基于潜变量增长模型的直肠癌低位前切除患者术后症状发展轨迹研究

Study on developmental trajectory of postoperative symptoms for rectal cancer patients undergoing low anterior resection based on latent growth modeling

目的分析直肠癌低位前切除患者术后症状评估的随访数据,探究其术后症状评分变化轨迹及影响因素,为制定针对性干预策略提供参考依据。方法采用便利抽样法,选取浙江省肿瘤医院2019年7月至2020年6月行直肠癌低位前切除术的患者,共122例。收集患者术后4个时间点的症状评估数据,利用Mplus工具构建2类无条件潜变量增长模型,选取最优拟合模型,确定直肠癌低位前切除患者术后症状发展轨迹,并在最优模型的基础上构建时间不变潜变量增长模型,观察协变量对直肠癌低位前切除患者术后症状变化轨迹的影响。结果除社会心理症状以外,一般症状、排便症状、排尿症状、性生活相关症状和症状总评分都呈非线性二次增长趋势,但二次增长时间不同。结论医护人员应关注直肠癌低位前切除患者术后症状发展轨迹,将排便症状与性生活相关症状作为术后12个月内患者的症状管理重点,建立相应管理方案,进行预见性护理及干预,促进患者康复。

Objective To analyze the follow-up data on evaluation of postoperative symptoms for rectal cancer patients undergoing low anterior resection(LAR),study the changing trajectory and influencing factors of their scores on postoperative symptoms in order to provide reference for finding out corresponding intervention measures.Method Choose 122 rectal cancer patients undergoing LAR in Zhejiang Cancer Hospital from July 2019 to June 2020 by convenient sampling.Collect the evaluation data of patients at four postoperative time points.Construct two types of unconditional latent growth modeling by Mplus,select the optimal fitting model,determine the developmental trajectory of postoperative symptoms for rectal cancer patients undergoing LAR and construct the time-unchanged latent growth model based on the best model.Observe the effect of covariates on changing trajectory of postoperative symptoms for rectal cancer patients undergoing LAR.Result General somatic symptoms,defecation symptoms,urination symptoms,sexual life function symptoms and the total score on symptoms show a trend of nonlinear quadratic increase,except psychological affective symptoms.But the time of quadratic increase is different.Conclusion Medical should pay attention to the developmental trajectory of postoperative symptoms for rectal cancer patients undergoing LAR,focus on bowel dysfunction and sexual dysfunction of patients in 12 months after surgery,establish corresponding management plan,provide predictive nursing and intervention to promote rehabilitation of patients.