老年肺癌患者围手术期生活质量状况及术后早期生活质量不良的危险因素

Perioperative quality of life and risk factors of poor early postoperative quality of life in elderly patients with lung cancer

【摘要】目的 调查老年肺癌患者围手术期生活质量,并分析术后早期生活质量不良的危险因素。方法 选取2021年9月至2023年9月河北北方学院附属第一医院胸心血管外科收治的155例行手术治疗的老年肺癌患者为研究对象,在术前、术后1周及术后1个月,对患者行问卷调查,最终回收有效问卷者142例。采用年龄校正查尔森合并症指数(aCCI)评估患者整体功能状态。在术前、术后1周及术后1个月,使用中文版肺癌患者生活质量测定量表(FACT-L)调查患者生活质量。在术后1周使用中文版安德森症状评估量表-肺癌模块评估患者症状群特点。以术后1周生活质量FACT-L总得分分组,将患者分为良好组74例(≥平均分)及不良组68例(＜平均分)。采用SPSS 24.0统计软件进行数据分析。采用logistic回归分析评估老年肺癌患者术后1周生活质量不良的危险因素。结果 术后1周时,老年肺癌患者FACT-L各维度评分及总分均显著低于术前及术后1个月(P＜0.05),术后1个月FACT-L各维度评分及总分与术前比较,差异无统计学意义(P＞0.05)。不良组吸烟史占比、aCCI＞5占比及气短、疲乏症状发生率均显著高于良好组,差异均有统计学意义(P＜0.05)。logistic回归分析显示,吸烟史(OR=3.425,95%CI 1.980～5.922；P＜0.05)、aCCI＞5(OR=2.627,95%CI 1.455～4.744；P＜0.05)、气短(OR=2.545,95%CI 1.284～5.043；P＜0.05)及疲乏(OR=3.086,95%CI 1.730～5.508；P＜0.05)均为老年肺癌患者术后1周生活质量不良的危险因素。结论 老年肺癌患者术后早期生活质量下降,但术后1个月可回升至术前水平。术后1周生活质量不良与吸烟史、基础状态差及术后气短、疲乏症状密切相关。

基金项目:张家口市重点研发计划(2221213D)

【Abstract】Objective To investigate the perioperative quality of life (QoL) and to analyze the risk factors of poor early postoperative QoL in elderly patients with lung cancer. Methods A total of 155 elderly lung cancer patients who received surgical treatment in the Department of Thoracic and Cardiovascular Surgery of the First Hospital Affiliated to Hebei North University from September 2021 to September 2023 were enrolled. A questionnaire survey was conducted among the patients before, one week after, and one month after surgery, and valid questionnaires were finally collected from 142 patients. Age-adjusted Charlson comorbidity index (aCCI) was used to assess overall functional status. The Chinese version of functional assessment of cancer therapy-lung cancer (FACT-L) was employed to assess QoL before, one week after, and one month after surgery. The Chinese version of Anderson symptom assessment scale-lung cancer module was used to evaluate the characteristics of symptom cluster one week after surgery. According to total score of FACT-L one week after surgery, the patients were divided into a good QoL group (n=74; ≥ average) and a poor QoL group (n=68; < average). SPSS 24.0 was used for statistical analysis, and logistic regression analysis was used to evaluate the risk factors of poor QoL one week after surgery. Results The scores of each dimension and total score of FACT-L in elderly lung cancer patients one week after surgery were significantly lower than those before surgery and one month after surgery (P<0.05), but there were no statistically significant differences in the these scores between one month after surgery and before surgery (P>0.05). The proportions of smoking history and aCCI>5, and the incidence of shortness of breath and fatigue in the poor QoL group were significantly higher than those in the good QoL group (P<0.05). Logistic regression analysis found that smoking history (OR=3.425,95%CI 1.980-5.922; P<0.05), aCCI>5 (OR=2.627,95%CI 1.455-4.744; P<0.05), shortness of breath (OR=2.545,95%CI 1.284-5.043; P<0.05) and fatigue (OR=3.086,95%CI 1.730-5.508; P<0.05) were risk factors of poor QoL in elderly lung cancer patients one week after surgery. Conclusion QoL in elderly lung cancer patients declines during the early postoperative period but recovers to the preoperative level one month after surgery. The poor QoL one week after surgery is closely related to smoking history, poor basic status and postoperative symptoms of shortness of breath and fatigue.

This work was supported by Zhangjiakou Key Research and Development Program (2221213D).