目的 研究妇科恶性肿瘤患者在化疗过程中不同时间节点不良反应的变化及其对生活质量的影响。方法 2022年1月至2023年10月，采用便利抽样法选取成都市某三级甲等专科医院住院化疗的3247例妇科肿瘤患者为研究对象，采用化疗后恶心呕吐分级、大便性状评分、疼痛评分、疲乏量表、睡眠质量指数及癌症功能评价量表等在患者接受第1、3、5次化疗后进行纵向调查。结果 重复测量方差分析和χ2检验发现，随着化疗次数增加，恶心呕吐和疲乏加重（χ²=82.187，P＜0.001；F=8.239，P＜0.001），睡眠质量和生活质量下降（F=16.876，P＜0.001；F=8.39，P＜0.01），大便异常人数增多（χ²=60.354，P＜0.001），疼痛减轻（F=3.876，P＜0.05）。广义估计方程分析表明，有医疗保险的患者生活质量较高，而疾病晚期、恶心呕吐明显、疼痛及疲乏重的患者生活质量较低。结论 妇科肿瘤患者化疗期间会出现多种不良反应，部分症状随化疗次数增加而加重。医保状况、疾病分期、恶心呕吐、疼痛和疲乏程度均会影响生活质量。

Objective To examine the changes in adverse symptoms and their impact on the quality of life in gynecological cancer patients in different stages in chemotherapy.Methods A longitudinal survey was conducted on 3,247 gynecological cancer patients undergoing chemotherapy in a tertiary A hospital in Chengdu from January 2022 to October 2023,who were selected with convenience sampling.Assessments of chemotherapy-induced nausea and vomiting grading,stool characteristics scoring,pain scoring,fatigue scales,Pittsburgh sleep quality index,and cancer functional assessment were used after the 1st,3rd,and 5th cycles of chemotherapy.Results Repeated measures ANOVA and chi-square tests revealed that with increasing chemotherapy cycles,nausea and vomiting and fatigue intensified (χ²=82.187,P＜0.001;F=8.239,P＜0.001),while sleep quality (F=16.876,P＜0.001) and quality of life (QoL) (F=8.39,P＜0.01) deteriorated.There was an increase in abnormal bowel movements (χ²=60.354,P＜0.001) and a decrease in pain severity (F=3.876,P＜0.05).Generalized estimating equation analysis showed that patients with medical insurance had better QoL,whereas those with advanced disease,more pronounced nausea and vomiting,and greater pain and fatigue had worse QoL.Conclusions Gynecological cancer patients experience a variety of adverse symptoms during chemotherapy,with some intensifying over cycles.Medical insurance status,stage of disease,and the severity of nausea and vomiting,pain,and fatigue all significantly affect QoL.

R473.73

成都市卫生健康委员会医学科研课题（2022097）