以质量求发展,以服务铸品牌

护理学报 ›› 2022, Vol. 29 ›› Issue (15): 59-64.doi: 10.16460/j.issn1008-9969.2022.15.059

• 调查研究 • 上一篇    下一篇

急性淋巴细胞白血病维持化疗阶段患儿的症状群及其前哨症状的调查

申心怡1,2a, 李蓉蓉2b, 阐玉英2c, 张冠珣1, 杨琦2a, 张琳1   

  1. 1.苏州大学苏州医学院 护理学院,江苏 苏州 215006;
    2.苏州大学附属儿童医院 a.血液科;b.护理部;c.工会,江苏 苏州 215002
  • 收稿日期:2022-03-21 出版日期:2022-08-10 发布日期:2022-09-07
  • 通讯作者: 李蓉蓉(1993-),女,江苏淮安人,硕士,护师。E-mail:lrr_0421@163.com
  • 作者简介:申心怡(1998-),女,安徽滁州人,本科学历,硕士研究生在读。
  • 基金资助:
    国家自然科学基金青年科学基金项目(72104167)

Symptom Clusters and Sentinel Symptoms of Children with Acute Lymphoblastic Leukemia during Maintenance Chemotherapy

SHEN Xin-yi1,2a, LI Rong-rong2b, CHAN Yu-ying2c, ZHANG Guan-xun1, YANG Qi2a, ZHANG Lin1   

  1. 1. School of Nursing, Suzhou Medical College of Soochow University, Suzhou 215006, China;
    2a. Dept. of Hematology;2b. Dept. of Nursing Administration;2c. Trade Union, Children's Hospital of Soochow University, Suzhou 215002, China
  • Received:2022-03-21 Online:2022-08-10 Published:2022-09-07

摘要: 目的 探讨急性淋巴细胞白血病患儿维持化疗阶段症状群及各症状群的前哨症状。方法 采用便利抽样法,选取2020年6月—2021年8月在苏州大学附属儿童医院血液科病房收治的处于维持化疗阶段的急性淋巴细胞白血病患儿作为研究对象,采用记忆症状评估量表儿童版对其进行调查。采用探索性因子分析并结合Spearman秩相关分析确定症状群;基于Apriori算法关联分析确定各症状群的前哨症状。结果 急性淋巴细胞白血病患儿在维持化疗阶段存在5类症状群,即情绪心理症状群、胃肠道症状群、躯体症状群、神经系统症状群、自我形象受损症状群,其Cronbach α系数分别为0.943、0.906、0.874、0.891、0.900;睡眠困难、呕吐、咳嗽、头痛、脱发依次为上述症状群的前哨症状。结论 急性淋巴细胞白血病患儿在维持化疗阶段经历多种症状群困扰。症状群及其前哨症状的确定有利于简化症状的评估和管理,提高症状管理效率,减轻患儿及家庭的疾病负担。

关键词: 急性淋巴细胞白血病, 儿童, 维持化疗, 症状群, 前哨症状

Abstract: Objective To explore the symptom clusters and their sentinel symptoms in children with acute lymphoblastic leukemia during maintenance chemotherapy. Methods With convenience sampling, children with acute lymphoblastic leukemia who received maintenance chemotherapy in department of hematology of Children's Hospital of Soochow University from June 2020 to August 2021 were selected and assessed by Memorial Symptom Assessment Scale 10-18. The formation of symptom clusters was determined by exploratory factor analysis with Spearman rank correlation analysis, and the sentinel symptoms of clusters were determined by Apriori algorithm association analysis. Results Five symptom clusters in children with acute lymphoblastic leukemia during maintenance chemotherapy were identified, including emotional-psychological cluster, gastrointestinal cluster, somatic cluster, neurosystem cluster, and self-image disorder cluster, and the Cronbach ɑ coefficient was 0.943, 0.906, 0.874, 0.891 and 0.900, respectively; insomnia, vomiting, cough, headache, and hair loss were the sentinel symptoms of the clusters respectively. Conclusion Children with acute lymphoblastic leukemia experience a variety of symptom clusters during maintenance chemotherapy. The identification of symptom clusters and sentinel symptoms is helpful to simplify the evaluation and management of symptoms, improve the efficiency of symptom management, and reduce the disease burden of children and their families.

Key words: acute lymphoblastic leukemia, children, maintenance chemotherapy, symptom clusters, sentinel symptoms

中图分类号: 

  • R473.55
[1] Yi M, Zhou L, Li A, et al.Global Burden and Trend of Acute Lymphoblastic Leukemia from 1990 to 2017[J]. Aging(Albany NY),2020,12(22):22869-22891.DOI:10.18632/aging.103982.
[2] Yang W, Cai J, Shen S, et al.Pulse Therapy with Vincristine and Dexamethasone for Childhood Acute Lymphoblastic Leukaemia (CCCG-ALL-2015): An Open-label, Multicentre, Randomised, Phase 3, Non-inferiority Trial[J]. Lancet Oncol, 2021, 22(9):1322-1332.DOI:10.1016/s1470-2045(21)00328-4.
[3] Kim HJ, McGuire DB, Tulman L, et al. Symptom Clusters: Concept Analysis and Clinical Implications for Cancer Nursing[J]. Cancer Nurs, 2005, 28(4):270-282.DOI:10.1097/00002820-200507000-00005.
[4] 郑渊,刘可,卜秀青,等. 急性白血病患儿化疗期间症状群的调查分析[J]. 中华护理杂志,2016, 51(11):1320-1324.DOI:10.3761/j.issn.0254-1769.2016.11.008.
[5] Li R, Ma J, Chan Y, et al.Symptom Clusters and Influencing Factors in Children with Acute Leukemia During Chemotherapy[J]. Cancer Nurs, 2020, 43(5): 411-418.DOI:10.1097/ncc.0000000000000716.
[6] 李蓉蓉, 马金玲, 阐玉英, 等. 急性淋巴细胞白血病患儿化疗期间症状群的纵向研究[J].护理学杂志,2019, 34(16):5-9.DOI:10.3870/j.issn.1001-4152.2019.16.005.
[7] Kirkova J, Aktas A, Walsh D, et al.Consistency of Symptom Clusters in Advanced Cancer[J]. Am J Hosp Palliat Care, 2010,27(5):342-346.DOI:10.1177/1049909110369869.
[8] Brown JK, Cooley ME, Chernecky C, et al.A Symptom Cluster and Sentinel Symptom Experienced by Women with Lung Cancer[J]. Oncol Nurs Forum, 2011, 38(6): E425-435.DOI:10.1188/11.Onf.E425-e435.
[9] 夏超, 段培蓓, 杨玲, 等. 166例胃癌术后化疗患者症状群内前哨症状的调查[J].护理学报,2021,28(8):44-49.DOI:10.16460/j.issn1008-9969.2021.08.044.
[10] 中华人民共和国国家卫生健康委员会,国家卫生健康委办公厅. 儿童急性淋巴细胞白血病诊疗规范(2018版)[EB/OL].(2018-10-8)[2022-03-21].http://www.nhc.gov.cn/yzygj/s7653/201810/aef82930c1af4fc5bf325938e2fcb075.shtml.
[11] Zheng R, Peng X, Zeng H, et al.Incidence, Mortality and Survival of Childhood Cancer in China during 2000-2010 Period: A Population-based Study[J]. Cancer Lett, 2015, 363(2): 176-180.DOI:10.1016/j.canlet.2015.04.021.
[12] 郑卫军, 何凡. 现况调查的样本量计算方法[J].预防医学, 2020, 32(6):647-648.DOI:10.19485/j.cnki.issn2096-5087.2020.06.028.
[13] Williamson Lewis R, Effinger KE, Wasilewski-Masker K, et al.Self-reported Late Effect Symptom Clusters among Young Pediatric Cancer Survivors[J]. Support Care Cancer, 2021,29(12):8077-8087.DOI:10.1007/s00520-021-06332-4.
[14] Collins JJ, Byrnes ME, Dunkel IJ, et al.The Measurement of Symptoms in Children with Cancer[J]. J Pain Symptom Manage, 2000,19(5):363-377.DOI:10.1016/s0885-3924(00)00127-5.
[15] Drake R, Frost J, Collins JJ.The Symptoms of Dying Children[J]. J Pain Symptom Manage, 2003, 26(1):594-603.DOI: 10.1016/S0885-3924(03)00202-1.
[16] 冯芳茗, 楼建华, 徐红, 等. 癌症患儿症状体验的现况调查[J].中国护理管理, 2012, 12(1):30-34.DOI:10.3969/j.issn.1672-1756.2012.01.010.
[17] 张浩彬. IBM SPSS Modeler 18.0 数据挖掘权威指南[M]. 北京:人民邮电出版社, 2019:356-366.
[18] Tang X, Mo L, Liu Q, et al.Adverse Experiences of Social Adaptation in Children with Leukaemia: A Qualitative Study from China[J]. BMJ Open, 2022, 12(3):e051953.DOI:10.1136/bmjopen-2021-051953.
[19] Rahiman EA, Rajendran A, Sankhyan N, et al.Acute Neurological Complications during Acute Lymphoblastic Leukemia Therapy: A Single-center Experience over 10 Years[J]. Indian J Cancer, 2021, 58(4): 545-552.DOI:10.4103/ijc.IJC_422_19.
[20] Mahon SM, Carr E.Skin Toxicities: Common Side Effect[J]. Clin J Oncol Nurs, 2021, 25(6):32.DOI:10.1188/21.Cjon.S2.32.
[21] Balachandran DD, Miller MA, Faiz SA, et al.Evaluation and Management of Sleep and Circadian Rhythm Disturbance in Cancer[J]. Curr Treat Options Oncol, 2021, 22(9): 81.DOI:10.1007/s11864-021-00872-x.
[22] Steur LMH, Kaspers GJL, van Someren EJW, et al. The Impact of Maintenance Therapy on Sleep-wake Rhythms and Cancer-related Fatigue in Pediatric Acute Lymphoblastic Leukemia[J]. Support Care Cancer, 2020, 28(12): 5983-5993.DOI:10.1007/s00520-020-05444-7.
[23] Paw Cho Sing E, Robinson PD, Flank J, et al. Classification of the Acute Emetogenicity of Chemotherapy in Pediatric Patients: A Clinical Practice Guideline[J]. Pediatr Blood Cancer, 2019, 66(5): e27646.DOI:10.1002/pbc.27646.
[24] Patel P, Robinson PD, Devine KA, et al.Prevention and Treatment of Anticipatory Chemotherapy-induced Nausea and Vomiting in Pediatric Cancer Patients and Hematopoietic Stem Cell Recipients: Clinical Practice Guideline Update[J]. Pediatr Blood Cancer, 2021, 68(5): e28947.DOI:10.1002/pbc.28947.
[25] 汪燕, 王宁玲, 谢志伟.甲氨蝶呤所致急性淋巴细胞白血病患儿相关药源性咳嗽诊治体会[J]. 安徽医学, 2014, 35(8):1111-1112.DOI:10.3969/j.issn.1000-0399.2014.08.031.
[26] Cho PSP, Turner RD.Cough and Pain: More Similar Than at First Glance[J]. Chest, 2021, 159(3):904-905.DOI:10.1016/j.chest.2020.10.001.
[27] Sadighi ZS, Ness KK, Hudson MM, et al.Headache Types, Related Morbidity, and Quality of Life in Survivors of Childhood Acute Lymphoblastic Leukemia: A Prospective Cross Sectional Study[J]. Eur J Paediatr Neurol, 2014, 18(6):722-729.DOI:10.1016/j.ejpn.2014.06.006.
[28] Rastogi RG, Arnold TL, Borrero-Mejias C, et al.Non-pharmacologic and Mindful-based Approaches for Pediatric Headache Disorders: A Review[J]. Curr Pain Headache Rep, 2021, 25(12):78.DOI:10.1007/s11916-021-00993-w.
[1] 陈莹莹, 丁红, 张根生. 患儿术后谵妄影响因素的研究进展[J]. 护理学报, 2024, 31(9): 32-35.
[2] 张可, 欧阳丽, 吴成慧, 廖秋燕, 谭玲玲, 朱维晔. 特定型语言障碍儿童语言发育水平的影响因素及路径分析[J]. 护理学报, 2024, 31(4): 7-11.
[3] 李佳萍, 朱云霞, 朱宇. 乳腺癌化疗患者症状群的范围综述[J]. 护理学报, 2024, 31(4): 60-64.
[4] 李伟, 王香, 裴丽, 高擎擎, 黄海超. 妊娠晚期孕妇症状群的范围综述[J]. 护理学报, 2024, 31(3): 51-56.
[5] 黄佳颖, 叶红雨, 朱沙, 贺云, 梁丽婵. 8例急性淋巴细胞白血病患儿应用培门冬酰胺酶继发颅内静脉窦血栓的护理[J]. 护理学报, 2024, 31(24): 68-70.
[6] 赵晓雨, 郭锦丽, 任清丽, 叶泉滟, 薛媛, 李国庆. 穴位按压技术在儿童操作性疼痛护理中的应用进展[J]. 护理学报, 2024, 31(22): 22-25.
[7] 胡宁宁, 李玉凤, 王仁媛, 李婉君, 林素兰. 学龄前儿童超重肥胖现状及影响因素分析[J]. 护理学报, 2024, 31(2): 16-21.
[8] 胡玉兰, 陈英, 余艮珍, 王梦月. 儿科护士的慢性病患儿过渡期护理态度问卷编制及信效度检验[J]. 护理学报, 2024, 31(10): 64-69.
[9] 许丽玲, 林艳, 王妹香. 巩固强化期急性淋巴细胞白血病患儿症状群与核心症状的研究[J]. 护理学报, 2023, 30(5): 59-64.
[10] 苗康康, 陈勤. 儿童环境健康知识和技能问卷的汉化及信效度分析[J]. 护理学报, 2023, 30(2): 17-22.
[11] 李朴, 王梅, 宇丽, 刘敏, 李平, 张泓, 陈瑜, 胡雁, 胡少华. 神经重症患儿早期活动的最佳证据总结[J]. 护理学报, 2023, 30(2): 48-53.
[12] 骆佳慧, 罗园园, 方庆虹, 叶艳欣, 刘素婷, 杨智慧, 缪景霞, 张立力. 肺癌患者认知功能的现状及影响因素分析[J]. 护理学报, 2023, 30(18): 1-5.
[13] 石晶, 钟娟平, 谢琪, 王兴蕾, 杨萌, 史晓凤, 豆欣蔓. 小丑照护在儿童围术期的应用进展[J]. 护理学报, 2023, 30(18): 31-35.
[14] 方加, 许丽玲, 刘春琴, 刘霞, 王妹香, 刘琼, 黄海英, 肖新华, 林艳. 白血病儿童化疗多维症状体验的同期症状网络分析[J]. 护理学报, 2023, 30(16): 1-6.
[15] 孙丽, 黄家丽, 胡成文, 顾道琴, 韦琦, 方敏, 刘群慧, 许宝惠. 基于文化敏感性框架肿瘤患儿安宁疗护方案的构建[J]. 护理学报, 2023, 30(15): 6-10.
Viewed
Full text


Abstract

Cited

  Shared   
No Suggested Reading articles found!