喉切除术后患者的生活质量评价

背景以往对头颈部恶性肿瘤的治疗重点强调提高患者术后的生存率,未充分考虑到患者术后回归社会的需求.随着医学模式的转变,评估肿瘤治疗效果的标准也发生了变化,除了生存率等生物学指标外,目前越来越强调重视患者的生活质量.喉是人们执行呼吸、交际、营养等重要功能的集中部位,喉切除术对患者的生活质量无疑会产生较大影响.目的研究喉切除术后患者的生活质量及其临床意义.设计以诊断为依据的调查研究.单位山东大学齐鲁医院耳鼻咽喉科.对象以1999-01/2000-12在山东大学齐鲁医院耳鼻咽喉科住院接受喉切除术的患者为研究对象,排除合并患有心肺等重大疾病的情况下,随机抽取50例,收集资料完整的42例作为最终研究对象进行统计处理.方法以综合生活质量评定问卷调查行喉切除术后患者的生活质量,研究生活质量主客观指标之间和各维度之间的相互关系及其对生活质量的影响.主要观察指标观察喉切除术后患者生活质量各指标间的关系.结果喉切除术后患者的生活质量在心理功能和社会功能维度主客观指标间呈现显著差异.主观满意度对生活质量的影响大于客观状态.客观状态较差时对主观生活满意度的影响较大,客观状态较好时对主观生活满意度的影响较小.影响躯体功能和社会功能的最重要的因素均为心理功能.影响心理功能最重要的因素为躯体功能.在对生存时间和生活质量做出选择时,多数患者首选生存时间.结论全面研究喉切除术后患者的生活质量可为临床决策提供重要依据,心理干预可望在提高患者生活质量方面起到重要作用.

Evaluation of quality of life for patients following laryngectomy

BACKGROUND: Previously, much emphasis has been placed on the survival rate of patients without taking the needs of patients to go back to society into consideration when treating head and neck cancer. With the transformation of medical pattern, the standard of evaluating therapeutic effects of tumor has already changed while much importance has been attached to patients except for the biological index like survival rate. Larynx is an important organ for people to breathe, oommunicate and nourish so that the quality of life(QOL) will be greatly affected after laryngectomy.OBJECTIVE: To study the QOL after laryngectomy and its clinical meaning.DESIGN: Investigation based on diagnosis.SETTING: Department of Otolaryngology, Qilu Hospital, Shandong University.PARTICIPANTS: Totally 50 patients who took the laryngectomy in Qilu Hospital of Shandong University during January 1999 to December 2000 without combination of heart and lung diseases were randomly selected for this study. Forty-two cases with completed information were performed analysis at last.METHODS: General QOL inventory was used to assess the QOL in patients following laryngectomy and to study the interrelationship between the objective, subjective indicators and different dimensions as well as the influence to the QOL.MAIN OUTCOME MEASURES: To observe the interrelationship between items of QOL of patients following laryngectomy.RESULTS: There was significant difference on the objective and subjective index of psychological and social functions of QOL in patients following laryngectomy. The effects of subjective satisfaction of QOL were stronger than that of objective situation. Poor objective condition greatly affected the subjective satisfaction to life while good objective condition slightly affected subjective satisfaction. Psychological function was the most important factor affecting physical function and social function while physical function was the most important factor for psychological function. When making choice between survival time and life quality, most patients preferred survival time.CONCLUSION: The QOL in patient following total laryngectomy can provide important basis for clinical decision. Psychological intervention can play an important role in improving QOL of patients.