口腔癌术后患者支持性照护需求纵向轨迹及相关因素研究-现代医学

口腔癌术后患者支持性照护需求纵向轨迹及相关因素研究

单位：华中科技大学同济医学院附属同济医院护理部, 湖北武汉 430030

分类号：R780

出版年·卷·期（页码）：2025·53·第十二期（1895-1901）

摘要：

目的：探讨口腔癌术后患者支持性照护需求纵向轨迹，并分析其相关因素。方法：选取本院2022年6月至2024年12月期间收治的261例口腔癌患者为研究对象，均行口腔癌根治术，采用癌症患者支持性照护需求量表(SCNS-SF34)评估患者支持性照护需求现状，并通过潜类别增长混合模型分析患者支持性照护需求的潜在轨迹类别，分析其潜在轨迹类别相关影响因素。结果：术前1 d至出院后3个月口腔癌患者SCNS-SF34评分呈现短期升高后逐渐下降的趋势；潜类别增长混合模型分析显示，当潜在轨迹类别为3时赤池信息准则(AIC)、拟合指标(BIC)、样本校正BIC(aBIC)相对较小，模型拟合度较好，熵值最大，分类准确度最高，分别为持续高需求患者(C1组)59例、中水平缓慢降低患者(C2组)113例、低水平持续降低患者(C3组)75例。以C3组为参照，年龄、心理困扰评分、合并症指数、营养状况评分、术后治疗为C1组危险因素，而社会支持评分、家庭人均月收入为C1组保护因素(P＜0.05)；年龄、心理困扰评分为C2组危险因素，家庭人均月收入为C2组保护因素(P＜0.05)。结论：口腔癌术后患者支持性照护需求呈现出持续高需求、中水平缓慢降低、低水平持续降低3种不同的纵向变化轨迹，其中年龄、心理困扰评分、合并症指数、营养状况评分、术后治疗、社会支持评分、家庭人均月收入为不同轨迹的相关因素，临床应根据轨迹类型及相关因素制定针对性干预措施，以更好地满足患者支持性照护需求，提高患者生活质量。

Objective: To explore the longitudinal trajectory of supportive care needs in postoperative patients with oral cancer and analyze the related factors. Methods: A total of 261 patients with oral cancer admitted to our hospital from June 2022 to December 2024 were selected as study subjects. All patients underwent radical oral cancer surgery. The Supportive Care Needs Survey-Short Form 34(SCNS-SF34) was used to evaluate the current status of patients' supportive care needs, and the latent class growth mixed model was used to analyze the potential trajectory categories of patients' supportive care needs and analyze the related influencing factors of their potential trajectory categories. Results: From 1 day before surgery to 3 months after discharge, the SCNS-SF34 scores of patients with oral cancer showed a trend of short-term increase followed by gradual decrease. The latent class growth mixed model analysis showed that when the potential trajectory category was 3, the AIC, BIC, and aBIC were relatively small, the model fit was good, the entropy value was the largest, and the classification accuracy was the highest, which were 59 patients with persistent high needs(C1 group), 113 patients with moderate level slow decrease(C2 group), and 75 patients with low level continuous decrease(C3 group), respectively. Taking C3 group as reference, age, psychological distress score, comorbidity index, nutritional status score, and postoperative treatment were risk factors for C1 group, while social support score and monthly family income per capita were protective factors for C1 group(P<0.05). Age and psychological distress score were risk factors for C2 group, while per capita monthly household income was a protective factor for C2 group(P<0.05). Conclusion: The supportive care needs of postoperative patients with oral cancer present three different longitudinal trajectories: persistent high needs, moderate level slow decrease, and low level continuous decrease. Among them, age, psychological distress score, comorbidity index, nutritional status score, postoperative treatment, social support score, and monthly family income per capita are related factors of different trajectories. Clinically, different intervention measures should be formulated according to trajectory types and related factors to reduce patients' supportive care needs and improve patients' quality of life.

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