基于不悦症状理论的烟雾病术后康复期患者症状管理体验的质性研究

A Qualitative Study on the Symptom Management Experience of Patients with Moyamoya Disease During Postoperative Recovery Based on the Theory of Unpleasant Symptoms

目的深入探讨烟雾病血运重建术后患者的不悦症状体验,为医护人员优化症状管理策略提供参考依据。方法以质性研究中的现象学研究方法为指导,基于不悦症状理论设置访谈提纲,采用目的抽样选取2023年3—7月在郑州市某三级甲等综合性医院神经外科接受烟雾病血运重建手术后即将出院的12名患者为研究对象,对其进行深入的半结构式访谈。采用Colaizzi 7步法和Nvivo 11软件分析和整理资料,提炼主题。结果共提炼出3个主题和11个亚主题。(1)症状层面:多维度不悦症状体验与心理状态改变共存(躯体不悦症状多样、负性情绪困扰、对家庭负担加重的担忧、渴望减轻不悦症状、期待预后)。(2)症状影响因素层面:生理、心理、环境因素交互作用(生理因素影响情绪变化与症状感知、情绪与环境的变化影响症状感知)。(3)症状结果层面:积极的症状管理和严重的症状是良好预后的促进和阻碍因素(积极应对可缓解不悦症状、精神支持可改善负性心理、严重的症状影响预后、症状反馈差异)。结论烟雾病术后患者的症状困扰复杂多样,患者渴望减轻不悦症状,期待良好的预后。医护人员应优化症状管理模式,促进多方面支持,减轻其不悦症状体验,改善烟雾病患者的健康结局。

Objective To comprehensively investigate the experiences of patients with unpleasant symptoms after cerebral revascularization surgery for moyamoya disease,thereby providing healthcare professionals with evidence-based insights to optimize symptom management strategies.Methods Guided by the phenomenological approach within qualitative research,based on the theory of unpleasant symptoms,an interview guide was developed,purposeful sampling was employed to select 12 patients who were preparing for discharge after undergoing cerebrovascular reconstruction surgery for moyamoya disease in the neurosurgery department of a tertiary-level a-grade comprehensive hospital in Zhengzhou from March and July 2023.These patients underwent in-depth semi-structured interviews.Data were analyzed and organized utilizing the Colaizzi 7-step method and Nvivo 11 software to distill the themes.Results A total of 3 themes and 11 sub-themes were identified.(1)Symptom level:the coexistence of multi-dimensional unpleasant symptoms and changes in psychological state(diversity of physical unpleasant symptoms,negative emotional distress,concern for increased family burden,desire to alleviate unpleasant symptoms,anticipation of prognosis).(2)Symptom influencing factors level:the interaction of physiological,psychological,and environmental factors(physiological factors affecting emotional changes and symptom perception,emotional and environmental changes affecting symptom perception).(3)Symptom outcome level:both effective symptom management and severe symptoms can promote or hinder a good prognosis(active coping can alleviate unpleasant symptoms,psychological support can improve negative psychology,severe symptoms affect prognosis,differences in symptom feedback).Conclusion Patients with postoperative moyamoya disease experience a spectrum of complex and multifaceted symptom distress.There is a strong desire among these patients to alleviate unpleasant symptoms and anticipate a positive prognosis.Healthcare professionals should strive to refine symptom management strategies and offer comprehensive support to alleviate the distress associated with these symptoms,thereby enhancing the overall health outcomes for patients with moyamoya disease.