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(rs=8.04)、紧密中心性(rC=0.007 8)和桥梁症状强度(rbs=5.58)最大,中介中心性最大的症状是入睡困难(rB=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(rs=7.62、7.83、8.02);紧密中心性最大的症状分别是焦虑(rc=0.007 3)、烦躁(rc=0.007 7)、焦虑(rc=0.008 0);中介中心性最大的症状分别是头晕(rB=52)、入睡困难(rB=38)、入睡困难(rB=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.
Abstract
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 pa-tients 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 multi-dimensional contemporaneous symptom network model was constructed using the R software qgraph package.Re-sults 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(rs=8.04),closeness(rc=0.007 8),and bridge strength(rbs=5.58)of overall anxiety were the high-est,and the symptom with the highest betweeness was difficulty falling asleep(rB=38).In terms of frequency,se-verity,and degree of distress,the symptoms with the highest strength was anxiety(rs=7.62,7.83,8.02);The biggest closeness symptoms were anxiety(rc=0.007 3),irritability(rc=0.007 7),and anxiety(rc=0.008 0);The symptoms with greater betweeness are dizziness(rB=52),difficulty falling asleep(rB=38),and difficulty fall-ing asleep(rB=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 ten-sion)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 pa-tients should be comprehensively evaluated.
基金项目
上海市闵行区自然科学研究课题(2023MHZ021)
上海交通大学医学院护理科研重中之重项目(Jyhz2310)
维普
万方数据