CAJ | 학술논문

目的：探索胃肠道肿瘤患者术后1周内的症状及症状群的发生情况。方法选取2013年1—12月于上海市第六人民医院普外科住院治疗的胃肠道肿瘤术后第7天的患者84例为研究对象。采取横断面研究方法，利用一般情况问卷、记忆症状评估量表（ MSAS）对患者进行问卷调查。结果发放问卷84份，回收有效问卷79份，有效回收率为94.0％。发生率前10位的症状依次是体质量下降（97.5％，77／79）、口干（96.2％，76／79）、疼痛（91.1％，72／79）、冒汗（84.8％，67／79）、精力不足（78.5％，62／79）、咳嗽（69.6％，55／79）、入睡困难（67.1％，53／79）、昏昏欲睡（51.9％，41／79）、腹胀（48.1％，38／79）、紧张（40.5％，32／79）。 Spearman相关性分析结果显示，精力不足与体质量下降、口干、疼痛、冒汗、咳嗽、入睡困难、昏昏欲睡、紧张，冒汗与口干、疼痛、入睡困难、昏昏欲睡、腹胀，疼痛与入睡困难、昏昏欲睡、紧张，紧张与咳嗽、入睡困难、腹胀，口干与体质量下降、入睡困难，咳嗽与腹胀分别呈正相关（P＜0.05）。探索性因子分析结果显示，共有6个症状群，分别为疾病行为症状群、困惑症状群、消化道症状群、手术相关症状群、疼痛相关症状群和其他症状群，总方差贡献率为56.54％，各症状群的方差贡献率分别为26.65％、8.02％、6.81％、5.78％、4.78％、4.50％， Cronbach′sα系数分别为0.83、0.72、0.82、0.57、0.61、0.51。结论胃肠道肿瘤患者术后1周内存在多个症状群，即疾病行为症状群、困惑症状群、消化道症状群、手术相关症状群、疼痛相关症状群和其他症状群，针对症状群的干预模式可能产生更好的临床效果。
목적：탐색위장도종류환자술후1주내적증상급증상군적발생정황。방법선취2013년1—12월우상해시제륙인민의원보외과주원치료적위장도종류술후제7천적환자84례위연구대상。채취횡단면연구방법，이용일반정황문권、기억증상평고량표（ MSAS）대환자진행문권조사。결과발방문권84빈，회수유효문권79빈，유효회수솔위94.0％。발생솔전10위적증상의차시체질량하강（97.5％，77／79）、구간（96.2％，76／79）、동통（91.1％，72／79）、모한（84.8％，67／79）、정력불족（78.5％，62／79）、해수（69.6％，55／79）、입수곤난（67.1％，53／79）、혼혼욕수（51.9％，41／79）、복창（48.1％，38／79）、긴장（40.5％，32／79）。 Spearman상관성분석결과현시，정력불족여체질량하강、구간、동통、모한、해수、입수곤난、혼혼욕수、긴장，모한여구간、동통、입수곤난、혼혼욕수、복창，동통여입수곤난、혼혼욕수、긴장，긴장여해수、입수곤난、복창，구간여체질량하강、입수곤난，해수여복창분별정정상관（P＜0.05）。탐색성인자분석결과현시，공유6개증상군，분별위질병행위증상군、곤혹증상군、소화도증상군、수술상관증상군、동통상관증상군화기타증상군，총방차공헌솔위56.54％，각증상군적방차공헌솔분별위26.65％、8.02％、6.81％、5.78％、4.78％、4.50％， Cronbach′sα계수분별위0.83、0.72、0.82、0.57、0.61、0.51。결론위장도종류환자술후1주내존재다개증상군，즉질병행위증상군、곤혹증상군、소화도증상군、수술상관증상군、동통상관증상군화기타증상군，침대증상군적간예모식가능산생경호적림상효과。
Objective To explore the occurrences of symptoms and symptom clusters of gastrointestinal cancer patients within one week after operation.Methods From January to December 2012, 84 gastrointestinal cancer patients underwenting treatment at the first seven days postoperative period were recruited in General Surgery of the Sixth People′s Hospital of Shanghai.The general information questionnaire and the Memorial Symptom Assessment Scale ( MSAS ) were used in cross -sectional study.Results A total of 84 questionnaires were handed out, 79 of them were eligible, the recovery ratio was 94.0%. The study showed that the top ten symptoms were weight loss ( 97.5%, 77/79 ) , dry mouth ( 96.2%, 76/79 ) , pain (91.1%, 72/79), sweating (84.8%, 67/79), bradypsychia (78.5%, 62/79), cough (69.6%, 55/79), difficulty sleeping ( 67.1%, 53/79 ) , feeling drowsy ( 51.9%, 41/79 ) , feeling bloated ( 48.1%, 38/79 ) , feeling nervous (40.5%, 32/79) .The Spearman correlation analysis showed that bradypsychia was positively correlated with weight loss, dry mouth, pain, sweating, cough, difficulty sleeping, feeling drowsy and feeling nervous; sweating was positively correlated with dry mouth, pain, difficulty sleeping, feeling drowsy and feeling bloated; pain was positively correlated with difficulty sleeping, feeling drowsy and feeling nervous; feeling nervous was positively correlated with cough, difficulty sleeping, feeling bloated;dry mouth was positively correlated with weight loss and difficulty sleeping; cough was positively correlated with feeling bloated, respectively (P<0.05) .The exploratory factor analysis of symptoms revealed six major symptom clusters, which were sickness-behavior symptom cluster, confusion symptom cluster, gastrointestinal symptom cluster, surgery -related symptom cluster, pain-related symptom cluster and other symptom cluster.The cumulative variance contribution rate was 56.54%, while the variance contribution of each symptom cluster was 26.65%, 8.02%, 6.81%, 5.78%, 4.78% and 4.50%, respectively.The Cronbach′s αcoefficient of each symptom cluster was 0.83, 0.72, 0.82, 0.57, 0.61 and 0.51, respectively.Conclusion Gastrointestinal cancer patients can be categorized into several symptom clusters within one week after operation.They are sickness-behavior symptom cluster, confusion symptom cluster, gastrointestinal symptom cluster, surgery-related symptom cluster, pain-related symptom cluster and other symptom cluster.Symptom-cluster -targeted interventions may provide a better clinical efficacy.