乳腺癌放化疗患者认知功能障碍的影响因素分析
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摘要
目的探讨乳腺癌放化疗患者发生认知功能障碍的影响因素。方法选取100例乳腺癌放化疗患者作为研究对象,对患者的基线资料进行问卷调查,应用蒙特利尔认知评估量表(MoCA)、一般性自我效能量表、心理弹性量表对患者的认知情况进行评估,并分析乳腺癌放化疗患者发生认知功能障碍的影响因素。结果100例乳腺癌放化疗患者中,认知功能障碍者24例,认知功能障碍的发生率为24%(24/100)。单因素分析结果显示,不同年龄、文化水平、婚姻状况、工作情况、放化疗不良反应程度、运动锻炼情况、自我效能水平、心理弹性水平乳腺癌放化疗患者的认知功能障碍发生情况比较,差异均有统计学意义(P﹤0.05);不同合并症情况、TNM分期、放化疗情况乳腺癌放化疗患者的认知功能障碍发生情况比较,差异均无统计学意义(P﹥0.05)。多因素分析结果显示,年龄≥60岁、放化疗不良反应程度为2～3级是乳腺癌放化疗患者发生认知功能障碍的危险因素(P﹤0.05),而运动锻炼≥3次/周、自我效能高等水平、心理弹性高等水平是乳腺癌放化疗患者发生认知功能障碍的保护因素(P﹤0.05)。结论乳腺癌放化疗患者认知功能障碍的发生与其年龄、放化疗不良反应程度、运动锻炼情况、自我效能和心理弹性水平有关,积极提高患者的自我效能和心理弹性水平有助于减轻患者的认知功能障碍,从而提高患者的生活质量。
Objective To investigate the factors influencing the cognitive dysfunction in breast cancer patients after radiotherapy and chemotherapy. Method A total of 100 patients with breast cancer undergoing radiotherapy and chemotherapy were enrolled in the study. The baseline data of the patients were investigated by questionnaire. The cognitive situation of breast cancer patients afterradiochemotherapy was analyzed using Montreal Cognitive Assessment Scale(MoCA), general self-efficacy scale and the psychological resilience scale, and analyse the factors influencing the cognitive dysfunction in these patients. Result Among 100 breast cancer patients undergoing radiotherapy and chemotherapy, 24 patients showed cognitive dysfunction, with an incidence rate of 24%(24/100). Univariate analysis showed that, the occurrence of cognitive dysfunction in breast cancer patients undergoing radiochemotherapy with different age, cultural level, marital status, work status, severity of adverse reactions to radiochemotherapy, exercise situation, self-efficacy level,and psychological resiliencelevel were statistically significant(P<0.05); while there was no significant differences in the occurrence of cognitive dysfunction in breast cancer patients undergoing radiochemotherapy with different comorbidities,TNM stage, or radiotherapy and chemotherapy status(P>0.05). Multivariate analysis showed that, age≥60 and grade 2-3 adverse reactions to radiochemotherapy were risk factors(P<0.05), while exercise frequency ≥3 times/week, high level of self-efficacy and high level of psychological resilience were protective factors for the occurrence of cognitive dysfunction in patients with breast cancer undergoing radiotherapy and chemotherapy(P<0.05). Conclusion The occurrence of cognitive dysfunction in patients with breast cancer undergoing radiotherapy and chemotherapy is related to age, severity of adverse reactions to radiochemotherapy, exercise situation, self-efficacy and psychological resilience level. Actively improving the patient's self-efficacy and psychological resilience can help alleviate patients' cognitive dysfunction, and improve the quality of life of patients.
Objective To investigate the factors influencing the cognitive dysfunction in breast cancer patients after radiotherapy and chemotherapy. Method A total of 100 patients with breast cancer undergoing radiotherapy and chemotherapy were enrolled in the study. The baseline data of the patients were investigated by questionnaire. The cognitive situation of breast cancer patients afterradiochemotherapy was analyzed using Montreal Cognitive Assessment Scale(MoCA), general self-efficacy scale and the psychological resilience scale, and analyse the factors influencing the cognitive dysfunction in these patients. Result Among 100 breast cancer patients undergoing radiotherapy and chemotherapy, 24 patients showed cognitive dysfunction, with an incidence rate of 24%(24/100). Univariate analysis showed that, the occurrence of cognitive dysfunction in breast cancer patients undergoing radiochemotherapy with different age, cultural level, marital status, work status, severity of adverse reactions to radiochemotherapy, exercise situation, self-efficacy level,and psychological resiliencelevel were statistically significant(P<0.05); while there was no significant differences in the occurrence of cognitive dysfunction in breast cancer patients undergoing radiochemotherapy with different comorbidities,TNM stage, or radiotherapy and chemotherapy status(P>0.05). Multivariate analysis showed that, age≥60 and grade 2-3 adverse reactions to radiochemotherapy were risk factors(P<0.05), while exercise frequency ≥3 times/week, high level of self-efficacy and high level of psychological resilience were protective factors for the occurrence of cognitive dysfunction in patients with breast cancer undergoing radiotherapy and chemotherapy(P<0.05). Conclusion The occurrence of cognitive dysfunction in patients with breast cancer undergoing radiotherapy and chemotherapy is related to age, severity of adverse reactions to radiochemotherapy, exercise situation, self-efficacy and psychological resilience level. Actively improving the patient's self-efficacy and psychological resilience can help alleviate patients' cognitive dysfunction, and improve the quality of life of patients.
引文
[1]陈海珍,张兰凤,陈建国.健康信念模式在乳腺癌根治术后放化疗患者中的应用[J].齐鲁护理杂志, 2014, 20(22):115-116.
[2]郑燕梅,罗斌.乳腺癌化疗相关认知功能障碍研究进展[J/OL].中华临床医师杂志(电子版), 2015, 9(1):105-110.[2018-04-01]. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zhlcyszz201501023.
[3]柴丽君,祁川川,何真,等.乳腺癌化疗后轻度认知功能障碍的行为干预[J].中国实用神经疾病杂志, 2017, 20(17):94-95; 101.
[4]柴丽君.认知行为干预对乳腺癌术后化疗患者记忆能力的影响[D].郑州:郑州大学, 2017.
[5]李洁.乳腺癌患者认知功能受损及其预测因素的研究[D].济南:山东大学, 2014.
[6]张立秀,刘雪琴.蒙特利尔认知评估量表中文版的信效度研究[J].护理研究, 2007, 21(31):2906-2907.
[7] Schwarzer R, Aristi B. Optimistic self-beliefs:assessmentof general perceived self-efficacy in thirteen cultures[J].Word Psychol, 1997, 3(1-2):177-190.
[8]心理弹性量表中文版在医学生中的信效度检验[J].中国健康心理学杂志, 2016, 24(8):1209-1212.
[9] Sato C, Sekiguchi A, Kawai M, et al. Postoperative structur-al brain changes and cognitive dysfunction in patients withbreast cancer[J]. PLoS One, 2015, 10(11):e0140655.
[10] Lange M, Joly F. How to identify and manage cognitivedysfunction after breast cancer treatment[J]. J OncolPract, 2017, 13(12):784-790.
[11] Hermelink K, Bühner M, Sckopke P, et al. Chemotherapyand post-traumatic stress in the causation of cognitive dys-function in breast cancer patients[J]. J Natl Cancer Inst,2017, 109(10):djx057.
[12] Koleck TA, Bender CM, Clark BZ, et al. An exploratorystudy of host polymorphisms in genes that clinically char-acterize breast cancer tumors and pretreatment cognitiveperformance in breast cancer survivors[J]. Breast Cancer(Dove Med Press), 2017, 9:95-110.
[13]唐霓,张莹莹,高云.术前轻度抑郁症状对老年患者术后认知功能障碍的影响[J].重庆医学, 2014, 43(3):329-331.
[14]陆靖,史铁英,李鹤.乳腺癌患者创伤后成长与心理弹性、社会支持和自我效能的相关性研究[J].中国实用护理杂志, 2015, 31(16):1171-1174.
[15]张璠,孟鑫,叶萍.乳腺癌患者心理弹性及影响因素的研究[J].中华护理杂志, 2015, 50(9):1087-1090.
[2]郑燕梅,罗斌.乳腺癌化疗相关认知功能障碍研究进展[J/OL].中华临床医师杂志(电子版), 2015, 9(1):105-110.[2018-04-01]. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zhlcyszz201501023.
[3]柴丽君,祁川川,何真,等.乳腺癌化疗后轻度认知功能障碍的行为干预[J].中国实用神经疾病杂志, 2017, 20(17):94-95; 101.
[4]柴丽君.认知行为干预对乳腺癌术后化疗患者记忆能力的影响[D].郑州:郑州大学, 2017.
[5]李洁.乳腺癌患者认知功能受损及其预测因素的研究[D].济南:山东大学, 2014.
[6]张立秀,刘雪琴.蒙特利尔认知评估量表中文版的信效度研究[J].护理研究, 2007, 21(31):2906-2907.
[7] Schwarzer R, Aristi B. Optimistic self-beliefs:assessmentof general perceived self-efficacy in thirteen cultures[J].Word Psychol, 1997, 3(1-2):177-190.
[8]心理弹性量表中文版在医学生中的信效度检验[J].中国健康心理学杂志, 2016, 24(8):1209-1212.
[9] Sato C, Sekiguchi A, Kawai M, et al. Postoperative structur-al brain changes and cognitive dysfunction in patients withbreast cancer[J]. PLoS One, 2015, 10(11):e0140655.
[10] Lange M, Joly F. How to identify and manage cognitivedysfunction after breast cancer treatment[J]. J OncolPract, 2017, 13(12):784-790.
[11] Hermelink K, Bühner M, Sckopke P, et al. Chemotherapyand post-traumatic stress in the causation of cognitive dys-function in breast cancer patients[J]. J Natl Cancer Inst,2017, 109(10):djx057.
[12] Koleck TA, Bender CM, Clark BZ, et al. An exploratorystudy of host polymorphisms in genes that clinically char-acterize breast cancer tumors and pretreatment cognitiveperformance in breast cancer survivors[J]. Breast Cancer(Dove Med Press), 2017, 9:95-110.
[13]唐霓,张莹莹,高云.术前轻度抑郁症状对老年患者术后认知功能障碍的影响[J].重庆医学, 2014, 43(3):329-331.
[14]陆靖,史铁英,李鹤.乳腺癌患者创伤后成长与心理弹性、社会支持和自我效能的相关性研究[J].中国实用护理杂志, 2015, 31(16):1171-1174.
[15]张璠,孟鑫,叶萍.乳腺癌患者心理弹性及影响因素的研究[J].中华护理杂志, 2015, 50(9):1087-1090.