基于网络分析的维持性血液透析患者透析期间核心症状研究

Investigation of core symptoms during hemodialysis period in maintenance hemodialysis patients:a network analysis

目的调查维持性血液透析(MHD)患者透析期间症状发生率及严重程度,构建症状网络探索核心症状及桥梁症状。方法采用便利抽样法选取541例MHD患者作为研究对象,采用透析症状指数调查MHD患者30个症状的发生率及严重程度,并基于R语言和Fruchterman-Reingold算法构建症状网络模型,分析中心性指标,确定核心症状及桥梁症状。结果541例MHD患者发生率排名前5位的症状依次为乏力(83.92%)、皮肤干燥(80.96%)、口干(78.37%)、易惊醒(77.82%)和入睡困难(76.16%);MHD患者最严重的症状是皮肤干燥,其后依次为瘙痒、乏力、口干和易惊醒。症状网络分析结果显示,生理症状中以皮肤干燥与瘙痒(weight=0.73)关联性最强,情绪症状中以烦躁与焦虑(weight=0.35)关联性最强。中心性指标显示,悲伤的强度中心性最强(r_(S)=1.61),被确定为核心症状;乏力的中介中心性最高(r_(B)=2.90),烦躁的紧密中心性最高(r_(C)=1.61)。烦躁、悲伤、注意力不集中是桥梁症状,桥梁强度分别为0.36、0.22、0.21。结论皮肤干燥和悲伤分别是MHD患者的最严重症状和核心症状,烦躁、悲伤和注意力不集中是桥梁症状。医护人员可基于核心症状和桥梁症状制订精准化的干预措施,提高MHD患者症状管理水平。

Objective To explore the prevalence and severity of symptoms during hemodialysis period in maintenance hemodialysis(MHD)patients,and to construct symptom network to identify core symptoms and bridge symptoms.Methods Using the convenience sampling method,a total of 541 MHD patients were admitted as study objects.Dialysis symptom index was used to investigate the prevalence and severity of 30 symptoms in MHD patients,and a symptom network model based on Fruchterman-Reingold algorithm was constructed to analyze the central indicators and determine the core symptoms and bridge symptoms.Results The top five commonly occurring symptoms were fatigue(83.92%),dry skin(80.96%),dry mouth(78.37%),waking up easily(77.82%)and difficulty in falling asleep(76.16%).The most severe symptoms were dry skin,followed by pruritus,fatigue,dry mouth and waking up easily.The symptom network analysis showed that dry skin was most strongly associated with pruritus(weight=0.73)among physiological symptoms,irritability was most strongly associated with anxiety(weight=0.35)among mood symptoms.The centrality index showed that the intensity of sadness was the most centrality(r_(S)=1.61)and was identified as the core symptom;fatigue had the highest mediation centrality(r_(B)=2.90)and irritability had the highest close centrality(r_(C)=1.61).Irritability,sadness,and inattention were identified as bridge symptoms,and their bridge centrality was 0.36,0.22,and 0.21.Conclusion Dry skin and sadness are respectively the most severe symptom and core symptom in MHD patients,while irritability,sadness and inattention are the bridge symptoms.Medical staff can formulate precise interventions based on core symptoms and bridge symptoms to improve the level of symptom management.