Abstract:

Objective To explore the changes of core symptoms and nursing strategies for lymphoma patients during chemotherapy using a dynamic network analysis model，and provide a reference for precise symptom intervention. Methods A longitudinal study was conducted，and lymphoma patients undergoing chemotherapy in the Department of Lymphoma at a tertiary hospital in Tianjin from September 2021 to December 2023 were conveniently sampled. The Lymphoma Patient Symptom Assessment Scale was used to track symptoms at 3 time points：7 to 14 days after the 1st treatment cycle（T1），the 3rd cycle（T2），and the 6th cycle（T3）. Dynamic symptom network analysis，including network relationships，core symptoms，and bridge symptoms，was performed using R software. Results During the research process，135 participants withdrew，resulting in a final inclusion of 865 cases for analysis. Fatigue exhibited the highest incidence rate（34.80%） at T1；alopecia was the most prevalent symptom （58.03% and 53.64%，respectively） at T2 and T3. The T1→T2 dynamic network analysis showed that fever had the highest out-expected influence（EI=0.551） and bridge expected influence（EI=0.225）. The T2→T3 dynamic network analysis showed that limb numbness exhibited the highest out-expected influence（EI=0.203） and bridge-expected influence（EI=0.170）. Reliability tests indicated that both dynamic networks demonstrated moderate accuracy but suboptimal stability. Conclusion Fatigue was the most common symptom at T1；alopecia was the most prevalent symptom at T2 and T3. Fever was the core symptom and bridging symptom in the T1→T2 symptom network，whereas limb numbness assumed the role of the core symptom and bridging symptom in the T2→T3 symptom network. The clinical practitioners could take high-incidence symptoms and core symptoms as intervention targets to develop precise symptom management strategies for lymphoma patients undergoing chemotherapy.

Key words: Lymphoma, Symptom Network Analysis, Core Symptoms, Longitudinal Studies, Nursing Care

摘要：

目的 探究淋巴瘤患者化疗期核心症状的纵向变化及护理对策，为症状的精准管理提供参考。 方法 该研究为纵向研究，便利选取2021年9月—2023年12月天津市某三级甲等肿瘤专科医院淋巴瘤内科收治的1 000例化疗患者作为调查对象，采用淋巴瘤患者症状评估量表，分别于第1周期化疗（T1）、第3周期化疗（T2）、第6周期化疗（T3）后7~14 d对患者进行追踪调查。应用R 4.3.2软件进行症状动态网络分析、网络准确性分析和稳定性检验。 结果 研究过程中脱落135例患者，最终纳入865例。T1疲乏发生率最高（34.80%）；T2、T3脱发发生率最高，分别为58.03%、53.64%。动态网络分析结果显示，在T1至T2症状动态网络中，发热是发出预测最多的症状，且出预期影响系数（EI=0.551）及桥梁预期影响系数（EI=0.225）最高；在T2至T3症状动态网络中，手脚麻木是发出预测最多的症状，且出预期影响系数（EI=0.203）及桥梁预期影响系数（EI=0.170）最高。两个动态网络的准确性均为中等，但稳定性相对不足。结论 疲乏是T1发生率最高的症状，脱发是T2、T3发生率最高的症状，发热是T1至T2症状网络的核心症状及桥梁症状，手脚麻木是T2至T3症状网络的核心症状及桥梁症状。临床护士可将高发生率症状及核心症状作为干预靶点，进一步构建淋巴瘤化疗患者精准化症状管理策略。

关键词: 淋巴瘤, 症状网络分析, 核心症状, 纵向研究, 护理