急性心力衰竭患者入院时及易损期核心症状群的纵向研究

The changes of core symptom clusters in patients with acute heart failure during admission and vulnerable phase:a longitudinal study

目的纵向探讨急性心力衰竭(acute heart failure,AHF)患者从入院时到易损期不同时期症状群的特点,以期为医护人员实施针对性的症状管理提供依据。方法采用前瞻性研究设计,便利选取2019年11月—2020年11月在郑州市某三级甲等医院心内科住院的265例AHF患者,分别在患者入院第3天、出院后2个月和出院后3个月,使用中文版Memorial心力衰竭症状评估量表进行调查,且对3个时间点症状发生率≥40%的症状进行探索性因子分析提取症状群,并进行统计描述。结果AHF患者入院第3天有4个症状群,分别是急性血容量负荷过重症状群、心理情绪症状群、疲乏症状群和外周及肺部淤血症状群;出院后2个月有3个症状群,分别是休息相关症状群、心脏及组织缺血症状群和胸痛/胸闷-紧张症状群;出院后3个月有3个症状群,分别是心理情绪症状群、睡眠困难-口干症状群和疲乏症状群。结论AHF患者的症状群在不同时间点呈现动态变化的特点,疲乏症状稳定出现,入院时症状群较为严重,但是易损期的症状群也不容忽视,医护人员可以根据不同时期的症状群特征,采取针对性的干预措施。

Objective To longitudinally investigate the characteristics of symptom clusters in patients with acute heart failure(AHF)from admission to vulnerable phase,in order to provide a basis for medical staff to implement targeted symptom management.Methods A prospective study design was adopted to facilitate the selection of 265 AHF patients hospitalized in the Cardiology Department of a tertiary hospital in Zhengzhou from November 2019 to November 2020.On the 3rd day of admission and the vulnerable phase(2 months after discharge,3 months after discharge),the Chinese version of the Memorial Symptom Assessment Scale-Heart Failure was used for investigation.Exploratory factor analysis was performed on the symptom incidence≥40%at 3 time points to extract the symptom clusters,and the statistical description was carried out.Results AHF patients had 4 symptom clusters on the 3rd day of admission,namely acute blood volume overload symptom cluster,psycho-emotional symptom cluster,fatigue symptom cluster,peripheral and lung congestion symptom cluster.There were 3 symptom clusters in 2 months after discharge,namely rest-related symptom cluster,heart and tissue ischemia symptom cluster,chest pain/tightness-tension symptom cluster.There were 3 symptom clusters in 3 months after discharge,namely psycho-emotional symptom cluster,sleep difficulty-dry mouth symptom cluster,and fatigue symptom cluster.Conclusion The symptom clusters of AHF patients show dynamic changes at different time points;fatigue symptoms appear steadily;the symptom clusters are relatively serious at admission.However,the symptom clusters in the vulnerable phase cannot be ignored.Medical staff can take targeted interventions according to the characteristics of the symptom clusters in different periods.