基于网络分析的膀胱灌注患者症状群及核心症状的识别 [中文引用][英文引用]

目的  探索膀胱灌注患者症状群的种类，并通过构建症状网络分析其核心症状，为膀胱灌注患者症状管理提供依据。方法  采用便利抽样法，选取 2023 年 3 月— 2024 年 7 月在贵阳市某三级甲等综合医院泌尿外科行膀胱灌注治疗的 226例膀胱肿瘤患者为研究对象，通过查阅患者病历资料，并应用一般资料调查问卷和膀胱灌注患者症状测评问卷进行调查。采用探索性因子分析提取症状群，运用 R 语言构建网络布局，描述症状间的关系，并计算中心性指标。结果  223 例膀胱肿瘤患者完成研究。共提取 4 个症状群，分别是泌尿系统症状群、消化系统症状群、躯体症状群、心理症状群，累积方差贡献率为66.038%。症状网络分析结果显示，尿痛和插管时尿道痛、尿不尽和排尿不畅、苦恼和睡眠质量下降之间存在较强的关联。中心性指标结果中，强度排前 3 的症状为尿痛（rS=2.26）、尿不尽（rS=0.99）、睡眠质量下降（rS=0.90）；预期影响排前 3 的症状为尿痛（rE=2.09），睡眠质量下降（rE=1.34），尿频（rE=0.55）；紧密中心性排前 3 的症状为尿痛（rC=2.23）、尿不尽（rC=0.64）、睡眠质量下降（rC=0.54）；尿痛的强度、预期影响和紧密中心性均最高，表明尿痛是膀胱肿瘤患者的核心症状。结论  膀胱灌注患者同时出现多种症状，症状之间相互关联，共同构成症状群，尿痛是最核心的症状。医护人员应多方位考虑膀胱灌注患者症状的发生率和核心症状，制定科学、合理、精准的症状管理策略，实施针对性干预。

Objective To explore the types of symptom clusters in patients with bladder instillation and identify the core symptoms through symptom network analysis, and to provide evidence for symptom management of the patients. Methods Convenience sampling was used to select 226 patients with bladder instillation for bladder cancer at a Tier-IIIA hospital in Guiyang from March 2023 to July 2024. Data were collected through review of medical record, general information questionnaires and symptom assessment questionnaires specific to the patients with bladder instillation. Exploratory factor analysis was used to extract symptom clusters, and symptom relationships were analysed using R language for network layout and centrality calculations. Results A total of 223 patients with bladder cancer completed the survey. Four symptom clusters were identified, namely the urinary system symptom cluster, digestive system symptom cluster, somatic symptom cluster and psychological symptom cluster, with a cumulative variance contribution rate of 66.038%. The symptom network analysis showed strong associations between dysuria and urethral pain during catheterisation, incomplete emptying and dysuria, as well as distress and poor sleep quality. In terms of centrality indicators, the top three symptoms by strength were dysuria（rS =2.26）, incomplete emptying（rS=0.99）and poor sleep quality（rS=0.90）. Of the expected impacts, the top three were dysuria（rE=2.09）, poor sleep quality（rE=1.34）and frequency of urinary（rE=0.55）. Regarding the closeness centrality, the top three were dysuria（rC=2.23）, incomplete emptying（rC=0.64）and poor sleep quality（rC=0.54）. Dysuria had the highest strength, expected impact and closeness centrality, indicating the dysuria was the core symptom in the patients with bladder cancer. Conclusion For the patients with bladder instillation experience, multiple and interconnected symptoms appear at the same time and together they form a symptom clusters, of which the pain in urination is the core symptom. Medical staff should consider symptom prevalence and core symptoms and to develop the targeted and precise management strategies for targeted nursing.