妇科恶性肿瘤患者围术期症状群和核心症状的研究

Study of perioperative symptom clusters and core symptoms in patients with gynecological malignancies

目的探讨妇科恶性肿瘤患者在围术期不同时间点症状群的构成及动态变化,构建症状网络,探索核心症状,为制定精准的症状管理方案提供参考。方法便利抽样法选取260例妇科恶性肿瘤(宫颈癌、卵巢癌、子宫内膜癌)手术患者进行调查,采用一般资料调查问卷和中文版安德森症状系列量表-妇科恶性肿瘤围手术期模块分别于手术前1 d(T1)、术后第3天(T2)和术后第7天(T3,即出院前)3个时间点对患者进行纵向调查。对3个时间点中发生率>20%的症状行探索性因子分析提取症状群,运用R语言构建症状网络,分析中心性指标。结果妇科恶性肿瘤患者围术期共提取4个症状群,分别是疲乏-疼痛-情绪症状群、消化道症状群、能量不足症状群和潮热-神经症状群。其中疲乏-疼痛-情绪症状群持续存在于T1~T3,且群内症状组成较稳定。潮热-神经症状群存在于T1~T3、消化道症状群存在于T2和T3、能量不足症状群仅存在于T2,且群内症状组成呈动态变化。症状网络中,悲伤和苦恼是围术期3个时间点的核心症状,其他中心性指标动态变化。T1除悲伤外,潮热的紧密中心性和中介中心性最大,T2恶心、T3疲乏的紧密中心性和中介中心性最大。结论医护人员应对稳定存在的症状群及核心症状进行全程干预,将症状群与网络中心性指标相结合,制定更为精准的管理方案,改善患者围术期生活质量。

Objective To explore the composition and dynamic changes of symptom clusters of patients with gynecological malignancies at different perioperative time points,to construct symptom networks,to explore core symptoms,and to provide references for the development of precise symptom management plans.Methods Convenient sampling method was used to select 260 patients receiving surgery for gynecological malignancies(cervical cancer,ovarian cancer,endometrial cancer)for the survey.The general information questionnaire and the Chinese version of MD Anderson Symptom Inventory-Perioperative Gynecological Malignant Tumor Module were used to conduct a longitudinal survey of the patients at 3 time points:1 day before the surgery(T1),the 3st day after the surgery(T2),and the 7th day after the surgery(T3,namely before discharge from hospital).Symptoms with an incidence rate of>20%at the 3 time points were subjected to exploratory factor analysis to extract symptom clusters,and the R language was used to construct a symptom network and analyze the centrality indexes.Results Four symptom clusters were extracted for the perioperative period,namely,pain-fatigue-emotion symptom cluster,digestive symptom cluster,energy deficiency symptom cluster and hot flashes-neurological symptom cluster.Among them,the fatigue-pain-emotion symptom cluster existed persistently in T1-T3,and its composition was stable;the hot flashes-neurological symptom cluster existed in T1-T3,the digestive tract symptom cluster existed in T2 and T3,and the energy deficiency symptom cluster existed only in T2,and the symptom composition of the clusters changed dynamically.In symptom networks,sadness and distress were the core symptoms at all 3 time points in the perio-perative period,and the other centrality indicators changed dynamically.In addition to sadness,hot flashes in T1 and nausea in T2 and fatigue in T3 had the greatest tight centrality and mediating centrality,respectively.Conclusion Healthcare professionals should intervene throughout the whole process for stably existing symptom clusters and core symptoms,and combine symptom clusters with network centrality indicators to develop a more precise management plan and improve patients′perioperative quality of life.