| ObjectsTo revise the Symptom Distress Scale for the postoperative patients with pituitary adenomas and to conduct a londititudinal study concerning the symptom distress in patients with hypophysoma within six monthes after surgery,aiming to provide a theoretical evidence for clinical staffs to effectively manage symptoms and improve the life quality of operative patients with pituitary tumor.Methods1.The initial scale was developed on the basis of quantitative literature review,three rounds of patent consultations and preliminary experiment.Then,191 postoperative patients with hypophysoma were investigated effectively by the use of the initial scale.In the light of extreme-group method,exploration factor analysis and psychometric ananlysis,the final scale was performed.2.115 patients with pituitary tumors within six monthes after surgery were recruited for the longititudinal survey.The five time points in turn were preoperation(T1),one week postoperatively(T2),one month postoperatively(T3),three monthes postoperatively(T4),six monthes postoperatively(T5).The research instruments included self-made general information questionnaire and the revised Symptom Distress Scale for the postoperative patients with pituitary adenomas.Date analysis stastically were conducted using SPSS 20.0software,descriptive statistics and analysis of variance.Results1.The revised scale incorporated 16 items and four factors.The comulative variance contribution rate,and S-CVI/Ave of the revised scale were 77.978%,0.920 and0.915,respectively.The Cronbach's a of the four factors ranged from 0.736 to 0.936.2.In the longititudial survey,a total of 126 patients were recruited for the investigation at the outset,then,11 samples dropped during the follow-up,finally,115 cases completed the whole survey.3.Among 115 patients,49(42.61%)cases were males and 66(57.39%)were famales.The mean age were 48.64 yeares.The average hospital stay ranged from 6 days to 63days.The corresponding proptions of nonfunctioning pituityary adenoma(NFPA),prolactinoma(PRL),acromegaly(ACRO),Cushing's disease(CD)were 60.00%,20.87%,16.52%and 1.74%,respectively.32 patients(27.83%)experienced diabete insipidus(DI),5patients(4.35%)developed cerebrospinal fluid leakage(CSF),2 patients(1.75%)incurred nasal adhesion,3 patients(2.61%)developed permanent hypotuitarism and 1 patient(0.87%)incurred intractable headache.4.At different time points,the occurrence of symptom distress were diverse.The average numbers of symptom distresses fluctuated in a range of 2.51±1.99~7.91±2.16.At T2 time point,patients experienced the maximum number of symptom distresses,while suffered the minimum at T5 time point.5.At different time points,the incurrence rate of symptom distress differed.At T1 time point,a majority of patients experienced visual limitation(56%),headache(46%),psychological disorder(41%),fatigue(32%)and dizziness(23%).At T2 time point,the first five were hyposmia(87%),fatigue(86%),nasal obstruction(84%),headache(79%)and thirstiness(62%).At T3 time point,the top five were fatigue(72%),nasal obstruction(57.39%),hyposmia(56%),visual limitation(45%)and psychological disorder(41%).At T4time point,the top five were fatigue(45%),nasal obstruction(45%),visual limitation(34%),hyposmia(34%)and psychological disorder(34%).At T5 time point,the first five were fatigue(37%),visual limitation(28%),nasal obstruction(27%),headache(28%)and hyposmia(23%).The incurrence of fatigue maintained at a high level in the whole course,waving from 32%to 86%.Nasal discomfort incurred postoperatively,the incurrence rate ranged from 23%to 87%.6.At different time points,the severity of symptom distress were distinct.The average severity of symptom distresses fluctuated from 1.00±0.00 to 3.86±1.09.The higher the score was,the more serious the symptom distress was.At T1 time point,the top five were visual limitation(2.70±1.60),headache(2.17±1.37),menstrual disorder(1.76±0.53),psychological disorder(1.72±0.97)and fatigue(1.63±1.00).At T2 time point,the top five were hyposmia(3.86±1.09),nasal obstruction(3.02±1.06),fatigue(2.91±0.90),headache(2.23±0.86)and much urine(2.19±0.95).At T3 time point,the top five were hyposmia(2.29±1.41),fatigue(2.18±0.98),nasal obstruction(1.92±0.98),visual limitation(1.85±1.13)and menstrual disorder(1.57±1.37).At T4 time point,the top five were fatigue(1.70±0.86),visual limitation(1.66±1.12),hyposmia(1.43±1.01),nasal obstruction(1.37±0.67)and menstrual disorder(1.46±1.25).At T5 time point,the first five were visual limitation(1.60±1.11),fatigue(1.45±0.65),menstrual disorder(1.43±1.21),hyposmia(1.43±1.01)and nasal obstruction(1.37±0.67).The severity of fatigue stayed at a high level in the whole time,with the highest at T2 time point,while the lowest at T5 time point.7.The degree of symptom distress were time-dependence.The average degree of symptom distresses ranged from 1.03±0.23 to 3.36±1.07.The degree of disturbance was not always inconsistent with the severity.The disturbances of visual limitation and fatigue were markedly high at the whole period of investigation.8.The one-way ANOVA showed that the difference in the numbers of symptom distress at five time points was significant(X~2=294.52,P<0.01),so were severity scores(F=185.63,P<0.01)and interference scores(X~2=185.63,P<0.01).Conclusion1.The revised scale owned preferable rability and validity,available to evaluate the symptom distress in patients with pituitary adenoma.2.The numbers,severity and disturbances of symptom distresses at different time were markedly distinct,therefore,clinical staffs should access symptoms comprehensively,multidimensionally and by multi-stage.3.The common symptom distresses in postoperative patients with hypophysoma were fatigue,psychological disorder,dizziness,nasal discomfort,thirstiness,much urine and dyssomnia.Fatigue was prevalent for postoperative patients,worthy of close attention.4.The more serious symptom distresses in postoperative patients with hypophysoma were fatigue,visual limitation,nasal discomfort,headache,much urine,menstrual disorder.The severity descenced along time.The severity of fatigue were retained high.Nasal discomfort appeared postoperatively,critically troubling,mitigated over time.The severities of fatigue,nasal discomfort and much urine changed obviously,significant reducing the health status of patients.Therefore,medical staffs ought to take effective manners to manage these persecuting symptom distresses.5.The more disturbling symptom distresses in postoperative patients with hypophysoma were fatigue,visual limitation,nasal discomfort,menstrual disorder,headache,psychological disorder and thirstiness.Fatigue,visual limitation and nasal discomfort,with higher degree of harassment all over the time,typically perplexed patients. |
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