终末期肾病患者甲状旁腺切除术后症状群及其前哨症状的回顾性研究

Retrospective Study on Postoperative Symptom Clusters and Sentinel Symptoms in End-stage Renal Disease Patients After Parathyroidectomy

目的探索终末期肾病患者行甲状旁腺切除术(parathyroidectomy,PTX)后症状群及其前哨症状,并分析相关影响因素。方法便利抽样法选取上海市某2所三级甲等医院行PTX的终末期肾病患者进行回顾性调查研究,提取内容包括疾病相关资料和透析症状指数等。采用探索性因子分析提取症状群,基于Apriori算法判定前哨症状,采用广义线性模型探索影响因素。结果共提取骨骼肌肉、皮肤和贫血3类症状群,其前哨症状分别是手/脚麻木、皮肤干燥和疲倦无力。患者性别、围术期血钙、术后甲状旁腺激素(parathyroidhormone,PTH)增长量与手/脚麻木程度有关;患者年龄、透析龄、是否规律透析、术前血磷和术后PTH增长量与皮肤干燥程度有关;患者年龄、透析龄、是否规律透析、术前血红蛋白和白蛋白水平与疲倦无力程度有关(均P<0.05)。结论患者PTX术后中长期存在3类症状群,其前哨症状与多项实验室指标关系密切。

Objective To explore the symptom clusters and sentinel symptoms after parathyroidectomy(PTX)in patients with end-stage renal disease,and to analyse the related influencing factors.Methods The end-stage renal disease patients after PTX were selected from two class-3 grade-A hospitals in Shanghai by the convenience sampling method.A retrospective investigation was conducted,including disease-related information and dialysis symptom index.The symptom clusters were extracted by exploratory factor analysis,the sentinel symptoms were determined based on the Apriori algorithm,and the influencing factors were explored by generalized linear model.Results Three symptom clusters were extracted,including skeletal muscle,skin,and anaemia.The sentinel symptoms were numbness in hands or feet,dry skin,and fatigue.Gender,perioperative blood calcium,and postoperative parathyroidhormone(PTH)increase were related to the degree of hand/feet numbness;age,dialysis duration,dialysis regularity,preoperative serum phosphorus,and postoperative PTH increase were related to the degree of skin dryness;age,dialysis duration,dialysis regularity,preoperative haemoglobin,and albumin levels were related to the degree of fatigue.Conclusions There are three symptom clusters in the medium and long term in the patients after PTX,and the sentinel symptoms are closely related to several laboratory indexes.