化疗期淋巴瘤患者症状群的探索与比较研究

Exploration and comparison of symptom clusters in lymphoma patients during chemotherapy

目的探索淋巴瘤患者化疗期所经历的症状群的种类及构成,为开展临床淋巴瘤患者症状管理提供参考。方法采用淋巴瘤患者症状评估量表,对上海某三级甲等医院血液科和日间病房310例淋巴瘤化疗期患者进行症状横断面调查,采用探索性因子分析确定症状群,并比较基于症状综合得分、严重程度和困扰程度拟合的症状群的数量、性质及内部结构的异同。结果化疗期淋巴瘤患者经历症状数目的中位数为8个(1~22个),发生率前10位的症状有疲乏、担忧、夜间出汗、睡眠不安、脱发、局部肿块、便秘、口腔疼痛、体质量下降、皮肤改变,发生率31.60%~72.60%。发生率≥20%的症状的严重程度均分1.85~2.72分,困扰程度均分2.13~2.80,综合得分均分2.02~2.67分。基于症状综合得分、严重程度、困扰程度得分进行探索性因子分析,均可提取5个公因子,累积方差贡献率分别为58.619%、62.892%、60.342%。综合不同拟合结果,化疗期淋巴瘤患者可能存在5个症状群:化疗毒副作用综合征群、神经心理症状群、消化-睡眠症状群、病感症状群、皮肤症状群。结论淋巴瘤患者化疗期间存在来自疾病本身及治疗相关的身心症状,且症状之间互相影响,以症状群的形式存在。基于严重程度拟合的症状群可能比基于症状综合得分拟合的症状群内部结构一致性更高。临床医护人员应以症状群为干预单位简化症状管理,提高护理效率。

Objective To explore the types and composition of symptom clusters experienced by lymphoma patients during chemotherapy,and lay the foundation for the symptom management of lymphoma patients.Methods With the Symptom Assessment Scale for Lymphoma Patients,a cross-sectional symptom survey was conducted in 310 lymphoma patients on chemotherapy in the hematology department and day wards of a 3A hospital in Shanghai.Exploratory factor analysis based on different types of scores(symptom total scores,severity scores,and distress scores)was used to determine the symptom clusters,and the numbers,nature and internal structure of symptom clusters were compared.Results The lymphoma patients experienced a median number of 8 symptoms(IQR:1-22).The top 10 symptoms included fatigue,worry,night sweat,restless sleep,hair loss,local lumps,constipation,oral pain,weight loss,and skin change,with incidence rates between 31.60%-72.60%.Symptoms with an incidence rate ≥20% scored averagely 1.85-2.72 in severity dimension,2.13-2.80 in distress dimension,and 2.02-2.67 in symptom totals.Exploratory factor analysis based on different types of scores(symptom total scores,severity scores,and distress scores)all extracted 5 clusters,which could explain 58.519%,62.892%,60.342% of total variance respectively.Viewed in totality,lymphoma patients plausibly have the following 5 symptom clusters:side-effect symptom cluster(oral pain-fever-hair loss-night sweat-constipation),neuropsychological symptom cluster(nervous-worry-social disturbance),digestive-sleep symptom cluster(nausea-fatigue-restless sleep-decreased appetite),sickness-behavior symptom cluster(dry mouth-drowsiness-dizziness-taste change),and skin symptom cluster(skin change-numbness-pain-itching-lump).Conclusion Lymphoma patients may suffer from psychosomatic distress both from disease and treatment,and there may exist inner relationship among symptoms in the same cluster.Symptom clusters extracted based on severity scores may have higher internal consistency level than those extracted based on symptom total scores.Symptom clusters should be laid emphasis as an intervention unit during symptom management to help lymphoma patients to enhance efficiency of nursing care.