应用蒽环类药物化疗的乳腺癌患者症状群调查研究  

Investigation of symptom clusters in breast cancer patients treated with anthracycline chemotherapy

作　　者：王艳 何瑞仙 苏伟才 刘妍 梅志红 张淑香 张彦新 Wang Yan;He Ruixian;Su Weicai;Liu Yah;Mei Zhihong;Zhang Shuxiang;Zhang Yanxin(Department of Nursing,National Cancer Center/Chinese Academy of Medical Sciences ＆ Peking Union Medical College,Cancer Hospital,Beijing100021,China)

机构地区：[1]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院内科,北京100021 [2]国家癌症中心/中国医学科学院北京协和医学院肿瘤医院护理部,北京100021

出　　处：《中国实用护理杂志》2018年第28期2199-2204,共6页Chinese Journal of Practical Nursing

基　　金：北京协和医学院“协和青年科研基金”（2017330025）

摘　　要：目的调查应用蒽环类药物化疗的乳腺癌患者的主要症状群，为进行症状群的干预提供依据。方法采用中文版安德森症状评估量表对应用蒽环类药物化疗的506例乳腺癌患者进行第1-4个化疗周期化疗后症状的调查。采用主成分法和方差最大正交旋转法对所调查的13个症状进行探索性因子分析，提取特征值〉1的因子。结果第1～4个化疗周期，发生率〉50％的症状分别为5、6、7、9个。疲劳、胃口差、恶心为最常见的症状，随着化疗次数的增加，其发生率分别为92．5％～97．1％，84．8％-95．1％，81．1％-91．3％。探索性因子分析得出第1、2个化疗周期各存在3个特征值〉1的因子，累计方差贡献率分别为63．233％和61．434％，因子1以疲劳和消化道症状为主，包括疲劳、睡眠不安、嗜睡、恶心、胃口差、呕吐、口干；第3、4个化疗周期则各提取出2个特征值〉1的因子，累计方差贡献率为62．660％和61．148％，因子1以心理、神经症状为主，包括悲伤感、疼痛、口干、麻木感、嗜睡、气短、健忘等。第1-4个化疗周期主要症状群Cronbachd α系数0．829-0．911。结论应用蒽环类药物化疗的乳腺癌患者，其症状群是随着治疗周期动态变化的，护理人员需要根据具体情况进行调整，采取有针对性的干预措施，改善患者的症状，提高患者的生命质量。Objective To explore the clinical symptom clusters in breast cancer patients with anthraeycline treatment, which could provide evidence for prevention. Methods The M.D.Anderson Symptom Inventory of Chinese version （MDASI-C） was applied to assess clinical symptoms in 506 breast cancer patients received anthracyeline therapy during their 1^st to 4^th cycle chemotherapy.Thirteen symptoms were analyzed using main-component analysis and variance orthogonal rotation. The exploratory factor analysis was conducted to find factors value greater than 1. Results The number of symptoms with incidence rate more than 50% was 5, 6, 7 and 9 during the 1^st to the 4^th cycle, respectively. Fatigue, poor appetite, and nausea were the most common symptoms, and the incidence of these symptoms were 92.5% to 97.1%,84.8% to 95.1%and 81.1% to 91.3% with the increasing cycle of chemotherapy.Three factors value greater than 1 were detected during the 1^st to 2^nd cycle chemotherapy by exploratory factor analysis.The cumulative variance contribution rates were 63.233% and 61.434% in the 1^st and 2^nd cycle, respectively. The main symptom clusters concentrate on fatigue and digestive tract symptoms, including fatigue, sleep disturbance, hypersomnia, nausea, vomit, poor appetite, dry mouth. Two factors value greater than 1 were detected during 3^rd to4^th cycle in chemotherapy. The cumulative variance contribution rates were 62.660% and 61.148% in the 3^rd and 4^th cycle, respectively. The main symptom clusters concentrate on psychological and nervous system symptoms including sadness, pain, dry mouth, numbness, hypersomnia, shortness of breath, amnesia and so on. The Cronbach α of cluster symptoms from the 1^st to the 4^th cycle chemotherapy was between 0.829 to 0.911. Conclusions Symptom clusters vary with the cycles of chemotherapy in breast cancer patients treated with anthracycline. Nurses should provide targeted intervention measures to improve symptom and enhance quality of life, according to specific situation.

关 键 词：乳腺肿瘤 蒽环类药物 化疗 症状群 

分 类 号：R737.9[医药卫生—肿瘤]