陈瑜 黄道琼 俞人悦 贺彩芳 孙彩霞

[摘要] 目的 了解影响肝癌介入患者安宁的因素及影响程度。 方法 选择2018年1月至2020年1月期间在我院介入科行介入手术的患者，收集202例患者的焦虑程度、抑郁程度、恐惧程度、病程长短、疼痛程度、不适程度、经济收入、家庭负担、就医负担、活动能力、病耻感及社会支持12项数据，构建相应的结构方程。 结果 所建的结构方程符合预期构想，其中χ2自由度比CMIN/DF=1.700<3.000，近似误差均方根RMSEA=0.059<0.080，拟合优度指数GFI=0.944>0.900。安宁=0.398×经济收入-0.397×抑郁程度-0.286×家庭负担-0.264×就医负担-0.261×病耻感-0.239×焦虑程度-0.189×病程长短-0.142×不适程-0.110×疼痛程度+0.069×活动能力-0.060×恐惧程度+0.009×社会支持。 结论 所建的结构方程可供肝癌介入患者照护参考。

[关键词] 肝癌患者;介入治疗;患者安宁;结构方程;肝肿瘤;姑息疗法;患者舒适度;统计模型

[中图分类号] R735.7          [文献标识码] B          [文章编号] 1673-9701（2021）32-0113-04

[Abstract] Objective To understand the factors influencing the hospice care of patients undergoing liver cancer intervention and their degree of impact. Methods Patients who underwent interventional surgery in the Interventional Department of our hospital from January 2018 to January 2020 were selected. 12 items of data of 202 patients were collected including anxiety degree， depression degree， fear degree， course of disease， pain degree， discomfort degree， economic income， family burden， medical care burden， activity ability， illness stigma and social support， so as to construct the corresponding structural equation. Results The constructed structural equation conformed to the expected conception， in which the chi squre/degree of freedom ratio CMIN/DF=1.700<3.000. The root mean square error of approximation RMSEA=0.059<0.080， and the goodness-of-fit index GFI=0.944>0.900. Hospice care=0.398×economic income-0.397×depression degree-0.286×family burden-0.264×medical care burden -0.261×illness stigma -0.239×anxiety degree -0.189×course of disease -0.142×discomfort degree -0.110×pain degree+0.069× activity ability-0.060×fear degree +0.009×social support. Conclusion The constructed structural equation can be used as a reference for the care of patients undergoing liver cancer intervention.

[Key words] Patients with liver cancer; Interventional therapy; Patient hospice care; Structural equation; Liver tumors; Palliative therapy; Patient comfort; Statistical model

原發性肝癌是全球常见的恶性肿瘤之一[1]，具有起病症状隐匿、发病初期症状不显著的特点。据调查，近年来，我国每年新发肝癌病例46.6万例，占全球总数的50%以上，给家庭和社会带来沉重的负担[2-4]。部分肝癌患者瘤体较大，不适合手术切除，可采取介入治疗[5]。介入治疗是把导管通过外周动脉血管延伸到肿瘤附近，使化疗药物直接作用于肝癌细胞，或者在肝癌附近灌注碘油、栓塞剂或明胶海绵，阻塞供应肝癌细胞的小血管，使肝癌细胞在人体内因缺血而坏死，以达到控制疾病进展、延长生命的目的[6]。肝癌介入患者通常需要多次手术，屡遭疾病、治疗、心理压力等打击，从而陷入痛苦境地，因此，如何减轻痛苦，提高安宁体验成为这类人群的主要照护目标[7-8]。……