原发性肝癌TACE治疗患者症状群及前哨症状的调查

Symptom cluster and sentinel symptoms in patients with primary liver cancer treated with TACE

目的了解原发性肝癌患者接受经导管肝动脉化疗栓塞术(TACE)期间的症状群,识别症状群内的前哨症状。方法采用便利抽样法,选取2022年6月—2023年1月江南大学附属医院介入科收治的接受TACE治疗的170例原发性肝癌患者为研究对象,从TACE治疗术后当天起至术后4 d,每天完成中文版安德森症状测评量表、原发性肝癌特异性症状模块和症状首次出现时间表的填写。先采用主成分分析法确定症状群,再根据群内症状的首发时间结合Apriori算法确定前哨症状。本研究共发放问卷170份,回收有效问卷163份,有效回收率为95.88%(163/170)。结果共提取出上消化道、栓塞后、病感、情绪、肝功能受损5个症状群。其中恶心、疼痛、睡眠困难、悲伤分别是上消化道、栓塞后、病感及情绪症状群的前哨症状,肝功能受损症状群未见明确前哨症状。结论原发性肝癌患者TACE治疗期间有多种症状群困扰,前哨症状的确定对提高症状管理效率及护理质量具有重要意义。

Objective To understand the symptom clusters of patients during transcatheter arterial chemoembolization(TACE)treatment for primary liver cancer and to identify the sentinel symptoms within the symptom clusters.Methods Using the convenient sampling method,a total of 170 patients with primary liver cancer who were admitted to the Interventional Department in Affiliated Hospital of Jiangnan University for TACE treatment from June 2022 to January 2023 were selected as research objects.From the day after TACE treatment to 4 days after surgery,M.D.Anderson Symptom Inventory-Chinese(MDASI-C),The Symptom Module Specific to Primary Liver Cancer(TSM-PLC)and First Symptom Appearance Schedule were completed every day.Firstly,the principal component analysis method was used to determine the symptom clusters,and then the sentinel symptoms are determined based on the initial onset time of the symptoms within the cluster combined with the Apriori algorithm.A total of 170 questionnaires were distributed in this study,and 163 valid questionnaires were collected,with an effective response rate of 95.88%(163/170).Results A total of 5 symptom clusters were extracted,including upper gastrointestinal tract,post embolism,feeling of illness,emotion and liver function impairment.Nausea,pain,difficulty sleeping,and sadness were sentinel symptoms in the upper gastrointestinal tract,post embolism,feeling of illness and emotional symptom groups,respectively.No clear sentinel symptoms were observed in the symptom cluster of liver function impairment.Conclusions Primary liver cancer patients have multiple symptom clusters during TACE treatment,and the determination of sentinel symptoms is of great significance in improving symptom management efficiency and nursing quality.