膝骨关节炎患者行全膝关节置换术后症状群的发生现状及影响因素分析  

Analysis of the status and influencing factors of the occurrence of symptom clusters in patients with knee osteoarthritis after total knee arthroplasty

作　　者：张梦珂 魏铭慧 张远 李佳雪 侯国梁 赵家菊 汪洋[2] 史凌云 Zhang Mengke;Wei Minghui;Zhang Yuan;Li Jiaxue;Hou Guoliang;Zhao Jiaju;Wang Yang;Shi Lingyun(School of Nursing,Xinjiang Medical University,Urumqi 830017,China;Department of Joint Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Nursing,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学护理学院,乌鲁木齐830017 [2]新疆医科大学第一附属医院关节外科,乌鲁木齐830054 [3]新疆医科大学第一附属医院护理部,乌鲁木齐830054

出　　处：《中国实用护理杂志》2024年第29期2271-2279,共9页Chinese Journal of Practical Nursing

基　　金：“天山英才”医药卫生高层次人才培养计划(TSYC202301B091);新疆维吾尔自治区自然科学基金(2022D01C475);新疆维吾尔自治区研究生科研创新项目(XJ2024G182)。

摘　　要：目的了解膝骨关节炎(KOA)患者行全膝关节置换术(TKA)后症状群的发生现状及其潜在类别特征,分析比较各潜类别患者在人口学特征及手术资料上的差异,为临床制订症状管理方案提供依据。方法采用多中心横断面调查研究,方便抽样法选取2023年11月至2024年2月在乌鲁木齐市4所三级甲等医院骨科病房收治的KOA行TKA的患者为研究对象,以一般资料调查表、疼痛视觉模拟评分量表(VAS)、综合医院焦虑抑郁量表(HADS)、匹兹堡睡眠质量指数(PSQI)对其进行调查,并测量其术后关节肿胀程度和瘀斑大小,使用Mplus 8.3软件进行潜在类别分析,采用SPSS26.0软件进行Logistic回归分析,探讨潜类别的影响因素。结果回收有效问卷共337份,问卷回收率为94.7%(337/356),年龄分布为47~85(65.19±6.99)岁,男90例(26.7%),女247例(73.3%);其中,92.3%(311/337)的TKA患者存在术后症状群。TKA患者术后症状群表现为3种类别,分别命名为"高水平疼痛-心理障碍组"(12.5%,39/311)、"高瘀斑-中水平心理障碍组"(25.4%,79/311)和"低症状组"(62.1%,193/311)。无序多分类Logistic回归分析结果显示,年龄45~59岁(OR=2.367)、体质量指数24.0~27.9 kg/m^(2)(OR=0.207)、与子女/父母居住(OR=6.473)、本次为第2次关节手术(OR=0.040)是"高水平疼痛-心理障碍组"的影响因素(均P<0.05)。与子女/父母居住(OR=4.023)、合并慢性病(OR=1.979、3.842)、术中出血量≤100 ml(OR=2.342)是"高瘀斑-中水平心理障碍组"的影响因素(均P<0.05)。结论TKA患者术后症状群的发生率相对较高,且症状群内部存在异质性,护理人员需根据不同类别的特征,早期识别风险患者,给予干预措施。Objective To investigate the prevalence and potential classification of symptoms after total knee arthroplasty(TKA)in patients with knee osteoarthritis(KOA),and to analyze the differences in demographic characteristics and surgical data,compare the different potential subgroups,in order to provide a basis for clinical symptom management plans.Methods This study was a multicenter cross-sectional survey.Through convenience sampling,patients with KOA undergoing TKA in the orthopaedic wards of four tertiary hospitals in Urumqi were selected as the study from November 2023 to February 2024.The study subjects were surveyed using a general information questionnaire,the Visual Analogue Scale(VAS)for pain,the Hospital Anxiety and Depression Scale(HADS),and the Pitts Burgh Sleep Quality Index(PSQI),and the degree of postoperative joint swelling and size of ecchymosis were measured.Latent class analysis was performed using Mplus 8.3 software,and Logistic regression analysis was conducted using SPSS 26.0 software to explore the influencing factors of the latent classes.Results Totally 337 effective questionnaires were collected,and the recovery rate was 94.7%(337/356),and the age distribution ranged from 47 to 85(65.19±6.99)years old,with 90(26.7%)males and 247(73.3%)females.There were 92.3%(311/337)of TKA patients with postoperative symptom cluster.The symptom cluster of patients with TKA were identified as 3 classes.They were named as"high level pain-psychological disorder group"(12.5%,39/311),"high bruises-moderate psychological disorders group"(25.4%,79/311)and"low symptom burden group"(62.1%,193/311).The results of the unordered multi-class logistic regression analysis showed that age 45-59 years(OR=2.367),body mass index 24.0-27.9 kg/m^(2)(OR=0.207),living with children/parents(OR=6.473),and this being the second joint surgery(OR=0.040)were the factors influencing the"high level pain-psychological disorders group"(all P<0.05).The factors influencing the"high bruises-moderate psychological disorders group"were living w

关 键 词：膝 骨关节炎 关节置换术 症状群 潜在类别分析 

分 类 号：R473.6[医药卫生—护理学]