基于聚类分析的头颈肿瘤颈淋巴结清扫术后患者颈肩功能特征分类研究  

Cluster analysis-based classification of neck and shoulder function characteristics in patients after neck lymph node dissection for head and neck tumors

作　　者：商淼[1] 田梓蓉[2] 刘雪[1] 韦昌韵 任晓波[1] Shang Miao;Tian Zirong;Liu Xue;Wei Changyun;Ren Xiaobo(Department of Otorhinolaryngology Head and Neck Surgery,Bejing Tongren Hospital,Capital Medical University,Beijing 100176,China;Department of Nursing,Bejing Tongren Hospital,Capital Medical University,Beijing 100176,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100176 [2]首都医科大学附属北京同仁医院护理部,北京100176

出　　处：《中华现代护理杂志》2025年第12期1642-1649,共8页Chinese Journal of Modern Nursing

基　　金：首都医科大学附属北京同仁医院青年人才培养计划(种子基金项目)(2019-YJJ-ZZL-049)。

摘　　要：目的识别头颈肿瘤颈淋巴结清扫术后患者颈肩功能异常的分类,并分析颈肩功能异常分类的特征。方法采用便利抽样法,选取2024年3-5月在首都医科大学附属北京同仁医院头颈肿瘤康复护理门诊就诊的头颈肿瘤颈淋巴结清扫术后患者为研究对象。采用一般资料调查表、颈部功能症状指标问卷和肩部功能症状指标问卷进行调查。结果果共纳入113例头颈肿瘤颈淋巴结清扫术后患者,患者颈部功能异常发生率排名前3位的指标依次是颈部后仰异常(87.6%,99/113)颈部患侧弯曲异常(84.1%,95/113)和颈部患侧旋转异常(84.1%,95/113);肩部功能异常发生率排名前3位的指标依次是患侧肩前曲异常(83.2%,94/113)、患侧肩外展异常(81.4%,92/113)、患侧肩水平内收异常(80.5%,91/113)。以18个颈肩功能异常指标为聚类变量,将颈肩功能异常患者分为3类:重度异常类(53.1%,60/113)、中度异常类(35.4%,40/113)和轻度异常类(11.5%,13/113)。3类患者在疾病类型、颈肩功能各项指标方面的比较,差异均有统计学意义(P<0.05)。结论头颈肿瘤颈淋巴结清扫术后患者颈肩功能异常情况较为严重,主要表现为活动度的异常。提示医护人员应加强对头颈肿瘤颈淋巴结清扫术后患者的颈肩功能评估,可以将颈肩活动度锻炼作为重点康复项目。Objective To identify the classification of neck and shoulder dysfunction in patients after neck lymph node dissection for head and neck tumors and analyze the characteristics of these dysfunctions.Methods A convenience sampling method was used to select patients who underwent neck lymph node dissection and visited the Head and Neck Cancer Rehabilitation Nursing Clinic at Beijing Tongren Hospital,Capital Medical University,from March to May 2024.General data questionnaires,neck function indicators,and shoulder function symptom questionnaires were used for investigation.Results A total of 113 patients who underwent neck lymph node dissection for head and neck tumors were included in the study.The top three neck dysfunction indicators with the highest occurrence rates were abnormal neck extension(87.6%,99/113),abnormal neck bending on the affected side(84.1%,95/113),and abnormal neck rotation on the affected side(84.1%,95/113).The top three shoulder dysfunction indicators with the highest occurrence rates were:abnormal shoulder flexion on the affected side(83.2%,94/113),abnormal shoulder abduction on the affected side(81.4%,92/113),and abnormal horizontal shoulder abduction on the affected side(80.5%,91/113).Using 18 indicators of neck and shoulder dysfunction as clustering variables,patients were classified into three groups:severe dysfunction group(53.1%,60/113),moderate dysfunction group(35.4%,40/113),and mild dysfunction group(11.5%,13/113).The differences in disease type and neck and shoulder function indicators between the three groups were statistically significant(P<0.05).Conclusions Neck and shoulder dysfunction in patients after neck lymph node dissection for head and neck tumors is relatively severe,primarily manifesting as an abnormal range of motion.Healthcare providers should strengthen neck and shoulder function assessments in these patients and consider a range of motion exercises as a key rehabilitation program.

关 键 词：头颈部肿瘤 聚类分析 颈淋巴结清扫术 颈肩功能 

分 类 号：R473.73[医药卫生—护理学]