術後肺がん患者の退院時から術後6カ月までの身体的不快症状の実態

Postoperative Discomfort and Its Influence on Daily Life in Patients with Lung Cancer: A Study Concerning the Period from Hospital Discharge to 6 Months After Surgery

要旨

　本研究の目的は，肺がん手術後の身体的不快症状の実態とそれらが生活に及ぼす影響について，退院時から術後6カ月までの経時的推移を明らかにすることである．術後肺がん患者41名（平均年齢67.0歳）を対象とし，自記記入式質問紙法と診療録からデータ収集を行った．

　分析の結果，肺がん手術後6カ月を経過しても約6割の患者が2つ以上の不快症状を抱えていた．創部に関連する不快症状は，退院時は創部表面の訴えが最も多く，術後1カ月以降は創部内部の訴えへと変化した．創部以外の不快症状は，術後1カ月以降では半数以上の患者に術後の息苦しさが出現しており，経時的変化はみられなかったが，術式や喫煙経験により日常生活への影響の程度に関連がみられた．また術後1カ月が経過しても，術後術側急性肩部不快症状が約17％の患者に存在し，術後6カ月が経過しても約半数の患者に咳嗽が出現していた．

　以上より，患者へ術後出現する可能性のある不快症状の回復過程やその機序に関する情報提供を行い，患者自身に不快症状に対するセルフモニタリングの実施を促し，自らの症状に対する認識を深めることで，セルフケア支援へと繋げる必要がある．今後は，患者の不快症状体験を加味した周手術期肺がん看護プログラム開発の必要性が示唆された．

　The purpose of this study was to evaluate changes in discomfort over 6 postoperative months in patients with lung cancer and determine the influence of this discomfort on their daily life. Data was collected from 41 patients who underwent surgery for non-small cell lung cancer (mean age 67.0 years) through a self-administered questionnaire and medical records.

　The results indicated that approximately 60% of patients experienced two or more symptoms of discomfort, even at 6 months after surgery. The most common wound-related discomfort was at the wound surface at the time of hospital discharge and inside the wound 1 month after surgery. In addition, choking was a common complaint in ＞ 50% of patients 1 month after surgery and its incidence did not change over time, although the influence on the patients' daily life varied depending on the type of surgical procedure and smoking history. Furthermore, acute shoulder discomfort on the operated side remained in approximately 17% of patients 1 month after surgery, while coughing was experienced by approximately 50% patients at 6 months after surgery.

　These results suggest that surgeons should educate patients with lung cancer about the recovery process and possible postoperative discomfort and encourage self-monitoring to gain a better understanding of symptoms and promote self-care. Perioperative nursing programs should be established for these patients in the future.