恶性黑色素瘤患者接受免疫检查点抑制剂治疗相关症状群及影响因素

Analysis of Symptom Clusters and Influencing Factors in Malignant Melanoma Patients Treated with Immune Checkpoint Inhibitors

目的分析恶性黑色素瘤患者接受免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)治疗期间的相关症状群及其影响因素,以期为提高患者的治疗效果和生活质量提供参考。方法2022年1月至2023年9月,以便利抽样法选取在河南省某医院免疫治疗科接受治疗的MM患者109例为研究对象,采用肿瘤ICIs治疗症状评估量表对其进行调查。结果恶性黑色素瘤患者接受ICIs治疗期间皮疹、腹痛、视觉模糊、头晕、心悸、恶心、腹泻发生频率较高。因子分析显示形成肌肉-呼吸症状群、神经-感觉症状群、皮肤-肠胃症状群3个症状群。多因素分析结果显示,年龄、基础疾病以及疾病分期为患者肌肉-呼吸症状群的影响因素(F=16.892,P<0.001);发病部位、基础疾病为患者皮肤-肠胃症状群的影响因素(F=18.345,P<0.001);年龄、淋巴结或脏器转移数量为患者神经-感觉症状群的影响因素(F=11.456,P<0.001)。结论恶性黑色素瘤患者接受ICIs期间神经-感觉症状群和皮肤-肠胃症状群困扰严重。护士要注重对于年龄较大、患有基础疾病、肿瘤分期较晚、发病部位为黏膜、淋巴结或器官转移数量较多的患者的监测,并实施对症护理。

Objective To analyze the symptoms of patients with malignant melanoma(MM)during immune checkpoint inhibitors(ICIs)treatment,so as to provide a reference for enhancing the treatment effect and quality of life of patients.Methods From January 2022 to September 2023,a total of 109 MM patients treated in the Department of Immunotherapy of a hospital in Henan Province were selected by the convenient sampling method and a survey was conducted with the Tumor ICIs Treatment Symptom Assessment Scale.Results The frequency of rashes,abdominal pain,blurred vision,dizziness,palpitation,nausea and diarrhea were higher in patients with MM during ICIs treatment.Factor analysis showed that muscle-respiratory symptom group,nerve-sensory symptom group and skin-gastrointestinal symptom group were formed.The results of multi-factor analysis showed that age,underlying disease and disease stage were the influencing factors of muscle-respiratory symptom group(F=16.892,P<0.001).The location of the disease and the underlying disease were the influencing factors of the cutaneous and gastrointestinal symptoms(F=18.345,P<0.001).Age and the number of lymph node or organ metastases were the factors influencing the neurosensory symptom group(F=11.456,P<0.001).Conclusions During ICIs treatment,patients with MM were seriously disturbed by the nerve-sensory symptom group and skin-gastrointestinal symptom group.Nurses should pay attention to the monitoring of patients with older age,underlying diseases,late-stage tumors,and a large number of mucosal,lymph node or organ metastases,and implement symptomatic nursing.