头颈部肿瘤放化疗患者症状演变及护理启示

doi:10.3761/j.issn.0254-1769.2026.10.010

中华护理杂志 ›› 2026, Vol. 61 ›› Issue (10): 1371-1378.DOI: 10.3761/j.issn.0254-1769.2026.10.010

头颈部肿瘤放化疗患者症状演变及护理启示

杨雯雯¹(), 王嘉煜², 李素芳¹, 杜羿霏³, 赵瑞⁴, 陈梦然⁵, 李园园¹, 徐晓霞⁵()

¹ 郑州大学附属肿瘤医院/河南省肿瘤医院头颈外科郑州市 450008
² 河南中医药大学护理学院/智慧康养护理行业学院郑州市 450046
³ 郑州大学附属肿瘤医院/河南省肿瘤医院ICU 郑州市 450008
⁴ 郑州大学附属肿瘤医院/河南省肿瘤医院消毒供应中心郑州市 450008
⁵ 郑州大学附属肿瘤医院/河南省肿瘤医院护理部郑州市 450008

收稿日期:2026-01-08 出版日期:2026-05-20 发布日期:2026-05-09
*通讯作者: 徐晓霞，E-mail：xuxiaoxia2007@126.com
作者简介:杨雯雯：女，硕士，主管护师，E-mail：1617159790@qq.com
第一联系人：作者贡献声明
杨雯雯：研究设计、实施研究、论文撰写；王嘉煜：数据整理、统计学分析；李素芳：问卷调查/数据收集、研究指导；杜羿霏、赵瑞、陈梦然、李园园：数据整理、论文审阅；徐晓霞：研究指导、论文修改
基金资助:
河南省医学科技攻关计划项目(LHGJ20230095)

Dynamic evolution of symptom networks in head and neck cancer patients undergoing chemoradiotherapy and nursing implications

YANG Wenwen¹(), WANG Jiayu², LI Sufang¹, DU Yifei³, ZHAO Rui⁴, CHEN Mengran⁵, LI Yuanyuan¹, XU Xiaoxia⁵()

¹ Department of Head and Neck Surgery， the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital， Zhengzhou 450008， China
² School of Nursing， Henan University of Chinese Medicine， Zhengzhou 450046， China
³ Intensive Care Unit， the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital， Zhengzhou 450008， China
⁴ Central Sterile Supply Department， the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital， Zhengzhou 450008， China
⁵ Department of Nursing， the Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital， Zhengzhou 450008， China.

Received:2026-01-08 Online:2026-05-20 Published:2026-05-09
* Corresponding author: XU Xiaoxia，E-mail：xuxiaoxia2007@126.com
Funding program:
Henan Provincial Medical Science and Technology Research Project(LHGJ20230095)

摘要/Abstract

摘要：

目的探索头颈部肿瘤放化疗患者症状网络的时序演变规律，为精准症状管理提供参考。方法采用前瞻性纵向研究设计，便利选取2024年1月—2025年8月河南省某三级甲等肿瘤专科医院行放化疗的330例头颈部肿瘤患者，采用安德森症状评估量表-头颈部模块，分别于放化疗前（T0）、放化疗第3周（T1）、放化疗结束时（T2）进行评估。应用R 4.5.2软件进行症状动态网络分析，并评估网络稳定性。结果最终275例患者完成全部评估并纳入分析。T1口干发生率最高（82.9%），T2口腔/喉咙溃疡发生率最高（90.2%）。动态网络分析结果显示：T0至T1阶段，口腔/喉咙溃疡发出预测边最多，口干出预期影响系数最高（预期影响系数=2.365），二者共同构成早期双核心驱动症状；T1至T2阶段，吞咽/咀嚼困难取代前者成为发出预测边最多且出预期影响系数最高的症状（预期影响系数=3.506）；两阶段中食欲不振与吞咽/咀嚼困难为桥梁预期影响系数最高的症状，且网络整体连接强度呈递增趋势，网络稳定性良好。结论头颈部肿瘤放化疗患者症状网络呈时序动态性，提示护理人员应实施分阶段前瞻性症状监测与靶向干预，阻断症状介导的跨群传播链路，以延缓功能衰退，优化患者的生活质量。

关键词: 头颈部肿瘤, 放化疗, 症状管理, 网络分析, 护理

Abstract:

Objective To explore the temporal evolution of symptom networks in patients with head and neck cancer undergoing chemoradiotherapy，and to inform precise symptom management strategies.Methods A prospective longitudinal study design was adopted. A convenience sample of 330 patients undergoing chemoradiotherapy was recruited from the head and neck surgery department of a tertiary oncology hospital in Henan Province between January 2024 and August 2025. The M.D. Anderson Symptom Inventory-Head and Neck Module was used to assess symptoms at 3 time points：before chemoradiotherapy（T0），at week 3 of chemoradio-therapy（T1），and at treatment completion（T2）. Dynamic symptom network analysis was performed using R 4.5.2 software，and network stability was evaluated.Results A total of 275 patients completed all assessments and were included in the final analysis. Dry mouth had the highest incidence at T1（82.9%），and oral/throat sores had the highest incidence at T2（90.2%）. Dynamic network analysis revealed that during the T0-to-T1 phase，oral/throat sores had the most outgoing predictive edges and dry mouth had the highest out-expected influence（EI=2.365）. During the T1-to-T2 phase，difficulty swallowing/chewing emerged as the symptom with the most outgoing predictive edges and the highest out-expected influence（EI=3.506）. Lack of appetite and difficulty swallowing/chewing had the highest bridge expected influence，and the overall network connectivity strength increased. Network stability tests yielded satisfactory to acceptable results.Conclusion The symptom network in patients with head and neck cancer undergoing chemoradiotherapy exhibits temporal dynamics. These findings suggest that nurses should implement phase-specific proactive symptom monitoring and preventive targeted interventions to interrupt cross-cluster symptom propagation，thereby mitigating functional decline，and optimizing overall quality of life.

Key words: Head and Neck Cancer, Chemoradiotherapy, Symptom Management, Network Analysis, Nursing Care

杨雯雯, 王嘉煜, 李素芳, 杜羿霏, 赵瑞, 陈梦然, 李园园, 徐晓霞. 头颈部肿瘤放化疗患者症状演变及护理启示[J]. 中华护理杂志, 2026, 61(10): 1371-1378.

YANG Wenwen, WANG Jiayu, LI Sufang, DU Yifei, ZHAO Rui, CHEN Mengran, LI Yuanyuan, XU Xiaoxia. Dynamic evolution of symptom networks in head and neck cancer patients undergoing chemoradiotherapy and nursing implications[J]. Chinese Journal of Nursing, 2026, 61(10): 1371-1378.

图/表 3

表1 头颈部肿瘤放化疗患者不同时间点症状发生率和严重程度（n=275）

Table 1 Incidence and severity of symptoms in patients with head and neck cancer undergoing chemoradiotherapy at different stages（n=275）

图1 头颈部肿瘤放化疗患者T0至T1阶段症状动态网络结构注：蓝色圆圈表示口腔-咽喉症状群；红色圆圈表示发声-呼吸症状群；紫色圆圈表示疲乏-疼痛-心理症状群；橙色圆圈表示消化道症状群。S1为疼痛；S2为疲乏；S3为恶心；S4为睡眠不安；S5为苦恼；S6为气短；S7为健忘；S8为食欲不振；S9为瞌睡；S10为口干；S11为悲伤；S12为呕吐；S13为麻木感；S14为口腔/喉咙黏液；S15为吞咽/咀嚼困难；S16为窒息/咳嗽；S17为发声/讲话困难；S18为皮肤疼痛/皮疹；S19为便秘；S20为味觉改变；S21为口腔/喉咙溃疡；S22为牙齿/牙龈问题。

Figure 1 Dynamic network structure of symptoms in patients with head and neck cancer undergoing chemoradiotherapy from T0 to T1 phase

图2 头颈部肿瘤放化疗患者T1至T2阶段症状动态网络结构注：蓝色圆圈表示口腔-咽喉症状群；红色圆圈表示发声-呼吸症状群；紫色圆圈表示疲乏-疼痛-心理症状群；橙色圆圈表示消化道症状群。S1为疼痛；S2为疲乏；S3为恶心；S4为睡眠不安；S5为苦恼；S6为气短；S7为健忘；S8为食欲不振；S9为瞌睡；S10为口干；S11为悲伤；S12为呕吐；S13为麻木感；S14为口腔/喉咙黏液；S15为吞咽/咀嚼困难；S16为窒息/咳嗽；S17为发声/讲话困难；S18为皮肤疼痛/皮疹；S19为便秘；S20为味觉改变；S21为口腔/喉咙溃疡；S22为牙齿/牙龈问题。

Figure 2 Dynamic network structure of symptoms in patients with head and neck cancer undergoing chemoradiotherapy from T1 to T2 phase

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头颈部肿瘤放化疗患者症状演变及护理启示

Dynamic evolution of symptom networks in head and neck cancer patients undergoing chemoradiotherapy and nursing implications

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