成人脑胶质瘤患者症状群、症状困扰现状调查及影响因素分析★

Investigation on the symptom clusters and symptom distress status of adult patients with brain glioma and analysis of the influencing factors★

摘要:

目的 调查成人胶质瘤患者术前和术后症状群变化特点，并分析引起症状群加重的危险因素。方法 选取2021年10月—2023年2月于我院就诊的81例脑胶质瘤患者，参考中文版安德森症状评估量表（MDASI-BT）对患者术前、术后1周和术后1个月的症状群进行调查，并评估症状的严重程度。将严重程度评分≥5分的患者作为严重组，<5分的患者作为非严重组，进行单因素和二元Logistic回归分析，筛选症状群加重的独立危险因素。结果 一般症状群中，术前发生率最高的为苦恼，严重程度评分最高的为疼痛；术后1周发生率最高的为疼痛，严重程度评分最高的为嗜睡；术后1个月发生率最高的为疲乏，严重程度评分最高的为不安。脑肿瘤特异性症状群中，术前发生率最高的为癫痫，严重程度评分最高的为注意力不集中；术后1周发生率最高的为注意力不集中，严重程度评分最高的为半边身体虚弱无力；术后1个月发生率最高的为腹泻或便秘，严重程度评分最高的为注意力不集中；干扰项目中，术前、术后1周和术后1个月，一般症状群和脑肿瘤特异性症状群干扰患者最多的均为情绪。二元Logistic回归分析表明，脑胶质瘤患者家庭收入<6万元/年［OR=3.299， 95% CI （1.103，9.872）］、肿瘤病理分级Ⅲ~Ⅳ级［OR=3.349， 95% CI （1.198，9.363）］及KPS评分≤70分［OR=3.234， 95% CI （1.155，9.057）］是症状群加重的独立危险因素（P<0.05）。结论 临床护理人员应结合脑胶质瘤患者症状群在不同治疗阶段的轨迹变化采取针对性护理干预措施，同时应对存在症状群加重危险因素的患者给予重点关注。

Abstract:

Objective To investigate the characteristics of symptom changes in adult brain glioma patients before and after surgery, and to analyze the risk factors for symptom exacerbation.Methods A total of 81 patients with brain glioma who were treated in our hospital between October 2021 and February 2023 were selected in this study. The Chinese version of the M.D. Anderson Symptom Inventory-Brain Tumor Module (MDASI-BT) was applied to investigate the symptom clusters of patients before surgery, one week and one month after surgery, and to evaluate the severity of symptoms. Patients with a score of 5 or more were selected as the severe group, while those with a score of <5 were selected as the non-severe group. Univariate and binary Logistic regression analysis was conducted to screen for independent risk factors for symptom exacerbation.Results In the general symptom clusters, the most prevalent symptom was distress, and the symptom with the highest severity score was pain before surgery. One week after surgery, the assessment results showed that the most prevalent symptom was pain, while the symptom with the highest severity score was drowsiness. One month after surgery, the most prevalent symptom was fatigue, and the symptom with the highest severity score was restlessness. In the symptom clusters specific to brain tumors, the most prevalent symptom before surgery was epilepsy, and the most severe symptom was difficulty in concentrating. One week after surgery, the most prevalent symptom was difficulty in concentrating, and the most severe symptom was weakness on one side of the body. One month after surgery, the most prevalent symptom was diarrhea or constipation, and the most severe symptom was difficulty in concentrating. As for the interference items, among the general symptom clusters and the symptom clusters specific to brain tumors, the emotion of patients was interfered most before operation, one week after operation and one month after operation. Binary logistic regression analysis showed that family economic income of glioma patients <60 000 RMB/year [OR=3.299, 95% CI (1.103, 9.872)], tumor pathological grade Ⅲ or Ⅳ [OR=3.349, 95% CI (1.198, 9.363)], and KPS score ≤70 points [OR=3.234, 95% CI (1.155, 9.057)] were independent risk factors for symptom exacerbation (P<0.05).Conclusion Clinical nurses should tailor their interventions to the trajectory of symptom clusters in brain glioma patients at different stages of treatment, and pay special attention to patients at risk of symptoms exacerbation.