肾移植患者术后早期症状群及影响因素的研究

doi:10.3761/j.issn.0254-1769.2025.22.006

摘要/Abstract

摘要：

目的明确肾移植患者术后早期症状群种类及影响因素，为医护人员对肾移植患者实施精准的症状管理提供指导。方法采用便利抽样法，选取2024年5月—2025年3月在天津市某三级甲等医院接受肾移植手术的183例肾移植患者作为调查对象，采用一般资料调查表和中文版改良移植症状发生和症状困扰量表进行调查，采用探索性因子分析提取症状群，利用多元逐步线性回归分析明确症状群的影响因素。结果回收有效问卷180份，有效问卷回收率为98.36%。肾移植患者术后提取出了能量缺乏症状群、激素紊乱症状群、情绪睡眠症状群和皮肤不适症状群。多元逐步线性回归分析结果显示，年龄、婚姻状况、工作状态、医疗付费方式、居住情况、移植前透析时长、移植前合并症、血糖、血红蛋白是症状群的影响因素（P<0.05）。结论肾移植患者术后早期存在复杂的症状经历，受人口学特征与疾病相关因素的影响。医护人员应以症状群为干预模块，以影响因素为靶点，制订精准的症状管理方案，以降低肾移植患者术后早期再入院率。

关键词: 肾移植, 症状群, 影响因素分析, 护理

Abstract:

Objective To identify the types，composition，and influencing factors of symptom clusters in kidney transplant recipients during the early postoperative period，and to provide guidance for healthcare professionals in implementing precise symptom management strategies. Methods A total of 183 kidney transplant recipients who underwent renal transplantation in a tertiary hospital in Tianjin from May 2024 to March 2025 were enrolled as the research subjects by convenience sampling. The investigation was conducted using a general information questionnaire and the Chinese version of Modified Transplant Symptom Occurrence and Symptom Distress Scale. Exploratory factor analysis was employed to extract symptom clusters，and multiple stepwise linear regression was used to identify the influencing factors of symptom clusters. Results 180 valid questionnaires were recovered，with a valid response rate of 98.36%. Totally 4 symptom clusters were identified during the early postoperative phase by exploratory factor analysis，including energy deficiency symptom cluster，hormone disorder symptom cluster，emotional-sleep symptom cluster，and skin discomfort symptom cluster. Results of multiple stepwise linear regression showed that age，marital status，employment status，medical payment method，living situation，dialysis duration，preoperative comorbidities，blood glucose，and hemoglobin were influencing factors of symptom clusters（P<0.05）. Conclusion Kidney transplant recipients experience complex symptom profiles during the early postoperative period，which are influenced by demographic characteristics and disease-related factors. Healthcare providers should adopt symptom clusters as intervention modules and target influencing factors to develop precise symptom management strategies，thereby reducing the early postoperative readmission rate.

Key words: Kidney Transplantation, Symptom Cluster, Root Cause Analysis, Nursing Care

韩叶, 刘彦慧, 金彦, 罗如珍, 翟静波, 王娟, 张萌琦. 肾移植患者术后早期症状群及影响因素的研究[J]. 中华护理杂志, 2025, 60(22): 2723-2730.

HAN Ye, LIU Yanhui, JIN Yan, LUO Ruzhen, ZHAI Jingbo, WANG Juan, ZHANG Mengqi. Symptom clusters and influencing factors in kidney transplant recipients during the early postoperative period[J]. Chinese Journal of Nursing, 2025, 60(22): 2723-2730.

图/表 3

表1 肾移植患者的一般资料及术后早期症状群影响因素的单因素分析结果（n=180）

Table 1 General information of kidney transplant recipients and univariate analysis results of influencing factors for early postoperative symptom clusters（n=180）

表2 肾移植患者术后早期症状的因子载荷（n=180）

Table 2 Factor loadings of symptom clusters in kidney transplant recipients during the early postoperative period（n=180）

表3 肾移植患者术后早期症状群影响因素的多元逐步线性回归分析结果（n=180）

Table 3 Multivariate stepwise linear regression analysis of factors influencing symptom clusters in kidney transplant recipients during the early postoperative period（n=180）

参考文献 23

[1]	Global Observatory on Donation and Transplantation. The global observatory on donation and transplantation(GODT) 2023 data[EB/OL]. (2024-12-01)[2025-03-15]. https://www.transplant-observatory.org/uses-of-dataquoting-data/.
[2]	黄洁夫. 中国器官移植发展报告-2021[M]. 北京: 人民卫生出版社, 2022:38-40.
	Huang JF. China organ transplantation development report-2021[M]. Beijing: People’s Medical Publishing House, 2022:38-40.
[3]	Du CY, Wu SS, Fu YX, et al. Transplant-related symptom clusters in renal transplant recipients[J]. Clin Nurs Res, 2021, 30(3):343-350. DOI URL
[4]	储爱琴, 张海玲, 陈娟, 等. 肾移植术后居家患者症状群及影响因素[J]. 护理学杂志, 2020, 35(17):19-23.
	Chu AQ, Zhang HL, Chen J, et al. Symptom clusters in stay-at-home kidney transplant recipients and the influencing factors[J]. J Nurs Sci, 2020, 35(17):19-23.
[5]	Famure O, Kim ED, Au M, et al. What are the burden,causes,and costs of early hospital readmissions after kidney transplantation?[J]. Prog Transplant, 2021, 31(2):160-167. DOI URL
[6]	王克芳, 徐东娟, 王雅琦. 护理领域量表类论文问题分析及建议[J]. 中华护理杂志, 2024, 59(3):287-291. DOI
	Wang KF, Xu DJ, Wang YQ. Analysis and recommendations for issues in scale-based research papers in the field of nursing[J]. Chin J Nurs, 2024, 59(3):287-291. DOI
[7]	Naylor KL, Kim SJ, Kuwornu JP, et al. Pre-transplant maintenance dialysis duration and outcomes after kidney transplantation:a multicenter population-based cohort study[J]. Clin Transplant, 2022, 36(3):e14553. DOI URL
[8]	Moons P, De Geest S, Versteven K, et al. Psychometric properties of the “Modified Transplant Symptom Occurrence and Symptom Distress Scale”[J]. J Nurs Meas, 2001, 9(2):115-134. PMID
[9]	Dobbels F, Moons P, Abraham I, et al. Measuring symptom experience of side-effects of immunosuppressive drugs:the Modified Transplant Symptom Occurrence and Distress Scale[J]. Tran-spl Int, 2008, 21(8):764-773.
[10]	金三丽, 谢双怡, 路潜, 等. 中文版器官移植患者症状发生和症状困扰量表的信度及效度检验[J]. 中国护理管理, 2013, 13(9):21-24.
	Jin SL, Xie SY, Lu Q, et al. Reliability and validity of the Chinese version of “Modified Transplant Symptom Occurrence and Symptom Distress Scale”[J]. Chin Nurs Manag, 2013, 13(9):21-24.
[11]	Etxebarria A, Díez-Martín E, Astigarraga E, et al. Role of the immune system in renal transplantation,types of response,technical approaches and current challenges[J]. Immuno, 2022, 2(4):548-570. DOI URL
[12]	Vinke JSJ, Wouters HJCM, Stam SP, et al. Decreased haemoglobin levels are associated with lower muscle mass and strength in kidney transplant recipients[J]. J Cachexia Sarcopenia Muscle, 2022, 13(4):2044-2053. DOI PMID
[13]	Kuckuck S, van der Valk ES, Scheurink AJW, et al. Glucocorticoids,stress and eating:the mediating role of appetite-regulating hormones[J]. Obes Rev, 2023, 24(3):e13539. DOI URL
[14]	Uyar B. The analysis of immunosuppressant therapy adherence,depression,anxiety,and stress in kidney transplant recipients in the post-transplantation period[J]. Transpl Immunol, 2022, 75:101686. DOI URL
[15]	Li GF, Chen Y, Chaudhary S, et al. Sleep dysfunction mediates the relationship between hypothalamic-insula connectivity and anxiety-depression symptom severity bidirectionally in young adults[J]. Neuroimage, 2023, 279:120340. DOI URL
[16]	Dziri S, Azzabi A, Tlili G, et al. Dermatological conditions seen in kidney transplant recipients:prevalence and risk factors[J]. Exp Clin Transplant, 2024, 22(Suppl 1):310-314.
[17]	Zhai SY, Chen L, Liu H, et al. Skin barrier:new therapeutic targets for chronic kidney disease-associated pruritus-a narrative review[J]. Int J Dermatol, 2024, 63(11):1513-1521. DOI URL
[18]	Bossola M, Arena M, Urciuolo F, et al. Fatigue in kidney transplantation:a systematic review and meta-analysis[J]. Diagnostics, 2021, 11(5):833. DOI URL
[19]	Fariña-Hernández A, Marrero-Miranda D, Perez-Carreño E, et al. Pretransplant evaluation and the risk of glucose metabolic alterations after renal transplantation:a prospective study[J]. Nephrol Dial Transplant, 2023, 38(3):778-786. DOI URL
[20]	王巧松, 张坤, 张雪玲, 等. 移动血糖管理在妊娠期糖尿病孕妇中应用的范围综述[J]. 中华护理杂志, 2024, 59(10):1270-1277. DOI
	Wang QS, Zhang K, Zhang XL, et al. The application of mobile blood glucose management in pregnant women with gestational diabetes:a scoping review[J]. Chin J Nurs, 2024, 59(10):1270-1277.
[21]	St-Onge MP, Cherta-Murillo A, Darimont C, et al. The interrelationship between sleep,diet,and glucose metabolism[J]. Sleep Med Rev, 2023, 69:101788. DOI URL
[22]	David P, Singh S, Ankar R. A comprehensive overview of skin complications in diabetes and their prevention[J]. Cureus, 2023, 15(5):e38961.
[23]	赵梦璐, 卢晓虹, 曹丽华, 等. 基于移动医疗的症状群管理在慢性心力衰竭患者中的应用研究[J]. 中华护理杂志, 2024, 59(11):1294-1300. DOI
	Zhao ML, Lu XH, Cao LH, et al. Application research of an mHealth-based symptom clusters management program in the nursing of chronic heart failure patients[J]. Chin J Nurs, 2024, 59(11):1294-1300. DOI