| Background Primary Liver Cancer is one of the most common malignant tumors that threatening human life and health.Morbidity and mortality increased year by year.Surgical resection is the first choice for the treatment of liver cancer.Clinical practice shows,the patients were experienced surgical treatment,appeared symptoms group of coexist status.Compared to single symptom,symptom group influenced the function status more seriously,as well as quality of life and survival time.Therefore,the study of the symptom group is particularly important to the perioperative nursing of the patients with liver cancer.At present,the related research is still at the initial stage.Longitudinal research on perioperative symptoms and symptom clusters of liver cancer patients,plus scientific and effective symptom management will be beneficial to improve the patients' quality of life.Objective Dig the perioperative patients with liver cancer symptom experience and collect the first-hand data,assess the symptoms and analyze the variation and correlation factors,explore the composition and variation of perioperative symptoms of patients with hepatocellular carcinoma;functional evaluation of perioperative patients with liver cancer and postoperative life quality,analyze the correlation between quality of life and symptoms,liver cancer patients in the perioperative period to reduce symptom burden and improve the quality of life to provide empirical reference.Methods The combination of quantitative research and qualitative research is designed.1.The convenience sampling method was used to conduct a questionnaire survey and scale assessment for 160 patients with liver malignant tumors who were first treated by operation before operation 1-3 days before operation(T1),1-3 days after operation(T2)and 1-3 days before discharge(T3).The use of hepatocellular carcinoma patients with general information questionnaire collected demographic information and clinical data;the Chinese version of Anderson symptoms scale(M.D.Anderson Symptom Inventory-Chinese,MDASI-C),primary liver cancer specific symptoms(The Symptom Module Specific to module Primary Liver Cancer,TSM-PLC),the hospital anxiety and Depression Scale(Hospital Anxiety and Depression Scale,HADS)assessment of perioperative patients with different time symp toms and symptom distress;hepatobiliary functional assessment of cancer therapy scale(Functional Assessment of Cancer Therapy-Hepatobiliary Carcinoma,FACT-Hep)and the Karnofsky score(Karnofsky Performance,assessment Scale,KPS)quality of life and functional status of patients.SPSS21.0 software is used to analyze the data.Specific statistical methods include statistical description,t test,one-way ANOVA,multiple linear regression analysis,exploratory factor analysis and Spearman correlation analysis.2.Qualitative research was conducted on 8 patients with malignant liver tumors who underwent first surgery by qualitative sampling.1-2 days before discharge,semistructured in interviews were conducted.Data were analyzed and summarized by Colaizzi phenomenology.Results 1.The number of T1 symptoms in the perioperative period of liver cancer was 9.62±2.56,the number of T2 symptoms was 12.99±2.20,and the number of T3 symptoms was 8.38±2.24.2.Analyze symptoms that incidence rate is bigger than 20%,top three T1 severity are: one of the top three symptoms: dry mouth(3.55±1.75),tension(3.44±1.38)and abdominal distension(2.93±1.11)T2,the severity of the first three symptoms: abdominal pain(6.72±1.13),(6.58±1.15),dry mouth(6.43±1.27)T3,the severity of the first three symptoms: weight loss(2.93±1.55),tension(2.50±1.20),abdominal distension(2.20±1.12).The symptoms of T1 in the perioperative period of patients with liver cancer were mainly troubled with the pleasure of life(the distress rate was 5.66±0.92).The time of T2 and T3 mainly caused great distress to patients' work(T2 distress rate was 6.05±0.97,and T3 distress rate was 3.64±1.06).3.In each period the severity of the first three symptoms(dry mouth,tension,abdominal distension,pain,weight loss)by single factor analysis of variance and multiple linear regression analysis,the same symptoms to choose the most serious period,the result shows that the influence of dry mouth cancer embolus status by(P<0.05),nervous symptoms affected by family income(P<0.01),the effect of abdominal distention of cirrhotic(P<0.05),pain symptoms by TNM staging(P<0.01),weight loss effect of symptoms by affecting the Child classification(P<0.05).4.The exploratory factor analysis of the perioperative symptoms of the patients with liver cancer showed that the patients' symptoms could be clustered in groups.T1 has 3 symptoms: emotional nerve symptoms(variance contribution rate 20.65%)and related symptoms of liver function(the variance contribution rate of 32.92%),pain-fatigue symptoms(variance contribution rate 10.65%);T2 had 4 symptoms: emotional nerve symptoms(variance contribution rate 21.53%)and related symptoms of liver the function(the variance contribution rate of 25.04%),mental symptoms(variance contribution rate 13.52%),gastrointestinal symptoms group(variance contribution rate 23.03%);T3 had 3 symptoms: emotion al nerve symptoms(variance contribution rate 22.95%)and related symptoms of liver function(the variance contribution rate of 20.10%),mental symptoms(the variance contribution rate of 16.69%).5.In patients with liver cancer after all dimensions of quality of life scores for physical condition(10.94±1.79),social family status(19.85±1.50),emotional status(9.88±2.15)function(8.92±1.54),hepatocellular carcinoma specific status(42.12±2.44),QOL score(91.70 ± 4.55).Spearman correlation analysis was used to analyze the correlation between quality of life and symptoms of postoperative patients with liver cancer,among them,the scores of patients' functional status were the lowest,and the symptoms of distress,shortness of breath,vomiting,numbness,abdominal distention and diarrhea were more significant(P<0.05).6.The KPS score of the T1 time period of the liver cancer patients was 90.38±3.34,the KPS score of the T2 time period was 64.65±5.73,and the KPS score of the T3 time period was 88.68±3.40.The patients had the best functional status at T1 time,and the worst in T2 time.7.Semi structured interviews included 6 themes: illness uncertainty,multiple symptom distress,lifestyle changes,psychological overload,coping styles and knowledge needs.Conclusions 1.The number of symptoms experienced in the perioperative period of liver cancer patients was bigger,function status is worse,the symptom occurrence rate,severity of symptoms and distress degree were higher,and affected by many factors.2.Liver cancer patients in the perioperative period of symptoms could be clustered,symptoms group has the characteristic of stability and dynamic internal structure.3.The quality of life of the patients with liver cancer was poor,and all the dimensions of the quality of life were negatively correlated to the symptoms.4.Cancer patients have a strong sense of uncertainty in illness and psychological burden in the perioperative period,medical personnel should pay attention to the psychological needs of patients in the clinical work. |
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