急性淋巴细胞白血病患儿化疗期间症状群的纵向研究  

Symptom clusters among children with acute lymphocytic leukemia during chemotherapy:a longitudinal study

作　　者：李蓉蓉 马金玲 阐玉英[2] 杨琦[1] Li Rongrong;Ma Jinling;Chan Yuying;Yang Qi(Department of Hematology,Children′s Hospital Affiliated to Soochow University,Suzhou 215025,China)

机构地区：[1]苏州大学附属儿童医院血液科,江苏苏州215025 [2]苏州大学附属儿童医院纪监审办公室,江苏苏州215025

出　　处：《护理学杂志》2019年第16期5-9,共5页Journal of Nursing Science

摘　　要：目的探索急性淋巴细胞白血病(ALL)患儿化疗期间症状群的动态变化。方法便利选取134例ALL患儿,使用记忆症状评估量表儿童版分别于化疗前(T1)、诱导(T2)、巩固(T3)和维持期(T4)进行调查。结果ALL患儿各时间点严重度前3位的症状为T1:缺乏活力[2.50(1.00,3.00)]、出汗[2.00(1.00,2.00)]、没有食欲[1.00(1.00,2.00)];T2:缺乏活力[2.50(2.00,3.00)]、出汗[2.00(2.00,2.00)]、头发少了[2.00(2.00,2.00)];T3:头发少了[3.00(2.00,4.00)]、我看起来不像我自己[2.50(2.00,3.00)]、出汗[2.00(1.00,2.00)];T4:头发少了[2.00(0.00,2.00)]、我看起来不像我自己[2.00(0.00,2.00)]、皮肤改变[1.50(0.00,2.00)]。T1存在情志症状群、胃肠道症状群和躯体症状群3个症状群;T2和T3存在胃肠道症状群、情志症状群、躯体症状群、神经系统症状群、自我形象受损症状群和皮肤黏膜症状群6个症状群;T4存在情志症状群、胃肠道症状群、躯体症状群、神经系统症状群和自我形象受损症状群5个症状群。结论ALL患儿化疗期间症状的发生率及严重度均较高,不同时间点的症状可聚集成群,且症状群具有一定的稳定性和动态性,医护人员应根据每个阶段症状群的变化趋势,动态评估和管理患儿症状。Objective To explore the dynamic changes of symptom clusters among children with Acute Lymphoblastic Leukemia(ALL)during chemotherapy.Methods A total of 134 children with ALL were recruited using convenience sampling,who were then investigated using Memorial Symptom Assessment Scale 10-18(MSAS 10-18)before chemotherapy(T1),induction(T2),consolidation(T3)and maintenance of chemotherapy(T4).Results The top three serious symptoms at each time point were as followed:lack of energy[2.50(1.00,3.00)],sweating[2.00(1.00,2.00)]and lack of appetite[1.00(1.00,2.00)]at T1;lack of energy[2.50(2.00,3.00)],sweating[2.00(2.00,2.00)]and hair loss[2.00(2.00,2.00)]at T2;hair loss[3.00(2.00,4.00)],"I don′t look like myself"[2.50(2.00,3.00)]and sweating[2.00(1.00,2.00)]at T3;hair loss[2.00(0.00,2.00)],"I don′t look like myself"[2.00(0.00,2.00)]and skin changes[1.50(0.00,2.00)]at T4.There were 3 symptom clusters(emotional,gastrointestinal,and somatic)at T1,6(gastrointestinal,emotional,somatic,nervous system,self-image damage,skin mucosal)at T2 and T3,and 5(emotional,gastrointestinal,somatic,nervous system,self-image damage)at T4.Conclusion The incidence and severity of symptoms among children with ALL during chemotherapy are high,the symptoms at different time points can be aggregated into clusters,and the symptom clusters are stable and dynamic.Medical staff should dynamically assess and manage the symptoms of children according to the trend of symptom clusters at each stage.

关 键 词：急性淋巴细胞白血病 儿童 化疗 症状群 症状管理 情志症状 胃肠道症状 躯体症状 纵向研究 

分 类 号：R473.73[医药卫生—护理学] R473.72[医药卫生—临床医学]