Abstract:

Objective To explore changes in symptom clusters and identify core symptoms at different stages in patients after minimally invasive surgery for hypertensive intracerebral hemorrhage using network analysis. Methods A total of 294 patients who underwent minimally invasive surgery for hypertensive intracerebral hemorrhage in the neurosurgery department of a tertiary hospital in Qingdao from April 2025 to January 2026 were recruited by convenience sampling. Symptom assessments were conducted using the Stroke Symptom Experience Scale at 1 week （T1），1 month（T2），and 3 months（T3） postoperatively. Exploratory factor analysis was used to extract symptom clusters，and symptom networks were constructed using R software. Results All 261 patients completed the entire follow-up，with an effective response rate of 88.78%. A total of 3 symptom clusters were consistently extracted at each time point. In the symptom network，decreased self-care ability exhibited the highest strength（r_s=1.524），closeness centrality（r_c=0.005），and betweenness centrality（r_b=108） at T1. At T2，depressed mood had the highest strength（r_s=1.352），while being easily anxious showed the highest closeness centrality（r_c=0.004） and betweenness centrality（r_b=124）. At T3，distress due to inability to engage in desired activities had the highest strength（r_s=1.363） and betweenness centrality（r_b=120），and decreased self-care ability had the highest closeness centrality（r_c=0.004）. Conclusions Symptom clusters remained stable over time but core symptoms transitioned across stages. Decreased self-care ability was the core symptom at T1；depressed mood was the core symptom and being easily anxious was the bridge symptom at T2；psychological distress combined with decreased self-care ability formed a dual-core structure at T3. Staged and targeted interventions should be implemented to improve postoperative rehabilitation management efficiency.

Key words: Intracranial Hemorrhage, Hypertensive, Core Symptoms, Symptom Clusters, Network Analysis, Longitudinal Studies, Nursing Care

摘要：

目的 基于网络分析，探讨高血压脑出血微创术后患者不同时期症状群及核心症状的变化。 方法 采用便利抽样法，选取2025年4月—2026年1月在青岛市某三级甲等医院神经外科行微创手术治疗的294例高血压脑出血患者作为调查对象，使用脑卒中症状体验量表分别于术后1周（T1）、术后1个月（T2）、术后3个月（T3）进行症状评估。使用探索性因子分析法提取症状群并运用R软件构建症状网络。 结果 共261例患者完成全程调查，有效问卷回收率为88.78%。各时期均提取3个症状群。在症状网络中，T1自理能力下降是强度（r_s=1.524）、紧密中心性（r_c=0.005）和中介中心性（r_b=108）最大的症状；T2闷闷不乐是强度（r_s=1.352）最大的症状，容易着急是紧密中心性（r_c=0.004）和中介中心性（r_b=124）最大的症状；T3因不能做想做的事情烦恼是强度（r_s=1.363）和中介中心性（r_b=120）最大的症状，自理能力下降是紧密中心性（r_c=0.004）最大的症状。 结论 高血压脑出血微创术后患者症状群持续稳定存在；T1以自理能力下降为核心症状，T2以闷闷不乐为核心症状、容易着急为桥梁症状，T3为功能-心理双核心。临床应实施分阶段靶向干预，提升术后康复管理效率。

关键词: 颅内出血, 高血压性, 核心症状, 症状群, 网络分析, 纵向研究, 护理