Abstract:

Objective To explore the longitudinal trajectories of symptom clusters in patients with rectal cancer within 6 months after laparoscopic anal preservation surgery，and analyze the predictive factors of each trajectory subgroup. Methods A longitudinal survey was conducted to select 128 patients who underwent laparoscopic anal preservation surgery for rectal cancer at the Department of Gastrointestinal Surgery，a tertiary hospital in Nanchong from November 2021 to April 2022. The general information questionnaire，Chinese version of Anderson Symptom Inventory for Gastrointestinal Cancer and Charlson Comorbidity Index were used to conduct follow-up surveys of the selected patients at 2 weeks，1 month，3 months and 6 months after surgery. The symptom cluster were extracted by exploratory factor analysis，and the latent category growth model was constructed to identify the trajectory subgroups of each symptom cluster. The predictive factors of each trajectory subgroup were analyzed by Mplus statistical software. Results There were 4 symptom clusters within 6 months after laparoscopic anus preserving surgery for rectal cancer，which were named as sickness symptom cluster，psychological-sleep symptom cluster，gastrointestinal symptom cluster，and psychological-treatment-related symptom cluster. The variance contribution rates were 65.173%，66.225%，62.421%，and 60.492%，respectively. The latent class growth model identified that there are 4 to 5 trajectory subgroups in the symptom cluster. Gender，education level，Charles Comorbidity Index，clinical T stage，medical cost burden，and treatment method were the predictors of high-risk trajectory subgroups in the symptom cluster（P<0.05）. Conclusion There are 4 symptom clusters within 6 months after laparoscopic anus preserving surgery for rectal cancer. The gastrointestinal symptom cluster is a specific symptom cluster for this type of patients with the heaviest symptom burden. The overall trajectory of each symptom cluster shows a dynamic decline trend，but individual trajectory subgroups still have an exacerbation trend. There are differences in predictive factors for different symptom clusters. Clinical medical staff should pay attention to the management of symptom clusters in patients with female patients，low education level，high Charles Comorbidity Index，high clinical T stage，heavy medical cost burden，and patients whose treatment method is chemotherapy plus surgery. High-risk groups should be timely identified；corresponding intervention methods were dynamically adjusted；the quality of precision nursing was improved.

Key words: Rectal Tumor, Symptom Clusters, Trajectory Category, Root Case Analysis, Nursing Care

摘要：

目的 探讨直肠癌患者经腹腔镜保肛术后6个月内症状群纵向轨迹，并分析各轨迹的影响因素。 方法 采用纵向研究设计，便利选取2021年11月-2022年4月于南充市某三级甲等综合医院胃肠外科行经腹腔镜保肛术的128例直肠癌患者作为调查对象。使用一般资料调查表、中文版安德森消化道癌症状评估量表及查尔森合并症指数于患者术后2周、1个月、3个月、6个月进行4次调查。采用探索性因子分析提取症状群，构建潜类别增长模型识别各症状群轨迹亚组，使用Mplus软件纳入预测变量，分析各轨迹的影响因素。 结果 探索性因子分析结果显示，直肠癌患者经腹腔镜保肛术后6个月内存在4组症状群，分别命名为病感症状群、心理-睡眠症状群、胃肠道症状群、心理-治疗相关症状群，方差贡献率分别为65.173%、66.225%、62.421%、60.492%。潜类别增长模型识别出症状群存在4~5个轨迹，女性患者、文化程度低、查尔森合并症指数高、原发肿瘤分期高、医疗费用负担重、治疗方式为化疗+手术是症状群高危轨迹的预测因素（P<0.05）。 结论 直肠癌患者经腹腔镜保肛术后6个月内存在4组症状群，胃肠道症状群是此类患者的特异性症状群，症状负担最重。各症状群轨迹总体呈动态缓解趋势，但个别轨迹亚组仍有加重趋势。不同症状群的影响因素存在差异，临床医护人员应及时识别高危人群，动态调整相应的干预方针，提高精准护理质量。

关键词: 直肠肿瘤, 症状群, 轨迹类别, 影响因素分析, 护理