Abstract:

Objective This study conducted a dynamic network analysis of the symptoms in patients with hepatocellular carcinoma（HCC） at different postoperative time points，aiming to explore evolving core symptoms and provide a basis for developing precise clinical symptom management programs. Methods A longitudinal study was carried out involving 370 HCC patients who underwent surgical treatment at a hospital in Kunming city between February and December 2024. Questionnaires were administered on postoperative day 2（T1） and day 7（T2），using the Chinese version of the Memory Symptom Assessment Scale. Symptom networks of 18 symptoms were constructed for both time points using R software to explore core symptoms and their interconnections. A network comparison test was also performed to assess differences between the 2 time points. Results All 370 patients completed the questionnaire at T1，and 357 valid responses were collected at T2，yielding a response rate of 96.49%. At T1，“feeling nervous” had the highest centrality（r_s=1.29），while at T2，“feeling sad” was most central（r_s=1.11）. Overall strength of the symptom networks showed that notable changes were observed in the edge weights between symptoms（P=0.01）. Conclusion While the overall structure of early postoperative symptoms in HCC patients remained relatively stable over time，the core symptoms shifted. “Feeling nervous” emerged as the central symptom at T1，whereas “feeling sad” became predominant. Digestive-related symptoms are progressively more closely linked over time. Healthcare professionals should dynamically assess patients’ early postoperative psychological symptoms and digestive system related symptoms，and focus on intervening with symptoms of tension and sadness.

Key words: Hepatocellular Carcinoma, Symptom Management, Core Symptoms, Network Analysis, Nursing Care

摘要：

目的 探索肝癌患者术后的核心症状及其动态变化，为临床制订精准的症状管理方案提供参考。方法 采用方便抽样，选取2024年2—12月在昆明市某三级甲等医院进行手术治疗的370例肝癌患者作为调查对象，分别在术后第2天（T1）与术后第7天（T2）进行问卷调查，采用中文版记忆症状量表评估患者症状。运用R软件构建了2个时间点18种症状的症状网络，分别探索其核心症状和各症状之间的关系，并对2个症状网络进行了网络差异性检验。结果 T1时发放并回收问卷370份，T2时发放问卷370份，回收有效问卷357份，有效问卷回收率为96.49%。T1的症状网络中，感到紧张（r_s=1.29）强度最高； T2的症状网络中，感到悲伤（r_s=1.11）强度最高。不同时间点症状网络在边线权重上差异具有统计学意义（P=0.01）。结论 肝癌患者术后早期症状网络整体较为稳定，其核心症状具有一定的动态性。T1时核心症状为感到紧张，T2时核心症状为感到悲伤，且消化系统相关症状随时间推移联系逐渐紧密。医护人员应该动态评估患者术后早期的心理症状和消化系统相关症状，并将紧张与悲伤症状作为干预的重点。

关键词: 肝肿瘤, 症状管理, 核心症状, 网络分析, 护理