肺癌病患接受化學治療引發周邊神經病變及其對情緒與睡眠品質的影響

Abstract

化學治療引發周邊神經病變（Chemotherapy-Induced Peripheral Neuropathy, CIPN）是某特定類化學治療藥物（platinum類、taxanes類、vinca alkaloids類等）產生的副作用之一，其症狀主要是感覺或運動神經傳導問題，可能造成病患化療的不適，也影響其生活品質。本研究之目的為探討肺癌病患接受化學治療引發周邊神經病變症狀、周邊神經病變性疼痛（Peripheral neuropathic pain, PNP）、症狀困擾對病患情緒（焦慮、憂鬱）及睡眠品質的影響。研究設計為描述相關性研究，採用橫斷式研究設計（cross-sectional design），以立意取樣（purposive sampling）使用結構式問卷進行資料收集，包括：「周邊神經病變評估量表」、「神經性疼痛中文版量表」、「症狀嚴重度量表」、「簡易疼痛量表」、「基本資料表」、「醫院焦慮及憂鬱量表」、「醫療成果指標睡眠品質量表」，收案場所於台北某醫學中心之胸腔內科病房及門診化學治療室，於96年10月至97年5月共收案65人，檢力76％。研究結果顯示83％主訴有CIPN相關症狀，其中以視力糢糊發生率最高（55.4％），其次是手有麻麻的感覺（43.1 %）、腳有麻麻的感覺（40 %），症狀嚴重度皆以有一點最多，28％有PNP症狀主訴，以疼痛造成不愉快、整體疼痛強度、深部及表面疼痛並列為最常見前二項疼痛特質，CIPN症狀嚴重度與PNP嚴重度、完成化療週期數、憂鬱皆有顯著正相關（p<0.05），周邊神經病變評估量表的運動及自主神經面向則與睡眠品質有顯著相關，研究結果反映肺癌病患接受化療引發CIPN及PNP重要症狀特性及潛在問題，而以長期追蹤型研究來了解CIPN及PNP整體變化是有必要的，本研究有助於臨床人員對於CIPN及PNP症狀監測及相關問題更深入瞭解，可提供學術及臨床照護上具體參考依據。

Chemotherapy-Induced Peripheral Neuropathy (CIPN) is one of the major side effects from selected chemotherapeutic agents, including platinum, taxanes, vinca alkaloids. Limited studies have explored these problems. The purpose of this study is to examine (1) the patients’ experiences related to CIPN and peripheral neuropathic pain (PNP) and (2) the relationships of CIPN (and PNP) and anxiety, depression, and quality of sleep in lung cancer patients receiving the above mentioned drugs. A cross-sectional study with purposive sampling was used. Data were collected by (1) Brief Peripheral Neuropathy Inventory (BPNI), (2) Neuropathic Pain Scale (NPS), Symptom Severity Scale (SSS), Hospital Anxiety and Depression Scale (HADS), Medical Outcome Study Sleep Scale (MOS-sleep). Data were collected at a medical center in Taipei. A total of 65 lung cancer patients were recruited. The results showed that 83% had CIPN symptoms with blurred vision (55.4%), numbness on hands ( 43.1 %), numbness on feet (40 %) ranked as the top three symptoms. There are 28% of patients had PNP with “unpleasant,”“intense,”“deep pain” and“surface pain,” described by patients. There were significant correlation among BPNI and NPS, the numbers of chemotherapy courses, and depression. The result suggested the potential problems from CIPN and PNP in lung cancer patients with chemotherapy. Longitudinal studies would be necessary to further examine the changes of CIPN and PNS across time in lung cancer patients. These results can help health professionals better understanding patients’ problems related to CIPN and might enhance patients’quality of life.