他们进行及时的心理评估具有现实临床意义。

Objective To assess the psychological status of patients with lung cancer in ward preliminarily for providing the theoretical support for further clinical treatment. Methods Lung cancer patients were enrolled in this study during the period from January 2016 to January 2017, when they were being treated in the respiratory ward of Nanjing General Hospital. Their psychological status was assessed by using Symptom Check List 90, and the results with their demographic information and somatic symptoms were combined. Data were analyzed by using SPSS 18.0 software. Results This study included 239 inpatients, out of them 161 patients were male (67.4%), and the average age was 60.7±9.9 years. Sixty patients had a positive psychological status. The incidence of depression was 11.3% (27/239), of anxiety 4.2% (10/239), and of the total psychological disorder 25.1%. The patients had more serious psychological problems, when they had a longer course, more autonomic symptoms, or a lower score of Karnofsky performance scale, etc. Conclusion More serious psychological problems exist in patients with lung cancer, so it has the clinical significance for their timely psychological assessment.

关键词: 肺癌; 心理失调; 症状自评量表

Key words: Lung cancer; Psychological disorder; Symptom Check List 90

引用本文： 喻慧, 苏欣, 施毅. 肺癌患者心理问题的评估及其意义. 中国呼吸与危重监护杂志, 2018, 17(6): 582-587. doi: 10.7507/1671-6205.201705031 复制

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表1 患者一般情况

分类	亚分类	结果
性别［例（%）］	男	161（67.4）
	女	78（32.6）
年龄（岁）	\begin{document}$\overline x \!\!\; $\end{document} ±s	60.7±9.9
	范围	23～80
肺癌分型［例（%）］	小细胞肺癌	23（9.6）
	非小细胞肺癌	170（71.2）
	未定型	46（19.2）
知情与否［例（%）］	知晓病情	188（78.7）
	不知晓病情	51（21.3）
确诊时间［例（%）］	>3 个月	185（77.4）
	≤3 个月	54（22.6）
自主症状［例（%）］	>3 个	89（37.2）
	≤3 个	150（62.8）
癌症家族史［例（%）］	有	28（11.7）
	无	211（88.3）
KPS 评分［例（%）］	60	34（14.2）
	70	53（22.2）
	80	72（30.1）
	90	65（27.2）
	100	15（6.3）

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表2 量表得分与患者确诊时间长短的关系（分，）

项目	F1	F2	F3	F4	F5	F6	F7	F8	F9	GSI
>3 个月	1.92±0.48	1.83±0.45	1.57±0.45	1.98±0.41	1.64±0.35	1.69±0.38	1.50±0.37	1.38±0.36	1.52±0.33	1.73±0.26
≤3 个月	2.13±0.82	1.53±0.58	1.28±0.30	1.59±0.28	1.56±0.26	1.48±0.29	1.27±0.28	1.36±0.35	1.61±0.41	1.58±0.22
t 值	–0.989	1.598	1.649	2.430	0.581	1.403	1.579	0.138	–0.658	1.454
P 值	0.338	0.113	0.107	0.020	0.577	0.167	0.115	0.859	0.476	0.167
科恩系数	–0.406	0.656	0.676	0.997	0.238	0.575	0.648	0.057	–0.270	0.596

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表3 量表得分与患者一般资料之间的关系（分，）

项目	F1	F2	F3	F4	F5	F6	F7	F8	F9	GSI
知晓病情与否
是	1.46±0.44	1.38±0.42	1.25±0.33	1.46±0.43	1.28±0.32	1.32±0.34	1.19±0.29	1.17±0.26	1.26±0.28	1.35±0.30
否	1.40±0.42	1.22±0.26	1.14±0.20	1.22±0.26	1.21±0.26	1.21±0.24	1.10±0.19	1.11±0.23	1.14±0.18	1.22±0.21
t 值	0.872	2.587	2.268	3.798	1.438	2.167	2.096	1.496	2.900	2.905
P 值	0.356	0.008	0.027	0.000	0.175	0.038	0.038	0.147	0.005	0.005
科恩系数	0.138	0.410	0.327	0.602	0.228	0.344	0.332	0.237	0.460	0.461
确诊时间
>3 个月	1.46±0.42	1.38±0.41	1.25±0.33	1.46±0.44	1.27±0.33	1.31±0.35	1.20±0.30	1.16±0.27	1.25±0.27	1.34±0.30
≤3 个月	1.40±0.47	1.24±0.31	1.15±0.20	1.27±0.27	1.22±0.23	1.24±0.23	1.08±0.15	1.12±0.21	1.19±0.26	1.25±0.22
t 值	0.899	2.322	2.114	3.009	1.041	1.384	2.835	1.003	1.449	2.048
P 值	0.375	0.020	0.034	0.003	0.241	0.174	0.005	0.234	0.124	0.032
科恩系数	0.140	0.361	0.328	0.467	0.162	0.215	0.440	0.156	0.225	0.318
自主症状
>3 个	1.63±0.50	1.36±0.37	1.24±0.27	1.53±0.40	1.33±0.33	1.36±0.34	1.20±0.25	1.16±0.25	1.27±0.24	1.39±0.27
≤3 个	1.34±0.35	1.34±0.41	1.22±0.33	1.34±0.41	1.22±0.29	1.26±0.31	1.16±0.29	1.15±0.26	1.22±0.28	1.28±0.29
t 值	5.259	0.378	0.484	3.495	2.691	2.325	1.084	0.292	1.406	2.908
P 值	0.000	0.642	0.618	0.000	0.007	0.012	0.292	0.877	0.163	0.002
科恩系数	0.707	0.051	0.065	0.470	0.362	0.312	0.146	0.039	0.189	0.391
癌症家族史
有	1.56±0.51	1.43±0.40	1.33±0.40	1.44±0.33	1.38±0.36	1.36±0.33	1.24±0.26	1.23±0.28	1.36±0.34	1.41±0.29
无	1.44±0.42	1.33±0.39	1.21±0.30	1.41±0.42	1.25±0.30	1.29±0.32	1.16±0.28	1.14±0.25	1.22±0.25	1.31±0.28
t 值	1.384	1.271	1.906	0.363	2.102	1.084	1.432	1.764	2.659	1.768
P 值	0.159	0.257	0.050	0.691	0.032	0.243	0.134	0.082	0.008	0.089
科恩系数	0.279	0.257	0.385	0.073	0.425	0.219	0.289	0.356	0.537	0.357
KPS 评分
60 及 70 分	1.65±0.50	1.44±0.42	1.28±0.29	1.62±0.43	1.39±0.37	1.37±0.33	1.22±0.29	1.21±0.31	1.34±0.28	1.44±0.29
80、90 及 100 分	1.34±0.35	1.29±0.37	1.19±0.32	1.29±0.35	1.19±0.24	1.25±0.31	1.14±0.27	1.12±0.22	1.18±0.25	1.25±0.26
t 值	5.613	2.869	2.163	6.443	5.062	2.812	2.145	2.612	4.555	5.210
P 值	0.000	0.005	0.031	0.000	0.000	0.008	0.027	0.014	0.000	0.000
科恩系数	0.758	0.387	0.292	0.870	0.683	0.380	0.290	0.353	0.615	0.703

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图1 KPS 评分与癌症家族史交互作用对 F5 均分的影响

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图2 自主症状多寡与癌症家族史交互作用对 F5 均分的影响

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表4 量表得分与患者具体症状之间的关系（分，）

项目	F1	F2	F3	F4	F5	F6	F7	F8	F9	GSI
失眠
有	1.61±0.49	1.42±0.42	1.30±0.38	1.57±0.44	1.35±0.34	1.37±0.36	1.24±0.30	1.20±0.30	1.31±0.30	1.43±0.31
无	1.36±0.37	1.30±0.38	1.18±0.25	1.32±0.37	1.21±0.28	1.25±0.29	1.13±0.25	1.13±0.23	1.19±0.24	1.25±0.25
t 值	4.454	2.260	2.939	4.686	3.435	2.814	3.039	2.021	3.389	4.899
P 值	0.000	0.030	0.004	0.000	0.001	0.007	0.005	0.024	0.001	0.000
科恩系数	0.558	0.297	0.356	0.604	0.440	0.358	0.390	0.254	0.431	0.624
疲惫无力
有	1.56±0.46	1.38±0.38	1.24±0.27	1.47±0.38	1.30±0.32	1.33±0.32	1.17±0.23	1.17±0.25	1.26±0.24	1.36±0.27
无	1.26±0.30	1.28±0.42	1.21±0.37	1.31±0.45	1.19±0.28	1.25±0.33	1.17±0.34	1.12±0.26	1.19±0.30	1.24±0.30
t 值	5.474	1.887	0.720	2.931	2.681	1.843	0.000	1.469	1.980	3.180
P 值	0.000	0.054	0.472	0.002	0.006	0.064	0.838	0.101	0.048	0.002
科恩系数	0.737	0.254	0.097	0.395	0.361	0.248	0.000	0.198	0.267	0.428
呼吸困难
有	1.64±0.47	1.41±0.41	1.27±0.30	1.51±0.41	1.34±0.37	1.35±0.35	1.20±0.29	1.17±0.29	1.27±0.29	1.39±0.30
无	1.39±0.41	1.32±0.39	1.21±0.31	1.38±0.41	1.23±0.28	1.28±0.32	1.16±0.27	1.15±0.24	1.22±0.26	1.29±0.28
t 值	3.937	1.527	1.308	2.126	2.418	1.432	0.975	0.529	1.252	2.351
P 值	0.000	0.143	0.236	0.033	0.017	0.120	0.435	0.669	0.289	0.020
科恩系数	0.590	0.229	0.196	0.318	0.362	0.214	0.146	0.079	0.188	0.352
疼痛
有	1.56±0.50	1.29±0.35	1.21±0.26	1.43±0.36	1.28±0.31	1.32±0.34	1.15±0.22	1.15±0.25	1.25±0.23	1.33±0.27
无	1.39±0.38	1.38±0.42	1.23±0.34	1.40±0.44	1.25±0.31	1.29±0.32	1.18±0.30	1.15±0.26	1.23±0.29	1.31±0.29
t 值	2.946	–1.674	–0.470	0.535	0.714	0.677	–0.806	0.000	0.546	0.521
P 值	0.003	0.100	0.691	0.612	0.472	0.461	0.316	0.906	0.587	0.614
科恩系数	0.574	–0.228	–0.064	0.073	0.097	0.092	–0.110	0.000	0.074	0.071

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