Correlation between self-management ability, psychological resilience, and complications in cervical cancer patients undergoing chemotherapy via PICC
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摘要:
目的 分析宫颈癌经外周静脉置入中心静脉导管（PICC）化疗患者的自我管理能力、心理弹性水平与导管相关并发症发生风险之间的关联性。 方法 收集2022年1月—2025年1月江苏省肿瘤医院收治的120例宫颈癌PICC置管化疗患者的临床资料并进行回顾性分析，按PICC置管1个月后并发症发生情况将患者分为无并发症组（95例）、并发症组（25例）。采用自我管理能力量表（SUPPH)、心理弹性量表（CD-RISC）评估患者的自我管理能力、心理弹性，采用二元logistic回归模型分析宫颈癌PICC置管化疗患者发生并发症的影响因素，采用Pearson相关分析宫颈癌PICC置管化疗患者自我管理能力与心理弹性的相关性。 结果 120例宫颈癌PICC置管化疗患者发生并发症25例（20.8%），其中最主要的并发症为感染[9例（7.5%）]，有3例患者发生2种及以上并发症。120例患者CD-RISC总分为33~66（48.59±7.38）分；SUPPH总分为54~111（82.86± 10.13）分。Logistic回归模型结果显示，年龄不是宫颈癌PICC置管化疗患者发生并发症的影响因素（P>0.05），化疗次数>5次、CD-RISC评分、SUPPH评分均是宫颈癌PICC置管化疗患者发生并发症的影响因素（P < 0.05）。Pearson相关分析显示，宫颈癌PICC置管化疗患者CD-RISC评分与SUPPH评分呈正相关关系（r=0.870，P < 0.001）。 结论 宫颈癌PICC置管化疗患者的并发症主要类型为感染，患者自我管理能力和心理弹性水平与并发症的发生密切相关，化疗次数>5次、较低的CD-RISC评分和SUPPH评分均是并发症发生的独立危险因素。 Abstract:Objective To analyze the correlation between self-management ability, psychological resilience level, and the risk of complications in chemotherapy patients with peripherally inserted central catheter (PICC) for cervical cancer, and to provide evidence for the development of targeted nursing strategies. Methods Between January 2022 and January 2025, a retrospective analysis was conducted on 120 patients with cervical cancer treated with PICC catheterization in Jiangsu Cancer Hospital. The patients were divided into a no-complication group (n=95) and a complication group (n=25) according to the occurrence of complications within one month after PICC tube placement. The self-management ability and psychological resilience were assessed used the strategies used by people to promote health (SUPPH) and the connor-davidson resilience scale (CD-RISC), respectively. The factors influencing complications in patients with cervical cancer PICC tube placement chemotherapy were analyzed by binary logistic regression model. The correlation between self-management ability (SUPPH score) and psychological resilience (CD-RISC score) of patients with cervical cancer PICC tube placement chemotherapy was analyzed by Pearson correlation. Results Complications occurred in 25 cases (20.8%) of 120 patients with cervical cancer PICC tube placement chemotherapy, with infection being the most common type (7.5%, 9 cases). Three patients experienced 2 or more complications. The total CD-RISC score ranged from 33 to 66, with a mean of 48.59±7.38, while the total SUPPH score ranged from 54 to 111, with a mean of 82.86±10.13. Binary logistic regression showed that age was not significantly associated with the occurrence of complications in patients undergoing PICC tube placement chemotherapy for cervical cancer (P>0.05). However, receiving more than 5 chemotherapy treatments, lower CD-RISC scores, and lower SUPPH scores were significantly associated with an increased risk of complications in patients undergoing PICC tube placement chemotherapy for cervical cancer (P < 0.05). Pearson's correlation analysis showed that CD-RISC score was positively correlated with SUPPH score in patients with cervical cancer PICC tube placement chemotherapy (r=0.870, P < 0.001). Conclusion The main type of complications in patients with PICC tube placement chemotherapy for cervical cancer is infection. Self-management ability and level of psychological resilience are closely related to the occurrence of complications. More than five chemotherapy treatments, lower CD-RISC scores, and SUPPH scores are the independent risk factors for the occurrence of complications. -
表 1 宫颈癌PICC置管化疗患者并发症发生情况
Table 1. Complication occurrence in patients with cervical cancer undergoing chemotherapy via PICC catheter insertion
种类 发生(例) 轻度(例) 中度(例) 占比(%) 感染 9 7 2 7.5 导管堵塞 5 4 1 4.2 静脉血栓 6 5 1 5.0 穿刺点渗液 5 3 2 4.2 静脉炎 3 2 1 2.5 总发生 25 18 7 20.8 
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表 2 宫颈癌PICC置管化疗患者自我管理能力、心理弹性得分情况
Table 2. The self-management ability and psychological resilience scores of patients with cervical cancer undergoing chemotherapy via PICC catheter insertion
项目 得分(x±s，分) CD-RISC量表 自强 15.23±3.30 坚韧 22.03±3.88 乐观 11.33±1.95 CD-RISC总分 48.59±7.38 SUPPH评分 减轻压力 54.93±8.35 积极态度 15.48±2.62 决策 12.46±2.59 SUPPH总分 82.86±10.13
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表 3 2组宫颈癌PICC置管化疗患者临床资料比较
Table 3. Comparison of clinical data of 2 groups of patients with cervical cancer undergoing PICC catheterization for chemotherapy
项目 无并发症
(n=95)并发症组
(n=25)统计量 P值 年龄[例(%)] 3.336a < 0.001 < 40岁 61(64.2) 8(32.0) 40~60岁 19(20.0) 5(20.0) >60岁 15(15.8) 12(48.0) 教育程度[例(%)] 0.757a 0.454 初中及以下 18(18.9) 4(16.0) 高中 34(35.8) 13(52.0) 大专及以上 43(45.3) 8(32.0) 婚姻状况[例(%)] 0.590b 0.442 已婚 45(47.4) 14(56.0) 离异或丧偶 50(52.6) 11(44.0) 病理分期[例(%)] 2.832b 0.092 Ⅰ~Ⅱ期 76(80.0) 16(64.0) Ⅲ~Ⅳ期 19(20.0) 9(36.0) 病理类型[例(%)] 0.002b 0.968 鳞癌 90(94.7) 23(92.0) 腺癌 5(5.3) 2(8.0) 化疗次数[例(%)] 2.106a 0.024 < 3次 21(22.1) 5(20.0) 3~5次 54(56.8) 7(28.0) >5次 20(21.1) 13(52.0) CD-RISC评分(x±s，分) 51.01±5.92 39.40±4.66 9.079c < 0.001 SUPPH评分(x±s，分) 86.18±7.85 70.24±7.65 9.081c < 0.001 注：a为Z值, b为χ2值，c为t值。
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表 4 自变量赋值情况
Table 4. The assignment situation of independent variables
变量 赋值方法 年龄 < 40岁=1；40~60岁=2；>60岁=3 化疗次数 < 3次=1；3~5次=2，>5次=3 CD-RISC评分 以实际值赋值 SUPPH评分 以实际值赋值
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表 5 宫颈癌PICC置管化疗患者发生并发症的logistic回归分析
Table 5. Logistic regression analysis of complications in patients with cervical cancer undergoing PICC catheterization for chemotherapy
变量 B SE Waldχ2 P值 OR值 95% CI 年龄(参照 < 40岁) 3.636 0.162 年龄40~60岁 -1.234 1.348 0.838 0.360 0.291 0.021~4.086 年龄>60岁 1.695 1.186 2.043 0.153 5.448 0.533~55.687 化疗次数(参照 < 3次) 6.921 0.031 化疗次数3~5次 -0.749 1.451 0.266 0.606 0.473 0.027~8.131 化疗次数>5次 3.281 1.595 4.231 0.040 26.595 1.167~606.003 CD-RISC总分 -0.411 0.200 4.229 0.040 0.663 0.448~0.981 SUPPH总分 -0.310 0.156 3.938 0.047 0.733 0.540~0.996
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