基于体质特征的胃癌化疗患者核心症状及影响因素研究

doi:10.3761/j.issn.0254-1769.2024.18.008

摘要/Abstract

摘要：

目的调查胃癌患者化疗期间症状的发生率及严重程度，构建症状网络以探索核心症状及桥梁症状。并结合患者的中医体质，进一步探讨核心症状与中医体质的关联性。方法 2023年3月—8月，便利选取江苏省苏南、苏中和苏北4所三级甲等中医院肿瘤科病区的胃癌化疗患者作为调查对象，采用安德森症状测评量表胃癌特异性模块调查胃癌化疗患者18个症状的发生率及严重程度，并评估患者的中医体质类型。通过R语言构建症状网络模型，分析中心性指标，确定核心症状及桥梁症状；通过Spearman相关分析评估不同体质与核心症状严重程度的关联性。结果共发放问卷346份，回收有效问卷340份，有效问卷回收率为98.3%。340例胃癌化疗患者症状发生率及严重程度排名前3位的依次为疲乏（85.59%）、食欲下降（82.35%）、味觉改变（81.18%）。症状网络分析中心性指标结果显示，悲伤的强度中心性、中介中心性、紧密中心性均最强（r_s=8.23、r_b=2.00、r_c=0.03），为核心症状；睡眠障碍、食欲下降、嗜睡、味觉改变是桥梁症状，桥梁强度分别为0.74、0.76、0.99、0.94。Spearman相关分析结果显示，气虚质、痰湿质与悲伤严重程度呈正相关（P<0.05）；痰湿质与味觉改变严重程度呈正相关（P<0.05）。结论胃癌化疗患者中，疲乏是最为严重的症状，悲伤是核心症状，睡眠障碍、食欲下降、嗜睡和味觉改变为桥梁症状。中医体质方面，气虚质、痰湿质是悲伤的危险体质，痰湿质是味觉改变的危险体质。护士可结合患者的核心症状与体质特点，优化症状干预策略。

关键词: 胃癌, 化疗, 核心症状, 桥梁症状, 体质, 中医护理学

Abstract:

Objective To investigate the incidence and severity of symptoms in patients with gastric cancer who received chemotherapy，we constructed a symptom network to explore core symptoms and bridge symptoms. Furthermore，the study explores the association between core symptoms and Traditional Chinese Medicine（TCM） constitutions. Methods Patients with gastric cancer who received chemotherapy in the medical oncology and surgical oncology department from March to August 2023 were selected for the study using a convenience sampling method. The MD Anderson Symptom Inventory Gastrointestinal Cancer was used for evaluating gastrointestinal symptoms and their severity among patients receiving chemotherapy for gastric cancer，as well as assessing the classification of TCM constitution among patients. The symptom network model was constructed using the R programming language，and the central index was analyzed to determine the core symptoms and bridge symptoms. Binary logistic regression analysis was employed to assess the association between different physical conditions and the occurrence of core symptoms. Results A total of 346 electronic questionnaires were collected，with 340 valid ones，and the effective recovery rate was 98.3%. The 3 most prevalent and severe symptoms among the 340 patients with gastric cancer were fatigue（85.59%），lack of appetite（82.35%），and taste alteration（81.18%）. The centrality index results indicated that grief exhibited the highest intensity，medium，and compactness centrality values（r_s=8.23，r_b=2.00，r_c=0.03），making it the core symptom of this condition. Sleep disorders，lack of appetite，drowsiness，and taste alteration were identified as bridging symptoms with bridge intensities of 0.74，0.76，0.99，and 0.94 respectively. The results of Spearman correlation analysis showed that there was a positive correlation between sadness and qi-deficiency constitution，phlegm-dampness constitution（P<0.05）. The phlegm-dampness constitution was positively correlated with the taste alterations（P<0.05）. Conclusion In patients with gastric cancer，fatigue emerges as the most prominent symptom，while sadness assumes the core symptom. Additionally，sleep disorder，lack of appetite，drowsiness，and taste alteration are bridge symptoms. According to the principles of TCM constitution，qi-deficiency and phlegm-dampness are constitutions associated with a higher risk of experiencing sadness，and phlegm-dampness is a constitution associated with a higher risk of taste changes. Nurses can integrate core symptoms and TCM constitutions characteristics to optimize the strategies for symptom intervention.

Key words: Gastric Cancer, Chemotherapy, Core Symptoms, Bridge Symptom, Constitution, Traditional Chinese Medicine Nursing

邹炎铃, 李易, 张紫嫣, 李洵, 杨丽华, 王晓庆, 高娟, 管慧芸, 段培蓓. 基于体质特征的胃癌化疗患者核心症状及影响因素研究[J]. 中华护理杂志, 2024, 59(18): 2238-2243.

ZOU Yanling, LI Yi, ZHANG Ziyan, LI Xun, YANG Lihua, WANG Xiaoqing, GAO Juan, GUAN Huiyun, DUAN Peibei. Examining core symptoms and influencing factors of patients with gastric cancer undergoing chemotherapy：the role of Traditional Chinese Medicine constitutional traits[J]. Chinese Journal of Nursing, 2024, 59(18): 2238-2243.

图/表 3

表1 调查对象的一般资料（n=340）

Table 1 Participants characteristics（n=340）

表2 胃癌化疗患者症状发生率及严重程度（n=340）

Table 2 Prevalence and severity of patients with gastric cancer undergoing chemotherapy symptoms（n=340）

表3 胃癌化疗患者体质与核心症状及桥梁症状关系（r值）

Table 3 Relationship between constitution and core symptoms and bridge symptoms in patients with gastric cancer undergoing chemotherapy（r value）

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