目的：调查肺癌患者化疗期间癌因性失眠（ CRI）现状，分析其与肿瘤相关症状间的关系。方法采用便利抽样法选择2014年2—9月在天津医科大学肿瘤医院肺部肿瘤科、放疗科住院的肺癌患者180例进行问卷调查。回收有效问卷155份（肿瘤组），有效率为86.1％。采用一般资料问卷、匹兹堡睡眠质量指数（ PSQI）问卷和安德森症状评估量表-肺癌（ MADSI-L）问卷。将肺癌患者按照PSQI得分分为CRI组（ PSQI得分＞7分）和正常组（ PSQI得分≤7分）。比较肺癌化疗患者与国内常模PSQI问卷各项因子（睡眠质量、入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能障碍）得分、 PSQI得分情况；分析PSQI得分与MDASI-L问卷各症状相关性；比较正常组与CRI组MDASI-L问卷各症状发生率、发生强度。结果肺癌化疗患者CRI发生率为68.4％（106／155），肺癌组患者PSQI问卷各项因子得分、 PSQI得分均高于国内常模（ P＜0.05）。肺癌化疗患者PSQI得分与疲劳、苦恼、食欲减退、麻木感、气短、恶心、疼痛、体质量下降、便秘、胸闷、呕吐症状存在相关性（P＜0.05）。 CRI组MDASI-L问卷恶心、气短发生率高于正常组（ P＜0.05）；两组其余MDASI-L问卷相关症状发生率比较，差异无统计学意义（ P＞0.05）。 CRI组MDASI-L问卷疲劳、恶心、苦恼、气短、食欲减退、便秘发生强度重于正常组（P＜0.05）；两组其余MDASI-L问卷相关症状发生强度比较，差异无统计学意义（ P＞0.05）。结论肺癌患者化疗期间CRI发生率较高，医务人员需关注对肺癌合并CRI患者疲劳、恶心、苦恼、气短、食欲减退、便秘症状的评估和预防； CRI的改善有望降低肿瘤相关症状的程度。%Objective To investigate the status of cancer -related insomnia ( CRI ) in patients with lung cancer during chemotherapy and its relationship with relevant symptoms of tumor.Methods Using convenience sampling method, the study enrolled 180 inpatients with lung cancer from the Oncology Department and the Radiotherapy Department of Tumor Hospital of Tianjin Medical Hospital from February to September 2014.Questionnaire survey was conducted with the patients.A total of 155 questionnaires were collected, with an effective returning rate of 86.1%.The questionnaire survey included a questionnaire of general data, the Pittsburgh sleep quality index ( PSQI) questionnaire and the MD Anderson symptom inventory-lung cancer (MDASI-L) questionnaire.According to PSQI score, the patients were divided into CRI group (PSQI>7) and normal group ( PSQI≤7) .Comparison was conducted between the patients and national norms in the scores of PSQI factors ( including sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleeping disturbance, use of sleeping medication, daytime dysfunction) and PSQI score; the correlation between PSQI score and each MDASI-L symptom was analyzed; comparison was made between the normal group and CRI group in the incidence and severity of each MDASI-L symptom.Results The incidence of CRI among the lung canar patients during chemotherapy was 68.4% ( 106/155 ) .The lung canar patients during chemotherapy were higher than the national norms in the score of each PSQI factor and PSQI score ( P<0.05 ) .Significant correlation was noted between PSQI score and fatigue, distress, loss of appetite, numbness, being short of breath, nausea, pain, loss of weight, constipation, chest congestion, and vomiting ( P<0.05 ) .The CRI group was higher than the normal group in the incidence of nausea and being short of breath ( P<0.05 ); two symptoms in MDASI-L questionnaire; the two groups were not significantly different in other MDASI-L symptoms ( P>0.05 ) .The CRI group was severer than the normal group in fatigue, nausea, distress, being short of breath, loss of appetite and conspitation ( P<0.05 ); the two groups were not significantly different in the severity of other MDASI-L symptoms (P>0.05) .Conclusion The incidence of CRI in lung cancer patients during chemotherapy is high.Cancer -related symptoms, including fatigue, nausea, distress, being short of breath, loss of appetite and constipation, should be assessed and precautioned.The alleviation of CRI may mitigate relevant symptoms of tumor.
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