摘要
目的 调查甲状腺癌患者围手术期3个时间点的症状发生率、严重程度及症状群的动态变化轨迹,为制定精准化症状群干预方案提供循证依据。方法 采用纵向调查法,选取某三级甲等医院接受甲状腺癌根治术治疗的患者作为研究对象。分别于术前1~2 d、术后2~4 d、术后28 d进行问卷调查,调查工具采用一般资料调查表和安德森症状评估量表——甲状腺癌模块。结果 共纳入306例甲状腺癌手术患者,其中女性214例、男性92例,平均年龄为(45.85±11.15)岁。患者术前1~2 d存在2个症状群,即心理-躯体症状群、应激反应症状群;术后早期(2~4 d)发展为4个症状群,分别为心理-躯体症状群、应激反应症状群、咽喉-嗓音症状群、睡眠节律紊乱症状群;术后28 d存在3个症状群,分别为心理-躯体症状群、应激反应症状群和咽喉-嗓音症状群。结果显示,甲状腺癌患者围手术期不同阶段症状群的数量及内在症状组合模式均呈现动态演变特征。结论 甲状腺癌患者围手术期存在4个症状群,核心症状群结构相对稳定,但其构成症状的发生频次与严重程度存在显著的时序波动。临床医护人员应建立动态评估体系,依据症状负荷进行分级监测,并实施精准化的干预措施。
Objective To investigate the incidence and severity of symptoms and the dynamic trajectories of symptom clusters at three time points during the perioperative period in patients with thyroid cancer,then to provide evidence-based support for developing targeted symptom cluster intervention strategies.Methods A longitudinal survey was conducted among patients undergoing radical thyroidectomy at a tertiary hospital.Questionnaires were administered at three time points:1 to 2 days preoperatively,2 to 4 days postoperatively,and 28 days postoperatively.The survey tools included a general information questionnaire and the M.D.Anderson Symptom Inventory-Thyroid Cancer Module.Results A total of 306 patients undergoing thyroid cancer surgery were included,comprising 214 females and 92 males,with a mean age of(45.85±11.15)years.At 1 to 2 days preoperatively,two symptom clusters were identified:psychological-somatic and stress response.During the early postoperative period(2 to 4 days),four symptom clusters emerged:psychological-somatic,stress response,throat-voice,and sleep rhythm disturbance.By 28 days postoperatively,three symptom clusters remained:psychological-somatic,stress response,and throat-voice.The results indicated that both the number of symptom clusters and the composition of symptoms within each cluster exhibited dynamic changes across different perioperative stages.Conclusion Four symptom clusters are present in thyroid cancer patients during the perioperative period.While the structure of the core symptom clusters remains relatively stable,the frequency and severity of their constituent symptoms show significant temporal fluctuations.Clinical healthcare providers should establish a dynamic assessment system,monitor symptom burden based on severity grading,and implement targeted interventions accordingly.
作者
陈茜
孙玲
王璐
王颖
张梦婷
CHEN Qian;SUN Ling;WANG Lu;WANG Ying;ZHANG Mengting(Department of Nursing,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China;Department of Thyroid and Breast Surgery,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China)
基金
2024年度同济医院院基金(2024D32)。
关键词
甲状腺癌
围手术期
症状群
纵向调查
thyroid cancer
perioperative period
symptom clusters
longitudinal investigation
