急性淋巴细胞白血病维持化疗阶段患儿的症状群及其前哨症状的调查

doi:10.16460/j.issn1008-9969.2022.15.059

摘要/Abstract

摘要： 目的探讨急性淋巴细胞白血病患儿维持化疗阶段症状群及各症状群的前哨症状。方法采用便利抽样法,选取2020年6月—2021年8月在苏州大学附属儿童医院血液科病房收治的处于维持化疗阶段的急性淋巴细胞白血病患儿作为研究对象,采用记忆症状评估量表儿童版对其进行调查。采用探索性因子分析并结合Spearman秩相关分析确定症状群;基于Apriori算法关联分析确定各症状群的前哨症状。结果急性淋巴细胞白血病患儿在维持化疗阶段存在5类症状群,即情绪心理症状群、胃肠道症状群、躯体症状群、神经系统症状群、自我形象受损症状群,其Cronbach α系数分别为0.943、0.906、0.874、0.891、0.900;睡眠困难、呕吐、咳嗽、头痛、脱发依次为上述症状群的前哨症状。结论急性淋巴细胞白血病患儿在维持化疗阶段经历多种症状群困扰。症状群及其前哨症状的确定有利于简化症状的评估和管理,提高症状管理效率,减轻患儿及家庭的疾病负担。

关键词: 急性淋巴细胞白血病, 儿童, 维持化疗, 症状群, 前哨症状

Abstract: Objective To explore the symptom clusters and their sentinel symptoms in children with acute lymphoblastic leukemia during maintenance chemotherapy. Methods With convenience sampling, children with acute lymphoblastic leukemia who received maintenance chemotherapy in department of hematology of Children's Hospital of Soochow University from June 2020 to August 2021 were selected and assessed by Memorial Symptom Assessment Scale 10-18. The formation of symptom clusters was determined by exploratory factor analysis with Spearman rank correlation analysis, and the sentinel symptoms of clusters were determined by Apriori algorithm association analysis. Results Five symptom clusters in children with acute lymphoblastic leukemia during maintenance chemotherapy were identified, including emotional-psychological cluster, gastrointestinal cluster, somatic cluster, neurosystem cluster, and self-image disorder cluster, and the Cronbach ɑ coefficient was 0.943, 0.906, 0.874, 0.891 and 0.900, respectively; insomnia, vomiting, cough, headache, and hair loss were the sentinel symptoms of the clusters respectively. Conclusion Children with acute lymphoblastic leukemia experience a variety of symptom clusters during maintenance chemotherapy. The identification of symptom clusters and sentinel symptoms is helpful to simplify the evaluation and management of symptoms, improve the efficiency of symptom management, and reduce the disease burden of children and their families.

Key words: acute lymphoblastic leukemia, children, maintenance chemotherapy, symptom clusters, sentinel symptoms

中图分类号:

R473.55

申心怡, 李蓉蓉, 阐玉英, 张冠珣, 杨琦, 张琳. 急性淋巴细胞白血病维持化疗阶段患儿的症状群及其前哨症状的调查[J]. 护理学报, 2022, 29(15): 59-64.

SHEN Xin-yi, LI Rong-rong, CHAN Yu-ying, ZHANG Guan-xun, YANG Qi, ZHANG Lin. Symptom Clusters and Sentinel Symptoms of Children with Acute Lymphoblastic Leukemia during Maintenance Chemotherapy[J]. Journal of Nursing, 2022, 29(15): 59-64.

参考文献

[1] Yi M, Zhou L, Li A, et al.Global Burden and Trend of Acute Lymphoblastic Leukemia from 1990 to 2017[J]. Aging(Albany NY),2020,12(22):22869-22891.DOI:10.18632/aging.103982.
[2] Yang W, Cai J, Shen S, et al.Pulse Therapy with Vincristine and Dexamethasone for Childhood Acute Lymphoblastic Leukaemia (CCCG-ALL-2015): An Open-label, Multicentre, Randomised, Phase 3, Non-inferiority Trial[J]. Lancet Oncol, 2021, 22(9):1322-1332.DOI:10.1016/s1470-2045(21)00328-4.
[3] Kim HJ, McGuire DB, Tulman L, et al. Symptom Clusters: Concept Analysis and Clinical Implications for Cancer Nursing[J]. Cancer Nurs, 2005, 28(4):270-282.DOI:10.1097/00002820-200507000-00005.
[4] 郑渊,刘可,卜秀青,等. 急性白血病患儿化疗期间症状群的调查分析[J]. 中华护理杂志,2016, 51(11):1320-1324.DOI:10.3761/j.issn.0254-1769.2016.11.008.
[5] Li R, Ma J, Chan Y, et al.Symptom Clusters and Influencing Factors in Children with Acute Leukemia During Chemotherapy[J]. Cancer Nurs, 2020, 43(5): 411-418.DOI:10.1097/ncc.0000000000000716.
[6] 李蓉蓉, 马金玲, 阐玉英, 等. 急性淋巴细胞白血病患儿化疗期间症状群的纵向研究[J].护理学杂志,2019, 34(16):5-9.DOI:10.3870/j.issn.1001-4152.2019.16.005.
[7] Kirkova J, Aktas A, Walsh D, et al.Consistency of Symptom Clusters in Advanced Cancer[J]. Am J Hosp Palliat Care, 2010,27(5):342-346.DOI:10.1177/1049909110369869.
[8] Brown JK, Cooley ME, Chernecky C, et al.A Symptom Cluster and Sentinel Symptom Experienced by Women with Lung Cancer[J]. Oncol Nurs Forum, 2011, 38(6): E425-435.DOI:10.1188/11.Onf.E425-e435.
[9] 夏超, 段培蓓, 杨玲, 等. 166例胃癌术后化疗患者症状群内前哨症状的调查[J].护理学报,2021,28(8):44-49.DOI:10.16460/j.issn1008-9969.2021.08.044.
[10] 中华人民共和国国家卫生健康委员会,国家卫生健康委办公厅. 儿童急性淋巴细胞白血病诊疗规范(2018版)[EB/OL].(2018-10-8)[2022-03-21].http://www.nhc.gov.cn/yzygj/s7653/201810/aef82930c1af4fc5bf325938e2fcb075.shtml.
[11] Zheng R, Peng X, Zeng H, et al.Incidence, Mortality and Survival of Childhood Cancer in China during 2000-2010 Period: A Population-based Study[J]. Cancer Lett, 2015, 363(2): 176-180.DOI:10.1016/j.canlet.2015.04.021.
[12] 郑卫军, 何凡. 现况调查的样本量计算方法[J].预防医学, 2020, 32(6):647-648.DOI:10.19485/j.cnki.issn2096-5087.2020.06.028.
[13] Williamson Lewis R, Effinger KE, Wasilewski-Masker K, et al.Self-reported Late Effect Symptom Clusters among Young Pediatric Cancer Survivors[J]. Support Care Cancer, 2021,29(12):8077-8087.DOI:10.1007/s00520-021-06332-4.
[14] Collins JJ, Byrnes ME, Dunkel IJ, et al.The Measurement of Symptoms in Children with Cancer[J]. J Pain Symptom Manage, 2000,19(5):363-377.DOI:10.1016/s0885-3924(00)00127-5.
[15] Drake R, Frost J, Collins JJ.The Symptoms of Dying Children[J]. J Pain Symptom Manage, 2003, 26(1):594-603.DOI: 10.1016/S0885-3924(03)00202-1.
[16] 冯芳茗, 楼建华, 徐红, 等. 癌症患儿症状体验的现况调查[J].中国护理管理, 2012, 12(1):30-34.DOI:10.3969/j.issn.1672-1756.2012.01.010.
[17] 张浩彬. IBM SPSS Modeler 18.0 数据挖掘权威指南[M]. 北京:人民邮电出版社, 2019:356-366.
[18] Tang X, Mo L, Liu Q, et al.Adverse Experiences of Social Adaptation in Children with Leukaemia: A Qualitative Study from China[J]. BMJ Open, 2022, 12(3):e051953.DOI:10.1136/bmjopen-2021-051953.
[19] Rahiman EA, Rajendran A, Sankhyan N, et al.Acute Neurological Complications during Acute Lymphoblastic Leukemia Therapy: A Single-center Experience over 10 Years[J]. Indian J Cancer, 2021, 58(4): 545-552.DOI:10.4103/ijc.IJC_422_19.
[20] Mahon SM, Carr E.Skin Toxicities: Common Side Effect[J]. Clin J Oncol Nurs, 2021, 25(6):32.DOI:10.1188/21.Cjon.S2.32.
[21] Balachandran DD, Miller MA, Faiz SA, et al.Evaluation and Management of Sleep and Circadian Rhythm Disturbance in Cancer[J]. Curr Treat Options Oncol, 2021, 22(9): 81.DOI:10.1007/s11864-021-00872-x.
[22] Steur LMH, Kaspers GJL, van Someren EJW, et al. The Impact of Maintenance Therapy on Sleep-wake Rhythms and Cancer-related Fatigue in Pediatric Acute Lymphoblastic Leukemia[J]. Support Care Cancer, 2020, 28(12): 5983-5993.DOI:10.1007/s00520-020-05444-7.
[23] Paw Cho Sing E, Robinson PD, Flank J, et al. Classification of the Acute Emetogenicity of Chemotherapy in Pediatric Patients: A Clinical Practice Guideline[J]. Pediatr Blood Cancer, 2019, 66(5): e27646.DOI:10.1002/pbc.27646.
[24] Patel P, Robinson PD, Devine KA, et al.Prevention and Treatment of Anticipatory Chemotherapy-induced Nausea and Vomiting in Pediatric Cancer Patients and Hematopoietic Stem Cell Recipients: Clinical Practice Guideline Update[J]. Pediatr Blood Cancer, 2021, 68(5): e28947.DOI:10.1002/pbc.28947.
[25] 汪燕, 王宁玲, 谢志伟.甲氨蝶呤所致急性淋巴细胞白血病患儿相关药源性咳嗽诊治体会[J]. 安徽医学, 2014, 35(8):1111-1112.DOI:10.3969/j.issn.1000-0399.2014.08.031.
[26] Cho PSP, Turner RD.Cough and Pain: More Similar Than at First Glance[J]. Chest, 2021, 159(3):904-905.DOI:10.1016/j.chest.2020.10.001.
[27] Sadighi ZS, Ness KK, Hudson MM, et al.Headache Types, Related Morbidity, and Quality of Life in Survivors of Childhood Acute Lymphoblastic Leukemia: A Prospective Cross Sectional Study[J]. Eur J Paediatr Neurol, 2014, 18(6):722-729.DOI:10.1016/j.ejpn.2014.06.006.
[28] Rastogi RG, Arnold TL, Borrero-Mejias C, et al.Non-pharmacologic and Mindful-based Approaches for Pediatric Headache Disorders: A Review[J]. Curr Pain Headache Rep, 2021, 25(12):78.DOI:10.1007/s11916-021-00993-w.

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