头颈癌吞咽障碍患者照料者第三方残疾的研究

doi:10.3969/j.issn.1006-9771.2025.09.006

摘要/Abstract

摘要：

目的基于《国际功能、残疾和健康分类》理念，评估头颈癌患者的吞咽障碍严重程度及其照料者的生活质量，探讨头颈癌吞咽障碍患者照料者第三方残疾程度，并研究其影响因素。

方法 2023年1月至2024年12月，选择中山大学附属第一医院54对头颈癌吞咽障碍患者及其照料者，对患者采用一般资料调查表、渗漏-误吸分级量表(PAS)、功能性经口摄食量表(FOIS)和头颈癌患者生存质量量表(FACT-H&N)进行评估，对照料者采用一般资料调查表、汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)进行评估，采用简明36项健康调查量表(SF-36)评估照料者的第三方残疾。

结果照料者的SF-36总分(59.63±20.10)分。单因素分析显示，不同肿瘤部位患者的照料者SF-36评分有显著性差异(F = 3.494, P < 0.05)。相关分析显示，患者PAS (r = -0.371)、FOIS (r = 0.384)、FACT-H&N (r = 0.484)评分，以及照料者HAMA (r = -0.378)、HAMD (r = -0.374)评分均与照料者SF-36总分相关(P < 0.05)。多元线性回归分析显示，患者PAS评分(β = -0.340)、照料者HAMA评分(β = -0.346)与照料者SF-36总分相关(P < 0.05)。

结论头颈癌吞咽障碍患者照料者存在第三方残疾，患者吞咽的严重程度和照料者的情绪状态影响照料者的生活质量。

关键词: 头颈癌, 吞咽障碍, 照料者, 第三方残疾, 生活质量

Abstract:

Objective To explore the extent of third-party disability among caregivers of head and neck cancer patients with dysphagia and to examine the influencing factors, based on the framework of the International Classification of Functioning, Disability and Health.

Methods From January, 2023 to December, 2024, 54 pairs of head and neck cancer patients with dysphagia and their caregivers were included in the study. The patients were assessed using the general information questionnaire, Penetration-Aspiration Scale (PAS), Functional Oral and Intake Scale (FOIS) and Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N). The caregivers were evaluated with the general information questionnaire, Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD) and the MOS Health Survey 36-item short-form (SF-36).

Results The total score of SF-36 of caregivers was (59.63±20.10). In univariate analysis, there was significant difference in the total score of SF-36 among different types of tumor (F= 3.494, P< 0.05). Correlation analysis showed that the scores of PAS (r = -0.371), FOIS (r = 0.384) and FACT-H&N (r = 0.484) of patients, and the scores of HAMA (r = -0.378) and HAMD (r = -0.374) of caregivers were all correlated with the total score of SF-36 (P< 0.05). Multiple linear regression analysis showed that the score of PAS of patients (β= -0.340) and the score of HAMA of caregivers (β= -0.346) were correlated with the total score of SF-36 (P< 0.05).

Conclusion There are third-party disabilities in caregivers of head and neck cancer patients with dysphagia, and the severity of the patient's swallowing and the caregiver's emotional state influence the caregiver's quality of life.

Key words: head and neck cancer, dysphagia, caregivers, third-party disability, quality of life

中图分类号:

R739.91

谭茗丹, 冯锭瑶, 李咏雪. 头颈癌吞咽障碍患者照料者第三方残疾的研究[J]. 《中国康复理论与实践》, 2025, 31(9): 1032-1037.

TAN Mingdan, FENG Dingyao, LI Yongxue. Third-party disability in caregivers of head and neck cancer patients with dysphagia[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(9): 1032-1037.

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项目		n	SF-36评分	F/t值	P值	项目		n	SF-36评分	F/t值	P值
患者年龄	18~49岁	11	68.45±17.34	1.756	0.183	患者家庭人均月收入	< 5000元	31	58.74±19.24	2.640	0.081
	50~59岁	21	60.09±20.38			患者家庭人均月收入	5000~< 10 000元	17	55.35±21.49
	60~80岁	22	54.77±20.10				> 10 000元	6	76.33±13.45
患者性别	男	37	60.54±18.94	0.238	0.628	患者工作状态	在职	2	83.50±14.85	2.099	0.133
	女	17	57.65±22.91			患者工作状态	离休、退休	43	57.37±20.31
患者肿瘤部位	鼻咽癌	29	64.76±17.21	3.494	0.022		失业	9	65.11±16.71
	喉癌	16	48.12±20.96			照料者与患者关系	配偶	30	58.16±22.70	0.353	0.555
	下咽癌	5	71.40±9.45			照料者与患者关系	子女	24	61.46±16.58
	舌癌	4	53.75±28.66			照料者年龄	18~49岁	34	59.88±19.56	0.887	0.418
患者病程	< 1年	16	57.62±23.86	0.151	0.860		50~59岁	16	62.19±20.54
	1~5年	21	61.33±18.98				60~80岁	4	47.25±24.10
	> 5年	17	59.41±18.61			照料者性别	男	26	54.92±22.27	2.844	0.098
患者BMI	< 18.5 kg/m²	20	64.25±17.73	2.118	0.131		女	28	64.00±17.11
	18.5~24 kg/m²	30	54.96±21.26			照料者照护时间	< 1年	33	62.24±19.81	1.406	0.254
	> 24 kg/m²	4	71.50±15.15			照料者照护时间	1~5年	12	59.92±20.18
患者居住地	城镇	42	59.00±21.67	0.183	0.671		> 5年	9	49.67±20.18
	农村	12	61.83±13.80			照料者工作状态	在职	38	60.68±20.13	0.583	0.562
患者医保费用支付方式	医疗保险	32	60.87±19.36	0.297	0.588	照料者工作状态	离休、退休	14	58.86±21.01
患者医保费用支付方式	自费	22	57.82±21.46				失业	2	45.00±14.14

项目	n	评分	r值	P值
患者PAS	54	4.92±2.44	-0.371	0.006
患者FOIS	54	3.11±2.06	0.384	0.004
患者FACT-H&N	54	65.65±31.20	0.484	< 0.001
照料者HAMA	54	21.81±13.13	-0.378	0.005
照料者HAMD	54	35.26±20.83	-0.374	0.005

变量	B值	SE	β值	t值	P值
常量	85.855	7.358	-	11.668	< 0.001
肿瘤部位	-0.499	2.722	-0.023	-0.183	0.855
患者PAS	-2.804	1.012	-0.340	-2.771	0.008
照料者HAMA	-0.530	0.190	-0.346	-2.782	0.008