成年人急性白血病初诊患者化疗期间症状的纵向变化研究

Longitudinal study of symptoms during chemotherapy in adults with newly diagnosed acute leukemia

目的了解成年人急性白血病患者在治疗期间症状的发生率、严重程度及变化,为临床医护人员进行针对性的症状筛查和管理提供参考。方法采用便利抽样法,选取2017年3月至2018年8月南方医科大学南方医院初诊为急性白血病的患者69例,采用记忆症状评估量表分别于化疗前(T1)、首次化疗后(T2)、第2~3次化疗后(T3)和第4~5次化疗后(T4)进行调查。结果成年人急性白血病患者在T1、T2、T3、T4测量的心理症状严重程度中位数(四分位数)分别为1.00(0.58,1.42)、1.00(0.83,1.67)、0.67(0.33,1.00)、0.67(0.33,1.00)分,躯体症状严重程度分别为0.50(0.21,0.83)、1.00(0.54,1.33)、0.75(0.58,1.17)、0.92(0.63,1.08)分,不同时间点症状严重程度差异有统计学意义(H=28.34、27.14,均P<0.01),且躯体维度症状在T2达到高峰。心理维度中精力不足的严重程度及发生率在T1~T4均较高。结论成年人急性白血病患者在不同治疗阶段的焦点症状不同,临床医护人员应根据患者不同的治疗阶段为其提供有效的个性化护理干预。

Objective To understand the incidence,severity and the change trajectory of symptoms in adult patients with acute leukemia during treatment,so as to provide a reference for clinical medical staff to conduct specific symptom screening and management.Methods From March 2017 to August 2018,69 patients who were newly diagnosed with acute leukemia at the Nanfang Hospital of Southern Medical University were conveniently selected.The Memory Symptom Assessment Scale was used to investigate the patients before chemotherapy(T1),after the first chemotherapy(T2),after the second to third chemotherapy(T3)and after the fourth to fifth chemotherapy(T4).Results The severity score of psychological symptoms in adult patients with acute leukemia at T1,T2,T3,and T4 were 1.00(0.58,1.42),1.00(0.83,1.67),0.67(0.33,1.00)and 0.67(0.33,1.00).The severity score of physical symptoms at T1,T2,T3,and T4 were 0.50(0.21,0.83),1.00(0.54,1.33),0.75(0.58,1.17)and 0.92(0.63,1.08),respectively.The score difference was statistically significant(H=28.34,27.14,both P<0.01)at different time points.The score of physical symptoms reached a peak at T2.In the psychological dimension,the severity and incidence of energy deficiency were higher in T1-T4.Conclusions Adult acute leukemia patients have different focal symptoms in different treatment stages.Clinical medical staff should provide effective and personalized nursing intervention for patients in different treatment stages.