冠状动脉旁路移植术后患者症状群识别及影响因素研究

doi:10.3761/j.issn.0254-1769.2023.02.004

摘要/Abstract

摘要：

目的了解冠状动脉旁路移植（coronary artery bypass grafting，CABG）术后患者症状严重程度及困扰程度，识别患者术后症状群，并分析其影响因素，为制订精准症状管理策略提供参考。方法便利选取2021年6月—2022年2月在宁夏回族自治区某三级甲等综合医院心脏大血管外科行CABG的患者135例，使用自制的一般资料调查表和CABG术后患者症状调查问卷进行横断面调查，通过探索性因子分析提取症状群，并采用多元线性回归分析明确其影响因素。结果最终纳入130例，CABG术后患者发生率最高的5个症状依次为手术切口疼痛（98.5%）、睡眠障碍（96.9%）、疲乏（96.2%）、引流管处疼痛（92.3%）和气短（79.2%），且症状发生率越高其严重程度及困扰程度越严重。探索性因子分析得出5个症状群，分别是身心应激症状群、躯体活动障碍症状群、胃肠道不适症状群、疲倦症状群和伤口疼痛症状群。既往史、主要照顾者、吸烟史是症状群发生的独立预测因子（P<0.05）。结论 CABG术后患者会经历多种症状，且症状之间相互关联，以症状群的形式存在。临床护理人员应重点关注症状群内起主导作用的症状，基于症状严重程度和困扰程度及症状群制订干预措施，提高症状管理效能，提升患者康复期的生活质量。

关键词: 冠状动脉旁路移植术, 非体外循环, 症状群, 症状管理, 影响因素分析, 横断面研究, 护理

Abstract:

Objective To understand the severity and distress of symptoms in patients after coronary artery bypass grafting（CABG），to identify postoperative symptom clusters of patients，and to analyze their influencing factors，so as to provide references for formulating accurate symptom management strategies. Methods 135 patients after CABG were conveniently selected in the cardiac macrovascular surgery department of a tertiary A general hospital in Ningxia from June 2021 to February 2022. The cross-sectional survey was conducted using a self-designed general data questionnaire and symptom questionnaire. Exploratory factor analysis was used to extract symptom clusters，and multiple linear regression analysis was used to determine the influencing factors. Results 130 cases were finally included. The 5 symptoms with the highest incidence rate after CABG were surgical incision pain（98.5%），sleep disturbance（96.9%），fatigue（96.2%），pain at the drain（92.3%），and shortness of breath（79.2%），and the incidence of symptoms would go up with the greater severity and distress. Exploratory factor analysis revealed 5 symptom groups，which were physical and mental stress symptom cluster，physical activity disorder symptom cluster，gastrointestinal discomfort symptom cluster，fatigue symptom cluster and wound pain symptom cluster. Previous history，primary caregiver，and smoking history were independent predictors of symptom cluster occurrence（P<0.05）. Conclusion After CABG，patients will experience a variety of symptoms，which are interrelated and exist in the form of symptom clusters. Clinical nursing staff should focus on the leading symptoms within the symptom cluster，formulate intervention measures based on the severity and distress of symptoms and symptom cluster，improve symptom management efficiency and promote the quality of life in the convalescent period.

Key words: Coronary Artery Bypass, Non-Extracorporeal Circulation, Symptom Cluster, Symptom Management, Root Cause Analysis, Cross-Sectional Studies, Nursing Care

马红雅, 郑栋莲, 郭淑萍, 毛亚娇, 王惠如, 米光丽. 冠状动脉旁路移植术后患者症状群识别及影响因素研究[J]. 中华护理杂志, 2023, 58(2): 158-164.

MA Hongya, ZHENG Donglian, GUO Shuping, MAO Yajiao, WANG Huiru, MI Guangli. Investigation of symptom clusters recognition and its influencing factors in patients after coronary artery bypass grafting[J]. Chinese Journal of Nursing, 2023, 58(2): 158-164.

图/表 4

表1 调查对象的一般资料和冠状动脉旁路移植术后患者症状群的单因素分析（n=130）

Table 1 General data of the respondents and univariate analysis of symptom clusters of patients after coronary artery bypass grafting（n=130）

表2 冠状动脉旁路移植术后患者常见症状及严重程度、困扰程度得分（n=130）

Table 2 Scores of common symptoms，severity and distress of patients after coronary artery bypass grafting（n=130）

表3 冠状动脉旁路移植术后患者症状群分析

Table 3 Symptom cluster analysis results of patients after coronary artery bypass grafting

表4 冠状动脉旁路移植术后患者症状群的多元线性回归分析

Table 4 Multiple linear regression analysis of patient symptom clusters after coronary artery bypass grafting

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