Abstract:

Objective To explore the current status of symptom clusters and sentinel symptoms in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD），to analyze the correlation between the severity of sentinel symptoms and inflammatory indexes，and to provide a basis for symptom cluster interventions. Methods From October 2021 to March 2022，165 patients with AECOPD hospitalized in the Department of Respiratory and Critical Care Medicine of a tertiary care hospital in Nanning were conveniently selected. The questionnaires were administered using a revised version of the Memory Symptom Assessment Scale，and the results of inflammatory indexes were collected from the patients’ first tests after admission. Principal component analysis was used to extract symptom clusters，and the results of association analysis based on the Apriori algorithm were used to determine the sentinel symptoms within symptom clusters，and correlation analysis was used to explore the relationship between patients’ sentinel symptoms and inflammatory indexes. Results 3 symptom clusters existed in AECOPD patients，including respiratory symptom cluster，affective symptom cluster，and fatigue symptom cluster. Correlation analysis by the Apriori algorithm showed that lack of energy was the sentinel symptom of respiratory symptom cluster，feeling sad was the sentinel symptom of affective symptom cluster，and inattention was the sentinel symptom of fatigue symptom cluster. Correlation analysis showed that neutrophil-to-lymphocyte ratio and calcitoninogen were positively correlated with the severity of energy deficiency（r=0.179，P<0.05；r=0.246，P<0.01），and prealbumin was negatively correlated with it（r=-0.167，P<0.05）；monocyte count was positively correlated with the severity of feeling sad（r=0.236，P<0.01）；eosinophil count was negatively correlated with the severity of inattentiveness（r=-0.197，P<0.05）. Conclusion Sentinel symptoms exist within the symptom cluster of AECOPD patients，and their severity correlates with inflammatory indicators neutrophil-to-lymphocyte ratio，calcitoninogen，prealbumin，monocyte count，and eosinophil count. It is recommended that healthcare professionals can use sentinel symptoms as an entry point for symptom cluster management and develop individualized interventions for patients.

Key words: Pulmonary Disease, Chronic Obstructive, Acute Exacerbation, Symptom Clusters, Sentinel Symptoms, Inflammation, Nursing Care

摘要：

目的 调查慢性阻塞性肺疾病急性加重期（acute exacerbation of chronic obstructive pulmonary disease，AECOPD）患者症状群及前哨症状，分析前哨症状严重程度与炎症指标的相关性，为护理人员开展AECOPD患者症状群干预提供参考。方法 2021年10月—2022年3月，便利选取南宁市某三级甲等医院呼吸与危重症医学科住院的165例AECOPD患者，采用一般资料调查表、修订版记忆症状评估量表进行问卷调查，并收集患者入院后首次检测的炎症指标。采用主成分分析法提取症状群，基于Apriori算法关联分析结果，判定症状群的前哨症状，采用相关性分析探讨患者前哨症状与炎症指标的关系。结果 AECOPD患者存在3个症状群，包括呼吸道症状群、情感症状群和疲乏症状群。Apriori算法关联分析显示，精力缺乏是呼吸道症状群的前哨症状，感到悲伤是情感症状群的前哨症状，注意力不集中是疲乏症状群的前哨症状。相关性分析显示，中性粒细胞与淋巴细胞比值、降钙素原水平与精力缺乏严重程度呈正相关（r=0.179，P=0.022；r=0.246，P=0.001），前白蛋白水平与精力缺乏严重程度呈负相关（r=-0.167，P=0.032）；单核细胞计数与感到悲伤严重程度呈正相关（r=0.236，P=0.002）；嗜酸性粒细胞计数与注意力不集中严重程度呈负相关（r=-0.197，P=0.011）。结论 AECOPD患者症状群存在前哨症状，其严重程度与中性粒细胞与淋巴细胞比值、降钙素原水平、前白蛋白水平、单核细胞计数、嗜酸性粒细胞计数相关，建议护理人员将前哨症状作为症状群管理的切入点，为患者制订个性化的护理措施。

关键词: 肺疾病, 慢性阻塞性, 急性加重期, 症状群, 前哨症状, 炎症, 护理