日间肺癌手术患者出院后症状纵向变化及护理对策研究

doi:10.3761/j.issn.0254-1769.2025.04.007

摘要/Abstract

摘要：

目的通过因子分析法探讨日间肺癌手术患者出院后症状的纵向变化，提出护理对策，以提高患者的生活质量。方法采用便利抽样法，选取2023年10月至2024年1月在浙江省某三级甲等综合医院胸外科接受日间手术治疗的患者作为调查对象。在患者出院后第1、3、14、30天，采用一般资料调查表和肺癌患者术后症状量表进行调查，通过探索性因子分析提取症状群。结果共随访患者227例，脱落19例，剔除2例，最终纳入206例。日间肺癌手术患者出院后9大症状呈动态变化，出院后第1天症状占比最高的是疼痛197例（95.63%）；出院第30天症状占比最高的是咳嗽129例（62.62%）。探索性因子分析结果显示，除第30天的Bartlett’s球形检验P=0.874，KMO=0.495外，出院后第1、3、14天均P<0.001、KMO>0.500，出院后第1天分别是消化道症状群、呼吸道症状群；出院后第3天分别是呼吸道症状群、消化道症状群、疲劳症状群；出院后第14天分别是疲劳症状群、呼吸道症状群。结论日间肺癌手术患者出院后的单一症状及症状群在不同时间点呈现动态变化，临床护士应针对日间肺癌手术出院患者不同时期的症状群特点，采取针对性的干预策略，实施精准地症状管理，减轻患者症状负担。

关键词: 日间手术, 肺癌, 症状群, 纵向研究, 护理

Abstract:

Objective To explore the longitudinal changes of symptoms after discharge in patients with daytime lung cancer surgery by factor analysis，in order to strengthen nursing countermeasures and improve the quality of life of patients. Methods Patients who underwent day surgery in the thoracic surgery department of a tertiary general hospital in Zhejiang Province from October 2023 to January 2024 were selected using convenience sampling. On the 1st，3rd，14th and 30th day after discharge，the general information questionnaire and the postoperative symptom inventory for patients with lung cancer were used for investigation. Exploratory factor analysis was performed to extract the symptom clusters. Results A total of 227 patients were followed up in this study，including 19 shed cases and 2 excluded cases，and 206 patients were finally included. The percentage of the 9 major symptoms of patients with daytime lung cancer surgery after discharge showed dynamic changes. The highest percentage symptom on the 1st day after discharge was pain in 197 cases（95.63%）. The highest percentage on the 30th day after discharge was cough in 129 cases（62.62%）. The results of exploratory factor analysis were P<0.001 and KMO>0.500 for Bartlett’s test of sphericity on days 1，3，and 14 after discharge，except for P=0.874 and KMO=0.495 on day 30，with digestive and respiratory symptom clusters on day 1；respiratory，digestive，and fatigue symptom clusters on day 3；fatigue and respiratory symptom clusters on day 14. Conclusion The single symptom and symptom clusters of patients with daytime lung cancer surgery after discharge showed dynamic changes at different time points. Therefore，in clinical work，targeted intervention strategies should be adopted，and precise symptom management should be implemented according to the characteristics of symptom clusters in different periods of discharge of patients undergoing daytime lung cancer surgery，so as to reduce the symptom burden of patients.

Key words: Day Surgery, Lung Cancer, Symptom Cluster, Longitudinal Study, Nursing Care

韩娜菲, 贺红, 袁华娣, 兰美娟, 吴小燕, 曹俊华, 高丽燕, 辛鼎杰. 日间肺癌手术患者出院后症状纵向变化及护理对策研究[J]. 中华护理杂志, 2025, 60(4): 432-438.

HAN Nafei, HE Hong, YUAN Huadi, LAN Meijuan, WU Xiaoyan, CAO Junhua, GAO Liyan, XIN Dingjie. Longitudinal changes of symptoms and nursing strategies of patients under daytime lung cancer surgery after discharge[J]. Chinese Journal of Nursing, 2025, 60(4): 432-438.

图/表 8

表1 调查对象的一般资料（n=206）

Table 1 General information of respondents（n=206）

表2 不同时间点日间肺癌手术患者症状发生率[n=206，例（百分率，%）]

Table 2 Symptom incidence at different time points of patients with daytime lung cancer surgery [n=206，case（percentage，%）]

表3 出院后第1天症状相关系数矩阵结果（n=206）

Table 3 Results of correlation coefficient matrix for systoms on day 1 after discharge（n=206）

表4 出院后第3天症状相关系数矩阵结果（n=206）

Table 4 Results of correlation coefficient matrix for systoms on day 3 after discharge（n=206）

表5 出院后第14天症状相关系数矩阵结果（n=206）

Table 5 Results of correlation coefficient matrix for systoms on day 14 after discharge（n=206）

表6 出院后第1天症状的因子载荷矩阵（n=206）

Table 6 Factorial loadings matrix of symptoms on day 1 after discharge（n=206）

表7 出院后第3天症状的因子载荷矩阵（n=206）

Table 7 Factorial loadings matrix of symptoms on day 3 after discharge（n=206）

表8 出院后第14天症状的因子载荷矩阵（n=206）

Table 8 Factorial loadings matrix of symptoms on day 14 after discharge（n=206）

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