维持性血液透析患者多维症状网络分析及影响因素研究

doi:10.3761/j.issn.0254-1769.2025.19.003

摘要/Abstract

摘要：

目的调查维持性血液透析（maintenance hemodialysis，MHD）患者症状现况，从多维症状负担角度分析影响因素、提取症状群并构建症状网络。方法以便利抽样法选取2025年3—4月在上海市某三级甲等医院血液净化中心接受MHD的490例患者作为调查对象，采用改良版透析症状指数量表，对MHD患者30个症状进行调查。通过SPSS和R软件分析MHD患者多维症状负担的影响因素、提取症状群并构建症状网络。结果回收有效问卷488份，有效问卷回收率为99.59%。患者经历症状的中位数为6（4，8）个，其中发生率前5位的症状分别为皮肤干燥（69.88%）、疲劳或乏力（56.97%）、瘙痒（56.97%）、忧虑（50.20%）和口干（46.31%）。多因素分析结果显示，年龄、透析龄、文化程度、并发症是不同维度症状负担的影响因素。提取出皮肤不适、疲乏疼痛、胃肠道、睡眠障碍、水电解质和尿毒症共6个稳定存在的症状群。不同维度构建症状网络结果均显示，入睡困难的强度中心性最显著（r_s=2.18、2.25、2.12）。结论 MHD患者症状负担重，存在多种影响因素，其症状关联相对稳定，入睡困难是核心症状，识别核心症状及影响因素有助于临床医护人员在症状群管理方面实现高效化和精准化。

关键词: 维持性血液透析, 症状群, 网络分析, 核心症状, 症状群管理, 护理

Abstract:

Objective To investigate the current symptom status of maintenance hemodialysis（MHD） patients，analyze the influencing factors from the perspective of multidimensional symptom burden，extract symptom groups，and construct a symptom network. Methods A total of 490 patients who received MHD at the blood purification center of a tertiary hospital in Shanghai from March to April 2025 were selected using a convenience sampling method. 30 symptoms of MHD patients were investigated using a modified dialysis symptom index table. SPSS and R software were utilized to analyze the influencing factors，extract symptom groups，and construct a multidimensional symptom network. Results A total of 488 valid questionnaires were collected, with a valid questionnaire recovery rate of 99.59%. The median number of symptoms experienced by patients was 6（interquartile range：4，8），with the top 5 symptoms being dry skin（69.88%），fatigue or tiredness（56.97%），itching（56.97%），worry（50.20%），and dry mouth（46.31%）. Multidimensional analysis indicated that age，duration of dialysis，education level，and complications were influencing factors of symptom burden scores across different dimensions. 6 stable symptom groups were extracted，namely skin discomfort，fatigue and pain，gastrointestinal tract，sleep disorders，water-electrolyte imbalance，and uremia. The results of the symptom network analysis revealed that difficulty of falling asleep had the highest intensity centrality（r_s=2.18，2.25，2.12）. Conclusion The symptom association is relatively stable，and difficulty of falling asleep is the core symptom. This finding can assist clinical medical staff in achieving efficiency and precision in symptom group management.

Key words: Maintenance Hemodialysis, Symptom Clusters, Network Analysis, Core Symptoms, Symptom Cluster Management, Nursing Care

成李, 邹玉娇, 胡天天, 嵇初敏, 邱亦阳, 朱政, 张咏梅, 吴燕. 维持性血液透析患者多维症状网络分析及影响因素研究[J]. 中华护理杂志, 2025, 60(19): 2321-2327.

CHENG Li, ZOU Yujiao, HU Tiantian, JI Chumin, QIU Yiyang, ZHU Zheng, ZHANG Yongmei, WU Yan. Research on the current status and influencing factors of the multidimensional symptom network in maintenance hemodialysis patients[J]. Chinese Journal of Nursing, 2025, 60(19): 2321-2327.

图/表 5

表1 维持性血液透析患者症状发生频率、严重程度及困扰程度评分（n=488）

Table 1 Frequency, severity, and distress scores of symptoms in MHD patients（n=488）

表2 维持性血液透析患者一般资料及多维症状负担单因素分析结果（n=488）

Table 2 General data of MHD patients and results of univariate analysis of multidimensional symptom burden（n=488）

表3 维持性血液透析患者多维症状负担的多因素分析（n=488）

Table 3 Multivariate analysis of MHD patients’ multidimensional symptom burden（n=488）

表4 维持性血液透析患者症状群的提取（n=488）

Table 4 Extracting symptom clusters in MHD patients（n=488）

图1 维持性血液透析患者多维症状网络注：皮肤不适症状群：A1皮肤干燥、A2瘙痒。疲乏疼痛症状群：B1忧虑、B2疲劳或乏力、B3骨或关节痛。胃肠道症状群：C1恶心、C2食欲下降、C3便秘。睡眠障碍症状群：D1易醒、D2入睡困难。水电解质症状群：E1肌肉痉挛、E2头晕、E3口干。尿毒症症状群：F1咳嗽、F2很难让腿静止不动、F3焦虑。

Figure 1 Multidimensional symptom network in MHD patients

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