肝移植受者症状群及其影响因素的研究

Symptom clusters and influencing factors in liver transplantation recipients

目的明确肝移植受者所经历症状群的种类、构成、分布特点及影响因素,为开展有效的症状管理奠定基础。方法采用肝移植受者症状体验评估问卷和肝移植受者症状体验影响因素调查表,对342例肝移植受者进行症状的横断面调查,采用探索性因子分析确定症状群,通过Logistic回归分析,明确症状群的影响因素。结果肝移植受者发生率最高的5个症状分别为疲乏(38.6%)、记忆力下降(34.5%)、易醒(33.5%)、入睡困难(31.9%)、多梦(28.1%)。探索性因子分析得出3个症状群,分别是睡眠相关症状群(入睡困难-易醒-多梦-焦虑)、神经系统相关症状群(视力下降-记忆力下降-瘙痒)、活动耐力下降症状群(疲乏-肌肉无力-气短-腹泻)。原发病为肝癌、疾病信念是症状群发生的独立预测因子。结论肝移植受者经历着复杂的不适症状,且症状之间互相影响,以症状群的形式存在。开展症状管理时应以症状群为干预单位,帮助肝移植受者对疾病形成正确认知,促进其将疾病管理融入个人及家庭的正常生活中。

Objective To identify types,constitution,distribution of symptom clusters among liver transplantation recipients,and analyze the influencing factors,so as to lay foundation for symptom management.Methods We conducted a cross-sectional study to evaluate 342 liver transplantation recipients’symptom characteristics using two self-designed questionnaires.We adopted exploratory factor analysis to identify symptom clusters and analyzed the influencing factors by logistic multivariate regression analysis.Results The five most common symptoms of participants were fatigue(38.6%),decreased memory(34.5%),easy wakening up(33.5%),difficulty in falling asleep(31.9%),and dreaminess(28.1%).Three symptom clusters were identified,including sleep-related symptom cluster,nervous system symptom cluster,and reduced activity tolerance symptom cluster.Liver cancer as the primary disease,and disease belief were the independent predictive factors of symptom clusters.Conclusion Liver transplantation recipients experienced complicated symptoms,which were mutually enhanced and existed as symptom clusters.Appropriate intervention should view a symptom cluster as an unit and assist patients to form correct recognition towards disease,to help patients involve disease management into individual and family’s normal activities.