白血病儿童化疗多维症状体验的同期症状网络分析

doi:10.16460/j.issn1008-9969.2023.16.001

摘要/Abstract

摘要： 目的建立急性白血病患儿化疗多维症状体验的同期症状网络,探讨急性白血病儿童化疗期间的核心症状和症状间的相互关系。方法采用便利抽样法,选取2021年1月—2022年10月在广州市1所三级甲等医院血液肿瘤科收治的374例急性白血病儿童作为研究对象,采用记忆症状量表儿童版进行问卷调查。运用R软件包构建了包括31种症状的同期症状网络,并使用网络分析的方法探索核心症状和分析症状间的关系。结果在症状网络中,担忧或焦虑（r_s=1.178,r_c=0.001,r_b=90.000）强度、紧密中心性值最大,烦躁易惹（r_s=0.893,r_c=0.001,r_b=107.000）是中介中心性指数最高的症状。缺乏活力是急性白血病儿童化疗最普遍的症状,但其中心性指数低于其它症状。化疗期间诱导缓解期症状网络密度显著高于其它化疗周期（巩固加强期和维持治疗期）症状网络密度（χ²=14.771,P<0.001）。结论症状网络为构建临床个性化的精准护理策略提供了新的经验性数据。研究表明需要评估症状网络的中心性指数和网络密度作为急性白血病儿童症状管理的重要组成部分,特别是处于诱导缓解期化疗的儿童。未来的研究有必要在纵向数据中建立动态症状网络和中心性指数的轨迹,以探索症状和干预标志物之间的因果关系。

关键词: 儿童, 急性白血病, 护理, 症状管理, 网络分析

Abstract: Objectives To establish a contemporaneous symptom network that captures the multidimensional symptom experience of children receiving chemotherapy for acute leukemia and to explore the core symptoms and relationship among symptoms. Methods A total of 374 cases of pediatric acute leukemia admitted to hematology-oncology department of a tertiary hospital's from January 2021 to October 2022 were selected as the study subjects using convenient sampling. The occurrence and severity of symptoms were investigated using the Children's Memory Symptom Scale. A contemporaneous symptom network including 31 symptoms was constructed using the R package. The core symptoms and the relationship among symptoms were explored using network analysis. Results The network showed worrying (r_s=1.178, r_c=0.001, r_b=90.000) and feeling irritable (r_s=0.893, r_c=0.001, r_b=107.000) were the most central symptoms across three centrality indices including strength, closeness, and betweenness. Lack of energy is the most common symptom in children undergoing chemotherapy for acute leukemia, but it has lower central indices than other symptoms. The density of the induction remission network differed significantly from that of the consolidation strengthening and maintenance network (χ²=14.771,P<0.001). Conclusion Symptom network provides new empirical data for the precise nursing strategy in clinical practice. There is a need to assess centrality indices and network density as critical components of pediatric cancer care, especially for children in induction remission. Future studies must establish trajectories of dynamic symptom networks and centrality indices in longitudinal data to explore the causal relationships between symptoms and intervention markers.

Key words: children, acute leukemia, nursing, symptom management, network analysis

中图分类号:

R473.55

方加, 许丽玲, 刘春琴, 刘霞, 王妹香, 刘琼, 黄海英, 肖新华, 林艳. 白血病儿童化疗多维症状体验的同期症状网络分析[J]. 护理学报, 2023, 30(16): 1-6.

FANG Jia, XU Li-ling, LIU Chun-qin, LIU Xia, WANG Mei-xiang, LIU Qiong, HUANG Hai-ying, XIAO Xin-Hua, LIN Yan. Contemporaneous symptom networks in children with acute leukemia during chemotherapy: a network analysis[J]. Journal of Nursing, 2023, 30(16): 1-6.

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