Abstract:

Objective To investigate the incidence and severity of morning symptoms in elderly patients with stable chronic obstructive pulmonary disease，and to construct a symptom network to identify core symptoms and bridge symptoms，providing a basis for the clinical construction of precise and efficient symptom management plans. Methods The convenience sampling method was employed to select 314 elderly patients with stable chronic obstructive pulmonary disease who visited a tertiary grade A hospital in Huai’an City from October 2023 to April 2025 as research subjects. The general information questionnaire and the Chinese version of the chronic obstructive pulmonary disease morning symptom diary were used for the investigation. Exploratory factor analysis was used to extract morning symptom clusters. Network analysis was conducted using R 4.4.1 software to identify core symptoms and bridge symptoms through expected influence and bridge expected influence. Results A total of 308 valid questionnaires were collected. Among the 308 patients，dyspnea when starting an activity had the highest incidence rate（88.31%），and the highest severity score. The highest incidence of the remaining symptoms was cough（91.88%），and the top 3 severity scores were cough，chest tightness，and expectoration. A total of 4 symptom clusters were extracted：dyspnea symptom cluster，cough-expectoration symptom cluster，chest discomforts-asthma symptom cluster，and general discomfort-sleep symptom cluster. The expected impact of “difficulty breathing when starting an activity” and “expectoration” was the highest （1.392 and 1.250 respectively）. The bridge expected influence of “difficulty breathing when starting an activity”，“phlegm volume”，“chest tightness”，and “feeling relaxed” was the highest in their respective symptom clusters （0.543，0.373，0.464 and 0.215 respectively）. Conclusion There are 4 symptom clusters for elderly patients with stable chronic obstructive pulmonary disease in the morning. “Difficulty in breathing when starting an activity” and “expectoration” are the core symptoms of patients with chronic obstructive pulmonary disease in the morning. “Difficulty in breathing when starting an activity” “phlegm volume” “chest tightness” and “feeling relaxed” are the bridge symptoms connecting the other 3 symptom clusters in their respective symptom clusters.

Key words: Aged, Pulmonary Disease，Chronic Obstructive, Morning Symptoms, Network Analysis, Core Symptoms, Bridge Symptoms, Chronic Disease Nursing

摘要：

目的 调查老年慢性阻塞性肺疾病（简称慢阻肺）患者稳定期晨间症状的发生率及严重程度，通过构建症状网络以识别核心症状、桥梁症状，为临床医护人员构建精准高效的症状管理方案提供依据。 方法 采用便利抽样法，选取2023年10月—2025年4月在淮安市某三级甲等医院就诊的314例老年慢阻肺稳定期患者为调查对象。采用一般资料调查表、中文版慢性阻塞性肺疾病晨间症状量表进行调查。采用探索性因子分析提取晨间症状群；应用R 4.4.1软件进行网络分析，通过预期影响和桥预期影响识别核心症状与桥梁症状。 结果 回收有效问卷308份，308例患者呼吸困难条目症状发生率最高的是着手做事时呼吸困难（88.31%），且严重程度评分最高；其余症状发生率最高的是咳嗽发作（91.88%），严重程度评分前3位是咳嗽发作、胸闷、咳痰频率。共提取出4个症状群：呼吸困难症状群、咳嗽-咳痰症状群、胸部不适-气喘症状群、全身不适-睡眠症状群。着手做事时呼吸困难、咳痰频率的预期影响最高（预期影响指数=1.392、1.250）；着手做事时呼吸困难、痰量多少、胸闷、感到轻松在各自症状群中的桥预期影响最高（桥预期影响指数=0.543、0.373、0.464、0.215）。 结论 老年慢阻肺患者稳定期晨间症状共4个症状群，着手做事时呼吸困难、咳痰频率是核心症状，着手做事时呼吸困难、痰量多少、胸闷、感到轻松是各自症状群中连接其他3个症状群的桥梁症状。

关键词: 老年人, 肺疾病，慢性阻塞性, 晨间症状, 网络分析, 核心症状, 桥梁症状, 慢性病护理