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胃切除後6ヶ月間における胃癌患者の食行動および,身体的・精神的状態の変化

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概要 Purpose : To quantitatively assess and clarify the relationships between eating behaviors, physical symptoms, and depression over 6 months postoperatively in patients who have undergone gastrectomy fo...r gastric cancer.
Methods : Questionnaire surveys to post-gastrectomy patients on eating behavior, post-gastrectomy dysfunction (DAUGS), and depression (CES-D) were conducted five times during the 6 months after surgery (before discharge, and 2 weeks, 6 weeks, 3 months, and 6 months after surgery). The longitudinal changes of each item were analyzed using a repeated measure ANOVA, and the relationships between post-gastrectomy dysfunction and patient factors were analyzed using a two-way ANOVA. The relationships between depression and post-gastrectomy dysfunction were analyzed using correlations.
Results : The subjects were 64 post-gastrectomy patients. The mean age was 66.5 (SD 10.3) years and 40 were males. Forty-six patients had distal gastrectomy. Fifty-three were diagnosed as gastric cancer stage Ⅰ. The participantsʼ body weight had decreased by about 10% at 6 months after surgery (p<.001). Although the patients who practiced eating behavior modifications such as food adjustment decreased from 80% to 50% at 6 months after surgery, food intake was recovered up to about 80% of the pre-operative intake. Post-gastrectomy dysfunction (DAUGS) was the worst at 2 weeks after surgery and improved significantly within 6 months (p <.05). The factors that were associated with significantly worse post-gastrectomy dysfunction were being employed and high depression groups. The post-gastrectomy dysfunction in the high depression group was worse than in the low depression group throughout the 6 months.
Conclusion : Post-gastrectomy dysfunction worsened immediately after discharge and was alleviated over 6 months, and a relationship between physical and depressive states was observed. Medical staff should be better to understand patientsʼ depressive state during hospitalization and continue to observe the post-gastrectomy dysfunction early postoperative period.
【目的】胃切除術を受けた胃癌患者の術後半年間における食行動,身体的状態およびうつ傾向の実態とそれらの関連を明らかにすることである.
【方法】胃癌で胃切除術を受けた患者を対象に,食行動,術後機能障害(DAUGS),抑うつ(CES-D)に関する質問紙調査を,術後半年の間に5 回(退院前,術後2週間,6 週間,3ヶ月,6ヶ月)縦断的に実施した.各項目の経時的変化は反復測定分散分析を用い,患者要因と術後機能障害の関連は二元配置分散分析を用いて検討した.抑うつと術後機能障害の関連は,相関関係を用いて分析した.
【結果】64 名の胃切除術後患者を対象とした.平均年齢66.5(SD10.3)歳,男性40 名であった.幽門側胃切除術46 名で,胃癌ステージⅠが53 名であった.体重は術後半年間で約10%減少した(p <.001).術後半年経つと,食事量調整などの食行動を実践している人は8 割から全体の半数に減少したが,食事摂取量は術前の8 割程度に回復した.術後機能障害(DAUGS)は術後2 週間が最も強く,その後半年間で有意に改善した(p <.05).患者要因によるDAUGS 得点の推移を見ると,就労群と高抑うつ群の機能がより障害されていた.高抑うつ群の術後機能障害の程度は,低抑うつ群と比べ,6 か月間を通じて重かった.
【結論】胃切除後の機能障害は退院直後が最も悪く,6ヶ月間で軽快し,身体的状態と抑うつ状態が関係していることが明らかになった.医療者は,入院中から患者の抑うつ状態を把握し,術後早期からの胃切除術後機能障害の継続的な観察を行う必要がある.
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登録日 2020.06.17
更新日 2022.10.25

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