目的 构建口腔颌面头颈肿瘤患者放疗期间的症状网络,识别核心症状及症状群。方法 采用便利抽样选取2024年1—12月在上海某三级甲等医院放疗科治疗的551例患者为研究对象,采用一般资料调查表、安德森症状评估量表-头颈部(M.D.Anderson symptom inventory-head & neck,MDASI-H&N)对其进行调查。通过探索性因子分析提取症状群,R软件进行症状网络分析,并确定核心症状以及核心症状群。结果 口干是放疗阶段发生率最高且最重的症状;4个症状群分别为疼痛症状群、心理睡眠症状群、胃肠道症状群、口腔和咽喉症状群,累计方差贡献率40.90%;在症状网络中,节点强度前3名的症状是疲乏(r_s=8.36)、睡眠不安(r_s=7.88)、口腔或咽喉酸痛(r_s=7.72);桥梁强度前3的症状是恶心(r_s=5.18)、疲乏(r_s=4.94)、口腔或咽喉酸痛(r_s=4.76)。结论 口腔颌面头颈肿瘤患者放疗阶段的核心症状为疲乏,核心症状群为口腔和咽喉症状群,临床医护人员可基于核心症状及症状群采取针对性干预措施,提高症状管理的效能。

Objective To construct a symptom network of patients with oral and maxillofacial head and neck tumors during radiotherapy, identify core symptoms and symptom clusters.Methods A convenience sampling method was used to select 551 patients treated in the radiotherapy department of a tertiary A hospital in Shanghai from January to December 2024.Data were collected using the general information questionnaire and the M.D.Anderson symptom inventory-head & neck (MDASI-H&N).Exploratory factor analysis was used to extract symptom clusters.Symptom network analysis was performed using R software to identify core symptoms and core symptom clusters.Results Dry mouth was the most prevalent and most severe symptom during radiotherapy.4 symptom clusters were identified: the pain symptom cluster, the psychological-sleep symptom cluster, the gastrointestinal symptom cluster, and the oral and throat symptom cluster, with a cumulative variance contribution rate of 40.90%.In the symptom network, the top 3 symptoms in terms of node strength were fatigue (r_s=8.36), sleep disturbance (r_s=7.88), and soreness in the mouth or throat (r_s=7.72).The top 3 symptoms in terms of bridge strength were nausea (r_s=5.18), fatigue (r_s=4.94), and soreness in the mouth or throat (r_s=4.76).Conclusions The core symptom in patients with oral and maxillofacial head and neck tumors during radiotherapy is fatigue, and the core symptom cluster is the oral and throat symptom cluster.Clinical medical staff can implement targeted intervention based on core symptoms and symptom clusters to improve the efficiency of symptom management.

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上海交通大学医学院护理学科建设人才培养计划项目学科骨干(SJTUHLXK2024)；上海交通大学医学院附属第九人民医院护理院级基金项目(JYHL2025ZD03)；上海市科委创新生态建设计划项目(25DZ2304900)