Effect of Early Interventional Palliative Treatment on Pain and Anxiety in Patients with Hepatitis-Related Liver Cancer
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摘要:
目的 探索整合姑息治疗后减轻肝癌患者疼痛及焦虑的影响。 方法 选取60名昆明市第三人民医院肝炎相关性肝癌患者并记录基本情况，患者分为标准治疗组30例（对照组）和姑息介入治疗组（研究组）30例，进行介入治疗后对2组患者分别进行疼痛量表和焦虑量表测评，研究组加入姑息治疗，12周后对2组患者进行2个量表测评，对比2组患者12周前后疼痛及焦虑评分，分析影响肝炎相关性肝癌患者疼痛及抑郁的因素，分析有关因素在2组患者疼痛及焦虑评分之间的相关性。 结果 年龄、性别、文化程度、吸烟史、酗酒史、医保类型、肝功能分级、肝炎类型在2个治疗组之间，差异无统计学意义（P > 0.05）；家庭背景、既往有无疼痛史、肿瘤分期、ECOG评分、治疗前NRS评分、治疗后NRS评分、治疗前焦虑评分及治疗后焦虑评分在2个治疗组之间差异有统计学意义（ P < 0.05）。通过配对样本 t检验对显著因素分析后得出12周后对照组的患者疼痛、焦虑评分明显高于研究组（P < 0.05）。 结论 姑息治疗联合标准治疗对于缓解疼痛及焦虑有明显效果，并且越早进入姑息治疗程序对患者疼痛、焦虑的改善更有优势，因此姑息治疗不仅限于晚期肝癌患者。 Abstract:Objective To explore the effect of integrating palliative care to reduce the pain and anxiety symptoms of liver cancer patients. Methods 60 patients with hepatitis related liver cancer in Kunming Third People’s Hospital were divided into standard treatment group （control group） （n = 30） and palliative interventional treatment group （n = 30） （study group）. The control group received interventional treatment, and the study group received interventional treatment plus palliative treatment. Patients in the two groups were evaluated by pain scale and anxiety scale respectively after interventional treatment. After 12 weeks, the two groups were evaluated again with the scales mentioned above, and the pain and anxiety scores of the two groups were compared before and after 12 weeks, to analyze the factors influencing the pain and depression in patients with hepatitis related liver cancer, and to analyze the correlation between the related factors in the pain and anxiety scores of the two groups. Results There was no statistical significance in age, sex, education level, smoking history, alcoholism history, medical insurance type, liver function grade and hepatitis type between the two treatment groups （P > 0.05）. There were statistically significant differences in family background, pain history, tumor stage, ECOG score, NRS score before treatment, NRS score after treatment, anxiety score before treatment and anxiety score after treatment between the 2 treatment groups （ P < 0.05）. After 12 weeks of treatment, the pain and anxiety scores of the patients in the control group were significantly higher than those in the research group （ P < 0.05）. Conclusion Palliative care combined with standard treatment has significant effects on alleviating pain and anxiety, and the earlier the palliative care program is entered, the better the improvement of patients’ pain and anxiety. Therefore, palliative care is not limited to patients with advanced liver cancer. -
Key words:
- Liver cancer /
- Interventional therapy /
- Palliative care /
- Pain /
- Anxiety /
- Impact analysis
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表 1 患者的基线特征[n（%）]
Table 1. Patient's baseline characteristics [n（%）]
项目 基本特征 对照组n = 30 研究组n = 30 χ2 P 年龄（岁） ≤50 7（23.3） 8（26.7） 0.550 0.76 50-65 19（63.3） 16（53.3） > 65 4（13.3） 6（20.0） 性别 男 19（63.3） 22（36.7） 1.518 0.351 女 11（73.3） 8（26.7） 文化程度 小学 6（20.0） 8（26.7） 1.663 0.87 初中 13（43.3） 13（43.3） 高中及以上 11（36.7） 9（30.0） 家庭背景 和谐 23（76.7） 26（86.7） 7.868 0.01* 离异 6（20.0） 1（3.3） 未婚 1（3.3） 3（10.0） 吸烟史（≥10 a） 有 21（70.0） 24（80.0） 1.947 0.29 无 9（30.0） 6（20.0） 酗酒史（≥10 a） 有 5（16.7） 7（23.3） 1.724 0.31 无 25（83.3） 23（76.7） 医保类型 职工医保 12（40.0） 8（26.7） 2.173 0.21 居民医保 15（50.0） 21（70.0） 自费 3（10.0） 1（3.3） 肝炎类型 乙肝 19（63.3） 20（66.7） 2.771 0.16 丙肝 10（33.3） 3（10.0） 乙肝、丙肝 1（3.3） 7（23.3） 肝癌类型 肝细胞肝癌 28（93.3） 23（76.7） 6.649 0.03* 胆管细胞肝癌 1（3.3） 5（16.7） 混合细胞肝癌 1（3.3） 2（6.7） 分期 I期 5（16.7） 0 24.915 < 0.001 * II期 20（66.7） 14（46.7） III期 3（10.0） 2（6.7） IV期 2（3.4） 14（46.7） ECOG评分 0 14（46.6） 6（20.0） 96.024 < 0.001 * 1 11（36.7） 14（33.3） 2 5（16.7） 10（30.0） 肝功能分级 A级 27（90.0） 23（76.7） 1.947 0.27 B级 3（10.0） 7（23.3） 既往有无疼痛 有 7（23.3） 18（60.0） 8.326 0.005* 无 23（76.7） 12（40.0） 治疗前NRS评分 ≤2分 25（83.3） 4（13.3） 57.884 < 0.001 * > 2分 5（16.7） 26（86.7） 治疗后NRS评分 ≤2分 26（86.7） 28（93.3） 7.258 0.02* > 2分 4（13.3） 2（6.7） 治疗前
焦虑评分< 50 7（23.3） 5（16.7） 56.694 < 0.001 * 50～59分 11（36.6） 4（13.3） 60～69分 9（30.1） 19（63.3） > 69 3（10.0） 2（6.7） 治疗后
焦虑评分< 50 8（26.7） 7（23.3） 9.124 0.003* 50～59分 6（20.0） 15（50.0） 60～69分 11（36.7） 2（6.7） > 69 5（16.7） 6（20.0） *P < 0.05。 
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表 2 治疗12周后2组患者焦虑与疼痛比较分组（ $ \bar x \pm s $）
Table 2. After 12 weeks of treatment，the anxiety and pain of the two groups of patients were compared and divided into groups （ $ \bar x \pm s $）
分组 焦虑量表评分 疼痛量表评分 2组之间的差异（95%CI） t P 对照组 0.47 ± 0.01 0.74 ± 0.89 0.59（0.48-0.70） 6.64 < 0.001 * 研究组 0.53 ± 0.12 0.82 ± 1.02 0.84（0.62-1.05） 7.08 < 0.001 * *P < 0.05。
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