头颈部肿瘤患者核心症状及症状群的网络分析与护理对策

doi:10.3761/j.issn.0254-1769.2024.07.009

摘要/Abstract

摘要：

目的调查头颈部肿瘤患者症状的发生率及严重程度，构建头颈部肿瘤患者症状网络，识别网络中的核心症状和症状群。方法便利选取于2022年3月—10月在湖南省长沙市3所三级甲等医院住院的366例头颈部肿瘤患者，采用安德森症状评估量表-头颈部调查症状的构成。通过探索性因子分析提取症状群，采用R软件构建症状严重程度网络和症状群网络并分析网络的中心性指标，包括强度、紧密度和中介度来确定核心症状和核心症状群。结果头颈部肿瘤患者治疗期间发生率最高的4个症状是口干（93.44%）、疲乏（89.07%）、食欲不振（86.34%）、吞咽或咀嚼困难（85.79%）；最严重的症状是口干、食欲不振、口腔或咽喉黏液、吞咽或咀嚼困难。提取的4个症状群分别是口腔咽喉部症状群、胃肠道症状群、情绪睡眠症状群和病感行为症状群，累计方差贡献率为67.415%。症状严重程度网络中，口腔或咽喉黏液（r_s=9.60）是强度最大的症状；症状群网络中，口腔或咽喉黏液（r_s=1.20）、恶心（r_s=1.00）、疲乏（r_s=1.10）和嗜睡（r_s=0.97）是4个症状群中强度最大的症状。结论口腔或咽喉黏液、恶心、疲乏和嗜睡是头颈部肿瘤患者症状群内的核心症状，口腔咽喉部症状群是核心症状群，建议医护人员基于核心症状和症状群制订干预措施，实施精准化症状管理，提高症状管理效率。

关键词: 头颈部肿瘤, 核心症状, 症状群, 网络分析, 护理

Abstract:

Objective To investigate the prevalence and severity of symptoms and to construct symptom networks in head and neck cancer patients during treatment to identify core symptoms and symptom clusters. Methods 366 patients who were hospitalized in 3 tertiary hospitals in Changsha were selected using convenience sampling from March to October 2022 and asked to complete the M.D. Anderson Symptom Inventory-Head & Neck. Exploratory factors analysis was used to extract the symptom clusters，and R packages were used to construct the symptom severity network and symptom clusters network. The centrality indexes of the networks，including strength，closeness，and betweenness，were analyzed to identify core symptoms and core symptom cluster. Results The most common symptoms in head and neck cancer patients during treatment were dry mouth （93.44%），fatigue（89.07%），loss of appetite（86.34%），and difficulty swallowing or chewing（85.79%），and the most severe symptoms were dry mouth，loss of appetite，oral or pharyngeal mucus，and difficulty swallowing or chewing. 4 symptom clusters were extracted，namely oral-pharyngeal，gastrointestinal，emotional-sleep，and sickness-sensing behavioral，which could explain 67.415% of the total variance. In the symptom severity network，oral or pharyngeal mucus（r_s=9.60） was a symptom with the highest strength. In the symptom clusters network，oral or pharyngeal mucus（r_s=1.20），nausea（r_s=1.00），fatigue（r_s=1.10），and drowsiness（r_s=0.97） were the symptoms with the highest strength across 4 symptom clusters. Conclusion Oral or pharyngeal mucus，nausea，fatigue，and drowsiness are the core symptoms of symptom clusters in head and neck cancer patients during treatment. Oral-pharyngeal symptom cluster is the core symptom cluster. It is recommended that clinical staff should develop interventions based on the core symptoms and symptom cluster to implement precise symptom management and improve symptom management efficiency.

Key words: Head and Neck Cancer, Core Symptoms, Symptom Clusters, Network Analysis, Nursing Care

刘美子, 安然, 吴子童, 高菲, 陈文凤. 头颈部肿瘤患者核心症状及症状群的网络分析与护理对策[J]. 中华护理杂志, 2024, 59(7): 828-834.

LIU Meizi, AN Ran, WU Zitong, GAO Fei, CHEN Wenfeng. A network analysis and nursing implications of core symptoms and symptom clusters in head and neck cancer patients[J]. Chinese Journal of Nursing, 2024, 59(7): 828-834.

图/表 4

表1 患者的一般资料（n=366）

Table 1 Participants characteristics（n=366）

表2 头颈部肿瘤患者治疗期间症状发生率、严重程度和症状群提取结果（n=366）

Table 2 Symptom prevalence and severity and symptom clusters extraction in HNC patients during treatment（n=366）

图1 症状严重程度网络注：A1吞咽或咀嚼困难，A2口腔或咽喉黏液，A3口腔或咽喉酸痛，A4发声或讲话困难，A5疼痛，A6口干，A7呛咳，A8牙齿或牙龈问题，B1呕吐，B2恶心，B3食欲不振，B4味觉异常，C1苦恼，C2睡眠不安，C3疲乏，C4悲伤难过，C5气短，D1皮肤疼痛，D2麻木针刺感，D3健忘，D4嗜睡，D5便秘。

Figure 1 Network of symptom severity

图2 症状群网络图注：A1吞咽或咀嚼困难，A2口腔或咽喉黏液，A3口腔或咽喉酸痛，A4发声或讲话困难，A5疼痛，A6口干，A7呛咳，A8牙齿或牙龈问题，B1呕吐，B2恶心，B3食欲不振，B4味觉异常，C1苦恼，C2睡眠不安，C3疲乏，C4悲伤难过，C5气短，D1皮肤疼痛，D2麻木针刺感，D3健忘，D4嗜睡，D5便秘。A1~A8代表口腔咽喉部症状群；B1~B4代表胃肠道症状群；C1~C5代表情绪睡眠症状群；D1~D5代表病感行为症状群。

Figure 2 Network of symptom clusters

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