目的 调查鼻咽癌患者放疗结束时症状发生率及严重程度,构建鼻咽癌患者放疗相关症状网络并识别症状群、核心症状及桥梁症状,为精准症状管理提供参考。方法 采用横断面研究,便利抽取2023年11月—2024年8月在广州市某三级甲等医院的210例鼻咽癌患者为调查对象。采用一般资料调查表、安德森症状评估量表-头颈部模块进行调查。采用探索性因子分析提取症状群,基于R软件构建症状网络,分析中心性指标,确定核心症状及桥梁症状。结果 鼻咽癌放疗患者最常见的症状是口腔/咽喉黏液（99.5%）;最严重的症状是口干;共识别4个症状群：口咽部症状群、情绪睡眠症状群、胃肠道症状群和神经相关症状群,累计方差贡献率为69.163%;在症状网络中,吞咽/咀嚼困难的强度和预期影响最大（rs=1.400,rE=1.398）;疲劳的紧密度和桥梁强度最大（rc=0.004,rbs=0.610）。结论 口咽部症状群是鼻咽癌放疗患者的核心症状群,吞咽/咀嚼困难是核心症状,疲劳是最重要的桥梁症状。护理人员可基于核心症状和桥梁症状制订个性化干预措施,提高鼻咽癌放疗患者的症状管理效率。
Abstract
Objectives To investigate the prevalence and severity of symptoms in nasopharyngeal carcinoma patients during radiotherapy, to construct a network of radiotherapy-related symptoms for this group of population to identify symptom clusters, core symptoms and bridge symptom, and to provide reference for precise symptom management. Methods From November 2023 to August 2024, we recruited 210 nasopharyngeal carcinoma patients by using convenience sampling from a tertiary grade-A hospital in Guangzhou. General Information Questionnaire and Anderson Symptom Assessment Scale Head and Neck Module were used to investigate the patients. Exploratory factor analysis was used to extract symptom clusters. A symptom network based on R packages was constructed; centrality indicators and core symptoms and bridge symptoms were analyzed and determined. Results The most common symptom of nasopharyngeal carcinoma patients undergoing radiotherapy was oral or pharyngeal mucus (99.5%); The most serious symptom was dry mouth; Four symptom clusters were identified: oropharyngeal symptom cluster, mood sleep symptom cluster, gastrointestinal symptom cluster and nerve-related symptom cluster, which could explain 69.163% of the total variance. In symptom network, difficulty swallowing or chewing had the greatest strength and expected influence (rs=1.400, rE=1.398); fatigue had the greatest closeness and bridge strength (rc=0.004,rbs=0.610). Conclusion Oropharyngeal symptom cluster is the core symptom cluster; difficulty swallowing or chewing is the core symptom, and fatigue is the most important bridge symptom in the symptom group of patients with nasopharyngeal carcinoma undergoing radiotherapy. Nursing staff can develop individualized interventions for core symptom and bridge symptom to improve the efficiency of symptom management in patients undergoing radiotherapy for nasopharyngeal carcinoma.
关键词
鼻咽癌 /
放疗 /
核心症状 /
症状网络 /
症状管理
Key words
nasopharyngeal carcinoma /
radiotherapy /
core symptom /
symptom network /
symptom management
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