结直肠癌术后化疗患者核心症状的纵向研究及护理对策

doi:10.3761/j.issn.0254-1769.2025.11.005

摘要/Abstract

摘要：

目的探讨结直肠癌术后化疗患者不同时期症状群及核心症状的变化，为制订精准的症状管理方案提供参考。方法采用便利抽样法，选取2023年8月—2024年5月在天津市2所三级甲等医院住院治疗的300例结直肠癌术后化疗患者作为调查对象，采用一般资料调查表、中文版安德森症状评估量表结直肠癌模块在第1化疗周期（T1）和第3化疗周期（T2）进行调查。使用探索性因子分析法提取症状群并运用R语言构建症状网络分析中心性指标。结果 T1时发放并回收调查问卷300份，T2时发放调查问卷300份，回收264份，有效问卷回收率为88.00%。结直肠癌术后化疗患者T1时存在5个症状群，T2时存在4个症状群。在症状网络中，T1时苦恼是强度（r_s=1.188）、紧密中心性（r_c=0.004）和中介中心性（r_b=36）最大的症状；T2时苦恼是强度（r_s=1.397）最大的症状，食欲下降是紧密中心性（r_c=0.004）和中介中心性（r_b=39）最大的症状。结论结直肠癌术后化疗患者的症状群持续稳定存在；苦恼既是结直肠癌术后患者化疗期稳定存在的核心症状又是化疗初期的桥梁症状，食欲下降是化疗中期的桥梁症状。医护人员在干预苦恼的同时还要优先干预食欲下降，提高症状管理效率。

关键词: 结直肠癌, 症状群, 化疗, 核心症状, 网络分析, 护理

Abstract:

Objective To explore the changes in symptom clusters and core symptoms at different stages in colorectal cancer patients undergoing postoperative chemotherapy，and to provide a reference for developing precise symptom management strategies in clinical practice. Methods 300 colorectal cancer patients who underwent postoperative chemotherapy at 2 tertiary hospitals in Tianjin from August 2023 to May 2024 were conveniently selected as the study subjects. General information questionnaires and the Chinese version of the MD Anderson Symptom Inventory for Colorectal Cancer were used to survey patients during the first chemotherapy cycle（T1） and the third chemotherapy cycle（T2）. Exploratory factor analysis was used to extract symptom clusters；R language was used to construct symptom networks. Results 300 questionnaires were distributed and collected at T1，and 264 questionnaires were distributed and collected at T2，with a recovery rate of 88.00%. Colorectal cancer patients undergoing postoperative chemotherapy had 5 symptom clusters at T1，and 4 symptom clusters at T2. In the symptom network，distress was the symptom with the highest strength（r_s=1.188），closeness centrality（r_c=0.004），and betweenness centrality（r_b=36） at T1. Distress was the symptom with the highest strength（r_s=1.397），while decreased appetite had the highest closeness centrality（r_c=0.004） and betweenness centrality（r_b=39） at T2. Conclusion The symptom clusters in colorectal cancer patients undergoing postoperative chemotherapy remain stable over time. Distress is a stable core symptom during chemotherapy，while decreased appetite is a bridging symptom in the mid-chemotherapy phase. Healthcare providers should prioritize interventions for decreased appetite while addressing emotional symptoms to improve the efficiency of symptom management.

Key words: Colorectal Cancer, Symptom Clusters, Chemotherapy, Core Symptoms, Network Analysis, Nursing Care

郑存风, 王峥, 刘海静, 高杰, 秦娅, 张清. 结直肠癌术后化疗患者核心症状的纵向研究及护理对策[J]. 中华护理杂志, 2025, 60(11): 1309-1315.

ZHENG Cunfeng, WANG Zheng, LIU Haijing, GAO Jie, QIN Ya, ZHANG Qing. Longitudinal study on core symptoms and nursing strategies for patients with colorectal cancer undergoing postoperative chemotherapy[J]. Chinese Journal of Nursing, 2025, 60(11): 1309-1315.

图/表 5

表1 调查对象的一般资料（n=264）

Table 1 General information of the survey subjects（n=264）

表2 结直肠癌术后化疗患者不同时期症状发生率及严重程度（n=264）

Table 2 Incidence and severity of symptoms at different stages for postoperative chemotherapy patients with colorectal cancer（n=264）

表3 结直肠癌术后化疗患者不同时间症状群的提取结果（n=264）

Table 3 The results of factor analysis at different stages for postoperative chemotherapy patients with colorectal cancer（n=264）

表4 结直肠癌术后化疗患者不同时期症状群严重程度比较[n=264，分，M（P25，P75）]

Table 4 The severity of symptoms clusters for postoperative chemotherapy patients with colorectal cancer at different stages[n=264，score，M（P25，P75）]

图1 结直肠癌术后化疗患者不同时期症状网络图

Figure 1 Symptom network diagrams of postoperative chemotherapy patients with colorectal cancer at different stages

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