急性冠脉综合征患者确诊前症状群及桥梁症状的同期网络分析  

Contemporaneous network analysis of pre-diagnosis symptom clusters and bridge symptoms in patients with acute coronary syndrome

作　　者：王雅惠 贺敏 赵晋波 谢任婷 侯永超[2] Wang Yahui;He Min;Zhao Jinbo;Xie Renting;Hou Yongchao(School of Nursing,Shanxi University of Chinese Medicine,Jinzhong 030619,China;Emergency Department,Shanxi Provincial People's Hospital,Taiyuan 030012,China)

机构地区：[1]山西中医药大学护理学院,晋中030619 [2]山西省人民医院急诊科,太原030012

出　　处：《中华现代护理杂志》2024年第28期3832-3838,共7页Chinese Journal of Modern Nursing

基　　金：山西省卫生健康委科研课题计划(2019023)。

摘　　要：目的探索急性冠脉综合征(ACS)患者确诊前症状群的类型,识别症状群间的桥梁症状。方法采用便利抽样法,选取2023年5—10月就诊于山西省人民医院的243例ACS患者为研究对象。采用一般资料调查表、麦克斯维尼急性和前驱心绞痛症状中文版问卷对患者进行调查。采用探索性因子分析识别症状群,网络分析识别症状群间的桥梁症状。本研究共发放243份问卷,回收有效问卷230份,问卷有效回收率为94.7%(230/243)。结果ACS患者确诊前存在4个症状群,分别为典型胸部症状群、典型肩背部症状群、疲乏相关症状群、心肺症状群。症状网络分析中,疲乏和焦虑是症状群间的桥梁症状,其中疲乏的桥梁预期影响系数最高(r_(bei)=0.3873),紧密中心性次之(r_(bc)=0.0242);焦虑的桥梁中介性(r_(bb)=35.000)和紧密中心性(r_(bc)=0.0248)最高。结论疲乏和焦虑是ACS患者的桥梁症状,连接不同症状群。识别桥梁症状有利于症状管理效率和准确性的提高。未来研究需考虑患者的异质性,有待开展症状群亚组研究,进一步探索核心症状和桥梁症状在临床中的实际意义。Objective To explore the types of pre-diagnosis symptom clusters in patients with acute coronary syndrome(ACS)and identify bridge symptoms between symptom clusters.Methods From May to October 2023,convenience sampling was used to select 243 ACS patients who visited Shanxi Provincial People's Hospital as participants.The General Information Questionnaire and Chinese version of the McSweeney Acute and Prodromal Myocardial Infarction Symptoms Survey were used for the survey.Exploratory factors were used to analyze symptom clusters,while network analysis was used to identify bridge symptoms between symptom clusters.A total of 243 questionnaires were distributed,and 230 valid questionnaires were collected,with a valid response rate of 94.7%(230/243).Results Before diagnosis,ACS patients had four symptom clusters,namely typical chest symptom cluster,typical shoulder and back symptom cluster,fatigue related symptom cluster,and cardiopulmonary symptom cluster.In symptom network analysis,fatigue and anxiety were bridge symptoms between symptom clusters,with fatigue having the highest expected impact coefficient(r_(bei)=0.3873),followed by close centrality(r_(bc)=0.0242).The bridge mediation(r_(bb)=35.000)and close centrality(r_(bc)=0.0248)of anxiety were the highest.Conclusions Fatigue and anxiety are bridge symptoms in ACS patients,connecting different symptom clusters.Identifying bridge symptoms is beneficial for improving the efficiency and accuracy of symptom management.Research needs to consider patient heterogeneity and conduct subgroup studies on symptom clusters to further explore the practical significance of core and bridge symptoms in clinical practice.

关 键 词：急性冠脉综合征 症状群 桥梁症状 网络分析 

分 类 号：R541.4[医药卫生—心血管疾病]