肝癌行經導管肝動脈化學栓塞病患之症狀困擾及症狀群集

肝癌的發生率及死亡率皆有逐年升高的趨勢，非手術治療方式以經導管肝動脈化學栓塞（Transcatheter Artery Chemoembolization [TACE]）治療為優先考量。但是病患於治療期間，須面對許多不適的治療副作用及多種症狀同時帶來的困擾，因此治療所造成的身心衝擊是值得關注的議題。本研究目的希望了解肝癌病患接受TACE治療的第一至七天，其症狀嚴重程度及症狀對日常生活干擾之嚴重程度、個案之基本屬性及疾病特性對病患接受TACE治療第一天，症狀嚴重程度及症狀影響日常生活之差異性，以及症狀間的群集現象。本研究為描述性及相關性之研究設計，採前瞻性縱貫性研究法，並以結構式問卷收集資料，問卷包括「人口學特性及疾病特性問卷」、「台灣版安德森症狀量表」等。採立意取樣，於南部某區域醫院肝膽腸胃科病房選取年滿20歲，診斷為肝癌且進行TACE患者為研究對象，共84位。所得資料以SPSS 17.0套裝軟體進行資料統計分析。本研究結果顯示肝癌病患行TACE治療後第一、二天，以「胃口差」、「疼痛」及「疲勞」等症狀最為嚴重，第三天起，「疼痛」、「口乾」、「胃口差」等症狀最為嚴重。症狀對生活干擾之嚴重度第一至五天皆為「一般活動」最為困擾，在第六天起，「工作」的干擾為最嚴重。另外也發現無宗教信仰、教育程度越低之患者症狀嚴重程度較高。無宗教信仰、教育程度越低、Child B、無接受過肝癌治療之病患，症狀干擾日常生活之嚴重程度較高。另外，肝癌病患行TACE治療後第一至七天有出現群集現象，群集內症狀與症狀間具有顯著相關性，而群集與群集間之相關性低。本研究結果可以提供醫療照護人員更清楚肝癌病患行TACE治療後一週內，每日症狀嚴重程度以及干擾生活的嚴重程度之變化，及症狀群集現象，以作為肝癌行TACE治療後之個案其症狀完整性、連續性評估及護理指導之依據。

關鍵字

肝癌；經導管肝動脈化學栓塞治療；症狀困擾；症狀群集

並列摘要

Both of the morbidity and mortality rate of the liver cancer was increasing in the recent years. Although, many treatment strategies have been developed, non-surgical treatment methods, such as, Transcatheter Artery Chemoembolization (TACE), have high priority in treating liver cancer. Nevertheless, patients often experienced distress and various kinds of symptoms caused by TACE treatment side effects. The physio-psychological impact on patients is worthy of study. The aims of this study were to investigate the severity of symptoms and the degree of interference on functional status during the 1st to 7th post-TACE days. The associations between subjects’ demographics and disease characteristics and the severity of symptoms and experienced distress were further evaluated. Also, the clustering effects of symptoms after TACE were also analyzed. This study was a prospective and longitudinal design. A descriptive and correlative data was collected by structured questionnaires, including Patient Demography and Disease Characteristics, as well as Anderson Symptom Inventory – Taiwan Form. A purposive sampling from a gastroenterology and hepatology ward of a regional hospital in Southern Taiwan was performed. A total of 84 subjects aged 20 and older, who were diagnosed as liver cancer and received TACE, were enrolled in into this study. All of the data was analyzed by SPSS 17.0 statistical software. The results shows that the most severe symptoms which patients experienced are poor appetite, pain and fatigue over the first two days post-TACE treatment. From the third post-TACE day afterward, pain, dry mouth and poor appetite are the most severe symptoms. For the first five post-TACE days, the symptoms primarily interfere with the general activity, while the working activity is most interfered from the sixth post-TACE day afterward. Subjects without religious belief and low education level are associated with a higher degree of symptom distress. Also, subjects without religious belief, low education level, early tumor stage, Child B classification, and without liver cancer treatment experience are associated with higher interference to daily functionality. Furthermore, symptom clusters are observed from the first to the seventh post-TACE days. The symptoms show significant correlations within clusters, but insignificant correlations between clusters. The results of this study provide healthcare givers useful information of the severity of symptoms, the degree of interference on functional status and symptom clusters within 1 week post-TACE treatment. Also, this study is helpful to establish a guideline for nursing staff in comprehensive and continuous assessing post-TACE patients. Key word: Liver Cancer, Transcatheter Artery Chemoembolization (TACE), Symptoms Distress, Symptom Cluster