初诊乳腺癌患者睡眠障碍的纵向研究  

Longitudinal study on sleep disorders in newly diagnosed breast cancer patients

作　　者：王超 刘生敏 丁海玲 路明静 李玉丽[3] 刘娜 Wang Chao;Liu Shengmin;Ding Hailing;Lu Mingjing;Li Yuli;Liu Na(Operating Room,Shandong Provincial Third Hospital,Jinan 250031,China;School of Medicine,Qilu Institute of Technology,Jinan 250200,China;School of Nursing and Rehabilitation,Shandong University,Jinan 250012,China;Department of Minimally Invasive Tumor Therapy,Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,China)

机构地区：[1]山东省立第三医院手术室,济南250031 [2]齐鲁理工学院医学院,济南250200 [3]山东大学护理与康复学院,济南250012 [4]山东第一医科大学附属省立医院肿瘤微创治疗科,济南250012

出　　处：《中国实用护理杂志》2025年第10期734-740,共7页Chinese Journal of Practical Nursing

基　　金：国家自然科学基金青年科学基金项目(81903180);山东省本科教学改革研究项目(M2023161)。

摘　　要：目的探讨初诊乳腺癌患者睡眠障碍纵向变化轨迹及其影响因素,为制订改善乳腺癌患者睡眠质量的干预措施提供理论依据。方法采用纵向研究方法,利用方便抽样法选取2023年4月至2024年6月山东省立第三医院、山东第一医科大学附属省立医院初诊乳腺癌患者为研究对象,使用一般资料调查问卷、匹兹堡睡眠质量指数量表(PSQI)、癌症复发关注量表(CARS)、痛苦自我表露指数量表(DDI)进行调查。采用Kruskal-Wallis H检验、广义估计方程模型检验乳腺癌患者睡眠障碍情况及其影响因素。结果回收有效问卷473份。473例初诊乳腺癌患者中,女435例,男38例,年龄(49.5±11.0)岁。患者入院时CARS总分为(3.00±1.12)分,其中对死亡的担忧(0.71±0.67)分,对女性特征的担忧(0.81±0.72)分;入院时DDI总分为(27.00±10.03)分。入院时、出院时、出院后1个月PSQI总分分别为(15.34±3.05)、(12.12±3.01)、(10.13±1.78)分,3个时间点的PSQI总分比较差异有统计学意义(H=33.19,P<0.05)。入院时、出院时、出院后1个月3个时间点的PSQI总分与入院时CARS总分和对死亡的担忧、对女性特征的担忧维度得分均呈正相关(r值为0.42~0.79,均P<0.05),与入院时DDI总分呈负相关(r=-0.41、-0.37、-0.31,均P<0.05)。广义估计方程模型显示,女性(β=1.35,95%CI 0.27~2.30)、初中及以下文化程度(β=1.89,95%CI 0.24~3.19)、疼痛评分重度(β=1.72,95%CI 0.32~3.12)、疼痛评分中度(β=2.51,95%CI 0.37~4.66)、浸润性特殊癌(β=2.57,95%CI 1.67~4.07)、浸润性非特殊癌(β=2.11,95%CI 1.98~3.12)、对病情部分了解(β=1.91,95%CI 1.23~3.01)、对死亡的担忧(β=1.61,95%CI 0.17~2.78)、对女性特征的担忧(β=1.34,95%CI 0.37~2.15)正向预测初诊乳腺癌患者的睡眠质量指数(均P<0.05);非浸润性癌(β=-3.82,95%CI-6.79~-3.36)、病情不了解(β=-3.96,95%CI-7.09~-4.62)、DDI得分(β=-1.45,95%CI-2.14~-0.15)负向预测初诊乳腺癌患者的睡眠质量指数(均P<0.05)Objective To explore the longitudinal trajectory of sleep disorders and their influencing factors in newly diagnosed breast cancer patients,and provide theoretical basis for formulating intervention measures to improve sleep quality of breast cancer patients.MethodsA longitudinal study was conducted using convenience sampling to select newly diagnosed breast cancer patients from Shandong Provincial Third Hospital and Shandong First Medical University Affiliated Provincial Hospital from April 2023 to June 2024.General information questionnaires,the Pittsburgh Sleep Quality Index(PSQI),the Concerns About Recurrence Scale(CARS),and the Distress Disclosure Index(DDI)were used for the survey.The Kruskal-Wallis H test and generalized estimating equation models were used to examine sleep disorders and their influencing factors.ResultsA total of 473 valid questionnaires were collected.Among the 473 newly diagnosed breast cancer patients,435 were female and 38 were male,aged(49.5±11.0)years old.The CARS score at admission was(3.00±1.12)points,with concerns about death(0.71±0.67)points and concerns about female characteristics(0.81±0.72)points.The DDI score at admission was(27.00±10.03)points.The PSQI scores at admission,discharge,and one month after discharge were(15.34±3.05),(12.12±3.01),and(10.13±1.78)points,respectively,the difference was statistically significant(H=33.19,P<0.05).The PSQI scores at these three time points were positively correlated with the CARS score and concerns about death and female characteristics(r values were 0.42-0.79,all P<0.05),and negatively correlated with the DDI score(r=-0.41,-0.37,-0.31,all P<0.05).The generalized estimating equation model showed that female gender(β=1.35,95%CI 0.27-2.30),education level of junior high school or below(β=1.89,95%CI 0.24-3.19),severe pain(β=1.72,95%CI 0.32-3.12),moderate pain(β=2.51,95%CI 0.37-4.66),invasive special cancer(β=2.57,95%CI 1.67-4.07),invasive non-special cancer(β=2.11,95%CI 1.98-3.12),partial understanding of the condition(β=1.9

关 键 词：乳腺肿瘤 睡眠障碍 癌症复发恐惧 痛苦自我表露 纵向研究 

分 类 号：R737.9[医药卫生—肿瘤]