目的 探索慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者症状网络时序演变规律,为临床分阶段精准症状管理提供依据。方法 2025年5-12月,便利抽样法选取蚌埠市某三级甲等医院呼吸科收治的372例COPD患者为研究对象,于入院时(T1)、出院时(T2)及出院后1个月(T3)采用修订版记忆症状评估量表评估症状。运用探索性因子分析提取症状群,R 4.3.1软件构建症状动态网络。结果 共提取4个稳定症状群;以出预期影响(out-expected influence,out-EI)值最高的为核心症状;T1→T2时段紧张、气短为核心症状(out-EI=0.225、0.205);T2→T3时段肢体肿胀、精力缺乏、烦躁为核心症状(out-EI=1.068、0.945、0.845)。难以入睡、肢体肿胀分别为两阶段入可预测性(in-predictability=0.814、0.991)最高的症状。相关稳定性系数均>0.5,网络稳定。结论 住院期聚焦心理/呼吸道症状(紧张、气短),出院后转向躯体症状(肢体肿胀、精力缺乏、烦躁)监测;以难以入睡与肢体肿胀为预警信号,早期干预可能阻断级联。

Objective To explore the temporal evolution patterns of symptom networks in patients with chronic obstructive pulmonary disease (COPD),and to provide a basis for stage-specific precise symptom management in clinical practice.Methods From May to December 2025,372 COPD patients admitted to the respiratory department of a tertiary A hospital in Bengbu were selected by convenience sampling.Symptoms were assessed using the revised memory symptom assessment scale (RMSAS) at admission (T1),discharge (T2),and 1-month post-discharge (T3).Exploratory factor analysis was used to extract symptom clusters,and R 4.3.1 software was employed to construct dynamic symptom networks.Results 4 stable symptom clusters were extracted.Core symptoms were identified by the highest Out-expected influence (out) values.From T1 to T2,nervousness and shortness of breath were the core symptoms (out-EI=0.225,0.205).From T2 to T3,limb swelling,lack of energy,and irritability were the core symptoms (out-EI=1.068,0.945,0.845).Difficulty falling asleep and limb swelling had the highest in-predictability in the 2 stages (0.814 and 0.991,respectively). All stability coefficients are > 0.5,indicating stable networks.Conclusions During hospitalization,monitoring should focus on psychological and respiratory symptoms (nervousness and shortness of breath),whereas after discharge,attention should shift to somatic symptoms (limb swelling,lack of energy,and irritability).Difficulty falling asleep and limb swelling can serve as early warning signals,and early intervention may interrupt the cascading effects.

R473.56

安徽省高等学校科学研究项目(2024AH052825)