老年结肠癌腹腔镜手术患者术后症状群纵向变化轨迹及影响因素  

Study of longitudinal trajectories and influence factors of symptom clusters in elderly patients with laparoscopic surgery for colon cancer

作　　者：姚慧敏 段静 徐文娟 田凌云 周阳 Yao Huimin;Duan Jing;Xu Wenjuan;Tian Lingyun;Zhou Yang(Department of Nursing,Shanxi Bethune Hospital,Taiyuan 030001,China)

机构地区：[1]山西白求恩医院护理部,太原030001

出　　处：《中国实用护理杂志》2025年第13期992-1000,共9页Chinese Journal of Practical Nursing

摘　　要：目的分析老年结肠癌腹腔镜手术患者术后症状群纵向变化轨迹,并探讨轨迹类别的影响因素。方法采用纵向追踪调查方法,便利抽样法选取2021年1月至2024年1月在山西白求恩医院行腹腔镜结肠癌根治术的老年患者作为调查对象。采用中文版MD安德森症状评估量表胃肠道肿瘤模块于患者术后2周、1个月、3个月、6个月进行调查。使用探索性因子分析提取术后各时间点症状群,潜类别增长模型识别其症状群变化轨迹,多元Logistic回归分析患者症状群潜在轨迹类别影响因素。结果最终纳人118例老年结肠癌患者,男69例,女49例,年龄(74.85±3.29)岁,其术后存在4种症状群,分别为能量不足症状群、消化道症状群、睡眠-精神症状群、心理-疲乏症状群,累计方差贡献率分别为62.486%、71.209%、73.937%、63.476%。潜类别增长模型识别患者症状群存在3种变化轨迹:高症状-缓慢降低组占33.0%(39/118)、中等症状-稳定下降组占39.0%(46/118)、低症状-快速降低组占28.0%(33/118)。大专及以上文化程度的患者倾向于发展为低症状-快速降低组(0R=0.365,95%CI0.083~0.603,P<0.05),传统腹腔镜手术(OR=3.679,95%CI1.297~4.432,P<0.05)、原发肿瘤分期为Ⅲ~IV期(0R=0.333,95%CI0.120~0.920,P<0.05)的患者容易发展为高症状-缓慢降低组。结论老年结肠癌腹腔镜手术患者术后存在4种症状群,且术后症状群变化特征呈明显异质性,医护人员应及时识别不同症状群轨迹类别的患者,动态调整干预方案,以提高护理质量。Objective To investigate the longitudinal trajectories of symptom clusters in elderly patients with laparoscopic surgery for colon cancer,and explore the predictive factors for each trajectories subgroup.Methods Using a longitudinal survey,elderly patients with laparoscopic surgery for colon cancer patients from Shanxi Bethune Hospital from January 2021 to January 2024 were collected by convenient sampling method.The Chinese Version of the MD Anderson Symptom Inventory Gastrointestinal Cancer Module was used to conduct follow-up surveys of the selected patients at 2 weeks,1 month,3 months and 6 months after surgery.The symptom cluster was extracted by exploratory factor analysis,and the latent category growth model was conducted to identify the trajectory subgroups of each symptom cluster,the predictive factors of each trajectory subgroup was analyzed by multiple Logistic regression analysis.Results A total of 118 cases were concluded in the present study,there were 69 males and 49 females with an age of(74.85±3.29)years old.There were 4 symptom clusters after surgery,which were named as energy deficit symptom cluster,digestive tract symptom cluster,sleep mental symptom cluster,and psychological fatigue symptom cluster,the variance contribution rates were respectively 62.486%,71.209%,73.937%,63.476%.The results from latent class growth model showed that there were 3 trajectory subgroups in the symptom cluster:high level-slow decline group accounted for 33.0%(39/118),moderate level-stable decline group accounted for 39.0%(46/118),low level-rapid decline group accounted for 28.0%(33/118).College education or above tends to developed into low level-rapid decline group(OR=0.365,95%CI 0.083-0.603,P<0.05),while patients undergoing traditional laparoscopic surgery(OR=3.679,95%CI 1.297-4.432,P<0.05)and primary tumor stages of II-IV were more likely to developed into high level-slow decline group(0R=0.333,95%CI 0.120-0.920,P<0.05).Conclusions There are 4 symptom clusters in elderly patients with laparoscopic surgery for

关 键 词：结肠肿瘤 症状群 轨迹类别 影响因素 

分 类 号：R473.73[医药卫生—护理学]