口腔癌围手术期患者的症状负担发展轨迹及其影响因素分析

蔡雅亿; 徐冬冬; 王艺静

doi:10.16766/j.cnki.issn.1674-4152.004313

口腔癌围手术期患者的症状负担发展轨迹及其影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.004313

1.
温州医科大学附属口腔医院口腔颌面外科, 浙江温州 325000
2.
温州医科大学附属第一医院口腔科, 浙江温州 325000

基金项目:

浙江省自然科学基金项目 LBQ20H140001

详细信息

通讯作者:
王艺静，E-mail：wyijing_ok@126.com

中图分类号: R739.8 R473.73
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- 文章访问数: 10
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- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2024-10-28
- 网络出版日期: 2026-03-13

Analysis of the development trajectory and influencing factors of symptom burden in perioperative patients with oral cancer

1.
Department of Oral and Maxillofacial Surgery, Stomatology Hospital Affiliated to Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的调查不同阶段口腔癌围手术期患者的症状负担状况及动态变化，为临床工作人员制定症状管理策略提供依据。方法选取2021年1月—2023年12月于温州医科大学附属口腔医院及温州医科大学附属第一医院因诊断为口腔癌进行手术治疗的210例患者为研究对象。采用自制问卷、营养风险筛查2002及MD Anderson症状量表-头颈部模块-中文版量表分别在术前(T1)、术后7 d(T2)和出院后1个月(T3)对患者进行评估。采用广义估计方程分析口腔癌患者围手术期症状负担的变化轨迹及影响因素。结果 T1时间节点有210份有效问卷、T2时间节点有207份有效问卷、T3时间节点有193份有效问卷。T1时间节点：显著存在的症状及发生率依次为疼痛(70.48%)、吞咽/咀嚼困难(59.52%)、口腔溃疡(57.62%)。T2时间节点：显著存在的症状及发生率依次为吞咽/咀嚼困难(89.85%)、说话困难(89.37%)、黏液问题(83.09%)。T3时间节点：显著存在的症状及发生率依次为麻木/刺痛(89.12%)、吞咽/咀嚼困难(88.60%)、说话困难(88.60%)。广义估计方程结果显示：合并症、晚期、NRS评分较高、接受辅助治疗的患者症状负担水平均较高(P＜0.05)。结论口腔癌围手术期患者症状负担发生率较高，且症状负担随时间变化。应加强对合并症、肿瘤Ⅳ期、有营养风险的口腔癌患者症状负担的评估、监测和管理。
- 口腔癌 /
- 围手术期 /
- 症状负担 /
- 纵向研究 /
- 影响因素
Abstract: Objective To investigate the status and evolutions of symptom burden among perioperative oral cancer patients at different stages of treatment, and to provide a scientific basis for developing targeted symptom management strategies. Methods A total of 210 patients diagnosed with oral cancer who underwent surgical treatment at the Affiliated Stomatology Hospital of Wenzhou Medical University and the First Affiliated Hospital of Wenzhou Medical University from January 2021 to December 2023 were selected as the study objects. Data were collected using self-designed questionnaires, the nutritional risk screening 2002, and the MD Anderson symptom scale-head and neck module (Chinese version). Assessments were conducted at three time points: before surgery (T1), 7 days after surgery (T2), and 1 month after discharge (T3). The trajectory and influencing factors of perioperative symptom burden in patients with oral cancer were analyzed by generalized estimation equation. Results A total of 210, 207, and 193 valid questionnaires were collected at T1, T2, and T3, respectively. At T1, the most common symptoms were pain (70.48%), difficulty in swallowing/chewing (59.52%), and mouth ulcers (57.62%). At T2, the predominant symptoms were difficulty in swallowing/chewing (89.85%), difficulty in speaking (89.37%), and mucus problems (83.09%). At T3, the main symptoms were numbness/tingling (89.12%), difficulty in swallowing/chewing (88.60%), and difficulty in speaking (88.60%). The results of generalized estimation equation showed that patients with occupational status as individuals, comorbidities, advanced stage, higher NRS score, and receiving adjuvant therapy experienced higher symptom burden (P < 0.05). Conclusion Perioperative oral cancer patients experience a high dynamic symptom burden that varies across disease stages. Clinical staff should strengthen the assessment, monitoring, and management of symptom burden, particularly for patients with comorbidities, stage Ⅳ disease, or oral nutritional risk, to improve overall postoperative outcomes.
- Oral cancer /
- Perioperative period /
- Symptom burden /
- Longitudinal study /
- Influencing factor

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图 1 口腔癌患者T1~T3时间节点症状负担变化情况

Figure 1. Changes in symptom burden at T1-T3 time points in oral cancer patients

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表 1 口腔癌患者3个时间点的症状发生率[例(%)]

Table 1. Symptom prevalence and severity at 3 time points in patients with oral cancer

症状	T1(n=210)	T2(n=207)	T3(n=193)
疼痛	148(70.48)	152(73.43)	70(36.27)
疲劳	92(43.81)	149(71.98)	124(64.25)
恶心	32(15.24)	44(21.25)	24(12.44)
睡眠障碍	91(43.33)	163(78.74)	95(49.22)
心理痛苦	95(45.24)	157(75.85)	152(78.76)
气促	30(14.29)	45(21.74)	28(14.51)
记忆力下降	64(30.48)	58(28.02)	77(39.90)
食欲不振	66(31.43)	63(30.43)	50(25.91)
昏昏欲睡	86(40.95)	150(72.46)	122(63.21)
口干	96(45.71)	160(77.29)	138(71.50)
悲伤	74(35.24)	107(51.69)	68(35.23)
呕吐	16(7.62)	32(15.46)	22(11.40)
麻木/刺痛	67(31.90)	135(65.22)	172(89.12)
黏液	113(53.81)	172(83.09)	143(74.09)
吞咽/咀嚼困难	125(59.52)	186(89.85)	171(88.60)
窒息/咳嗽	53(25.24)	38(18.36)	49(25.39)
说话困难	81(38.57)	185(89.37)	171(88.60)
皮肤损伤	40(19.05)	49(23.67)	47(24.35)
便秘	47(22.38)	46(22.22)	59(30.57)
味觉改变	44(20.95)	50(24.15)	73(37.82)
口腔溃疡	121(57.62)	137(66.18)	79(40.93)
牙齿/牙龈改变	115(54.76)	119(57.49)	126(65.28)

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表 2 影响症状负担因素的广义估计方程参数估计结果

Table 2. Parameter estimates of generalized estimating equations for factors affecting symptom distress

项目	B	SE	Waldχ²	P值	95% CI
时间点
T2	17.741	2.572	47.886	＜0.001	12.726~22.947
T3	2.633	1.856	2.044	0.152	-0.996~6.286
性别
女性	0.724	5.533	0.016	0.896	-10.134~112.602
年龄(岁)
45~59	0.567	4.136	0.018	0.892	-7.542~8.682
≥60	-3.224	5.746	0.317	0.573	-14.459~8.052
文化程度
初中	1.628	3.105	0.274	0.599	-4.455~7.715
高中	4.749	3.633	1.708	0.192	-2.373~11.872
专科及以上	-1.221	7.183	0.028	0.864	-15.294~12.853
婚姻状况
有配偶	11.358	9.015	1.583	0.209	-6.322~28.894
居住地
乡镇	-1.593	4.685	0.116	0.733	-10.786~7.595
城市	-1.565	3.664	0.183	0.671	-8.750~5.622
职业
农民	5.286	3.537	2.235	0.136	-1.646~12.224
职员	-2.205	6.269	0.123	0.725	-14.493~10.082
已退休	-4.750	4.905	0.937	0.332	-14.360~4.862
个体	11.345	7.373	2.369	0.131	0.811~21.879
收入水平(元)
3 000~6 000	1.535	2.813	0.298	0.587	-3.984~7.052
＞6 000	2.608	3.650	0.511	0.474	-4.546~9.760
保险类型
居民医保	-10.533	8.652	1.485	0.221	-27.384~6.552
职工医保	-7.295	9.468	0.592	0.440	-25.852~11.262
吸烟
是	-6.468	4.761	1.847	0.173	-15.795~2.863
饮酒
是	-1.778	4.270	1.175	0.672	-10.152~6.589
合并症
有	12.126	3.668	10.925	0.001	4.936~19.316
肿瘤分期
Ⅱ	6.715	3.216	4.360	0.036	0.412~13.023
Ⅲ	7.676	3.523	4.736	0.029	0.763~14.595
Ⅳ	13.870	3.337	17.265	＜0.001	7.327~20.422
气管切开
是	1.442	3.202	0.204	0.650	-4.830~7.717
接受辅助治疗
是	6.789	3.258	4.341	0.037	0.401~13.177
体重指数	-0.665	0.514	1.662	0.197	-1.676~0.347
NRS营养风险筛查	3.680	1.040	12.530	＜0.001	1.643~5.715
注：以时间点(T1)、性别(男性)、年龄(＜45岁)、文化程度(小学及以下)、婚姻状况(无配偶)、居住地(农村)、职业(工人)、收入水平(＜3 000元)、保险类型(无)、吸烟(否)、饮酒(否)、合并症(无)、肿瘤分期(Ⅰ期)、气管切开(否)、接受辅助治疗(否)为参照。

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