目的 建立失代偿期肝硬化患者的院前症状网络,探讨核心症状、桥梁症状和前哨症状,为临床工作人员实施症状管理提供理论依据。方法 2023年1月至2024年4月,采用便利抽样选取某院消化内科失代偿期肝硬化患者196例为研究对象,采用一般资料问卷、记忆症状评估量表对其进行问卷调查。数据分析采用探索性因子分析及网络分析。结果 失代偿期肝硬化患者院前症状的发生率为19.39%~74.49%。发病率最高的前5个症状分别是感觉肿胀(74.49%)、活动耐力差(73.47%)、食欲不振(70.41%)、瘙痒(65.31%)和口干(63.78%)。提取心理神经症状群、肝硬化特异性症状群和胃肠道症状群3个症状群。“感觉不像自己”(rs=2.571)、瘙痒(rs=1.829)的强度最高;“感觉不像自己”(rb=4.857)和瘙痒(rb=1.303)的中间性最高;“感觉不像自己”(rc=3.193)和便秘(rc=1.458)的亲密程度最高。结论 失代偿期肝硬化患者院前存在不同的症状群,临床护士可根据核心症状和症状群制订相关干预措施,更好地实施症状管理。

Objective To establish a pre-hospitalization symptom network for patients with decompensated cirrhosis,and to identify central symptoms,bridge symptoms,and sentinel symptoms,so as to provide a theoretical basis for clinical staff to implement symptom management.Methods From January 2023 to April 2024,196 patients with decompensated cirrhosis in the Department of Gastroenterology of a hospital were selected by convenience sampling.They were surveyed using the General Information Questionnaire and the Memorial Symptom Assessment Scale (MSAS).Exploratory factor analysis and network analysis were used for data analysis.Results The incidence of pre-hospitalization symptoms in patients with decompensated cirrhosis ranged from 19.39% to 74.49%.The five most common symptoms were feeling bloated (74.49%),lack of energy (73.47%),poor appetite (70.41%),itching (65.31%),and dry mouth (63.78%).Three symptom clusters were extracted:the psycho-neurological symptom cluster,the cirrhosis-specific symptom cluster,and the gastrointestinal symptom cluster."I don't feel like myself"(rs=2.571) and itching(rs=1.829) had the highest strength;"I don't feel like myself"(rb=4.857) and itching(rb=1.303) had the highest betweenness;and "I don't feel like myself"(rc=3.193) and constipation(rc=1.458) had the highest closeness.Conclusions Patients with decompensated cirrhosis present with distinct pre-hospitalization symptom clusters.Clinical nurses can formulate relevant interventions based on central symptoms and symptom clusters to better implement symptom management.

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国家自然科学基金青年项目(82202624)；南方医科大学护理科研重点专项(Z2024004)