摘要
目的调查维持性血液透析(maintenance hemodialysis,MHD)患者症状困扰现况,并构建多维同期症状网络。方法采用便利抽样法选取2023年6-9月上海市和浙江省共3家医院的512例MHD患者为研究对象,采用透析患者症状负担调查表(dialysis frequency,severity,and symptom burden index,DFSSBI)对MHD患者30项症状的发生频率、严重程度和困扰程度进行调查。使用R软件qgraph包构建多维同期症状网络模型。结果发生率排名靠前的症状分别是瘙痒(64.45%)、皮肤干燥(64.06%)、口干(56.64%)、乏力(51.76%)、入睡困难(51.37%)。症状网络分析的结果显示,症状困扰总体焦虑的强度中心性(r_(S)=8.04)、紧密中心性(r_(C)=0.0078)和桥梁症状强度(r_(bs)=5.58)最大,中介中心性最大的症状是入睡困难(r_(B)=38)。在发生频率、严重程度和困扰程度3个维度,强度中心性最大的症状均是焦虑(r_(S)=7.62、7.83、8.02);紧密中心性最大的症状分别是焦虑(r_(C)=0.0073)、烦躁(r_(C)=0.0077)、焦虑(r_(C)=0.0080);中介中心性最大的症状分别是头晕(r_(B)=52)、入睡困难(r_(B)=38)、入睡困难(r_(B)=44)。结论焦虑是MHD患者的核心症状,最容易影响其他症状,且5个心理症状(担心、悲伤、烦躁、焦虑、紧张)之间的关联性最强,入睡困难则在症状网络中起到关键的桥梁作用,提示医护人员应提高对MHD患者心理症状的关注度并关注患者自我报告症状,同时在制定护理方案时应综合评估患者的整体情况。
Objective To investigate the current status of symptom burden in maintenance hemodialysis(MHD)patients and construct a multidimensional contemporaneous symptom network.Methods A total of 512 MHD patients from 3 hospitals in Shanghai and Zhejiang province from June to September 2023 was selected as the research subjects by a convenience sampling method,and the frequency,severity,and degree of distress of 30 symptoms in MHD patients was investigated by the dialysis frequency,severity,and symptom Burden index(DFSSBI).A multidimensional contemporaneous symptom network model was constructed using the R software qgraph package.Results The symptoms with the highest incidence were itching(64.45%),dry skin(64.06%),dry mouth(56.64%),fatigue(51.76%),and difficulty falling asleep(51.37%).The results of symptom network analysis showed that the strength(r_(S)=8.04),closeness(r_(C)=0.0078),and bridge strength(r bs=5.58)of overall anxiety were the highest,and the symptom with the highest betweeness was difficulty falling asleep(r_(B)=38).In terms of frequency,severity,and degree of distress,the symptoms with the highest strength was anxiety(r_(S)=7.62,7.83,8.02);The biggest closeness symptoms were anxiety(r_(C)=0.0073),irritability(r_(C)=0.0077),and anxiety(r_(C)=0.0080);The symptoms with greater betweeness are dizziness(r_(B)=52),difficulty falling asleep(r_(B)=38),and difficulty falling asleep(r_(B)=44).Conclusion Anxiety is the core symptom of MHD patients,which is most likely to affect other symptoms,and the correlation between 5 psychological symptoms(worry,sadness,irritability,anxiety,and tension)is strongest,and difficulty falling asleep plays a key bridging role in the symptom network.It suggests that medical staff should increase their attention to the psychological symptoms of MHD patients and pay attention to the self-reported symptoms of patients.At the same time,when formulating nursing plans,the overall situation of patients should be comprehensively evaluated.
作者
刘婷婷
赵丹
曾小君
汪洁滢
吴志国
奚慧琴
顾乐怡
姚春瑛
余倍烯
章海芬
LIU Tingting;ZHAO Dan;ZENG Xiaojun;WANG Jieying;WU Zhiguo;XI Huiqin;GU Leyi;YAO Chunying;YU Beixi;ZHANG Haifen(Department of Nursing,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China;Department of Nephrology,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China;Clinical Research Center,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China;Department of Psychiatry,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China;Blood Purification Centre,Shanghai Pu'nan Hospital of Pudong New District,Shanghai 200125,China;Blood Purification Centre,Ningbo Hangzhou Bay Hospital,Ningbo 315336,Zhejiang,China)
出处
《护士进修杂志》
2024年第20期2224-2232,共9页
Journal of Nurses Training
基金
上海市闵行区自然科学研究课题(编号:2023MHZ021)
上海交通大学医学院护理科研重中之重项目(编号:Jyhz2310)。
关键词
血液透析
症状困扰
多维度
网络分析
核心症状
症状管理
hemodialysis
symptom burden
multidimensional
network analysis
core symptom
symptom management
