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Article(id=1241102816912134367, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202405225, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1715702400000, receivedDateStr=2024-05-15, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773831570127, onlineDateStr=2026-03-18, pubDate=1724515200000, pubDateStr=2024-08-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773831570127, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773831570127, creator=13701087609, updateTime=1773831570127, updator=13701087609, issue=Issue{id=1241102813938380911, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='16', pageStart='2881', pageEnd='3072', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773831569418, creator=13701087609, updateTime=1773831807198, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241103811318706322, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241103811318706323, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241102813938380911, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=3055, endPage=3061, ext={EN=ArticleExt(id=1241102818644381938, articleId=1241102816912134367, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Study on core symptom group and its correlation with quality of life in patients with hypertensive cerebral hemorrhage, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To construct a symptom network for patients with hypertensive cerebral hemorrhage in the acute phase, and to explore the core symptom clusters to provide reference for healthcare professionals to carry out individualized and precise symptom management.

Methods

From December 2022 to January 2024, 423 hypertensive cerebral hemorrhage patients hospitalized in the neurosurgery departments of three tertiary-level A hospitals in Hebei Province were conveniently selected for the study. General information questionnaire, Chinese version of Memory Symptom Assessment Scale, National Institutes of Health Stroke Scale, and Stroke Specific Quality of Life Scale were used to collect data. Symptom clusters were analyzed by exploratory factor analysis, symptom networks were constructed in R language to analyze the centrality indexes, and the symptom clusters that had the greatest impact on patients’ quality of life were clarified through stratified regression to determine the core symptom clusters.

Results

The most common symptoms in patients with hypertensive cerebral hemorrhage were pain (83.5 %), worry (80.6%), nausea (75.7%), and the most severe symptom was pain (2.29±0.05), followed by nausea (1.93±0.06) and worry (1.72±0.06). Exploratory factor analysis identified five symptom clusters, namely, sickness symptom cluster, dysfunction symptom cluster, mental-emotional symptom cluster, respiratory symptom cluster, and gastrointestinal symptom cluster, with a cumulative variance contribution of 61.832%. The symptom with the highest expected impact value in the symptom network was pain (rs=1.17). Stratified regression analyses showed that the cluster of sickness symptoms had the greatest impact on quality of life (β=-4.677，95%CI：-5.224 - -4.131，P<0.001), explaining 46.5% of the model.

Conclusion

The symptom cluster is the core symptom cluster in the acute phase of hypertensive cerebral hemorrhage patients, based on which healthcare professionals can take appropriate interventions to carry out symptom management and further improve the efficiency of symptom management.

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目的

构建急性期高血压脑出血患者的症状网络，探索核心症状群，为医护人员开展个体化、精准化症状管理提供参考。

方法

2022年12月—2024年1月便利抽取河北省三所三级甲等医院神经外科住院的423例高血压脑出血患者为研究对象。采用一般资料调查表、中文版记忆症状评估量表、美国国立卫生院卒中量表、脑卒中专用生活质量量表收集资料。探索性因子析取症状群，R语言构建症状网络分析中心性指标，并通过分层回归明确对患者生活质量的影响最大的症状群，确定核心症状群。

结果

高血压脑出血患者最常见的症状是疼痛（83.5 %）、担忧（80.6%）、恶心（75.7%），最严重的症状是疼痛（2.29±0.05），其次是恶心（1.93±0.06）、担忧（1.72±0.06）。探索性因子分析出5个症状群，分别是病感症状群、功能障碍症状群、精神情绪症状群、呼吸道症状群和消化道症状群，累计方差贡献率为61.832%。症状网络中预期影响值最大的症状为疼痛（rs=1.17）。分层回归分析结果表明，病感症状群的对生活质量影响程度最大（β=-4.677，95%CI：-5.224 ~ -4.131，P<0.001），对模型解释度为46.5%。

结论

病感症状群为高血压脑出血患者急性期的核心症状群，医护人员可基于此采取相应的干预措施开展症状管理，进一步提高症状管理的效率。

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成杰，E-mail：
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高硕（1999—），女，硕士在读，研究方向：神经外科

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高硕（1999—），女，硕士在读，研究方向：神经外科

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高硕（1999—），女，硕士在读，研究方向：神经外科

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Journal of Pain and Symptom Management, 2022, 63(2): 230-243., articleTitle=Symptom clusters and quality of Life in gastric cancer patients receiving chemotherapy, refAbstract=null)], funds=[Fund(id=1241102825682424492, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, awardId=22377758D, language=CN, fundingSource=河北省重点研发计划项目(22377758D), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241102819638432039, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, xref=1., ext=[AuthorCompanyExt(id=1241102819646820649, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, companyId=1241102819638432039, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=North China University of Science and Technology，Tangshan, Hebei 063210，China), AuthorCompanyExt(id=1241102819659403563, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, companyId=1241102819638432039, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.华北理工大学，河北 唐山 063210)]), AuthorCompany(id=1241102819743289647, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, xref=2., ext=[AuthorCompanyExt(id=1241102819751678256, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, companyId=1241102819743289647, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.华北理工大学附属医院)])], figs=[ArticleFig(id=1241102824088588858, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, language=EN, label=Fig.1, caption=Network of symptoms in the acute phase of hypertensive cerebral hemorrhage, figureFileSmall=xtVHl3wDCK24dCfAd269CA==, figureFileBig=9sMX0iZWEzMUrH9eB2CnHg==, tableContent=null), ArticleFig(id=1241102824206029378, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, language=CN, label=图1, caption=高血压脑出血急性期症状网络

注：D1=吞咽困难；D2=记忆力下降；D3=肢体功能障碍；D4=言语不利；G1=食欲不振；G2=体重下降；G3=便秘；M1=感到紧张；M2=烦躁不安；M3=担心；M4=感到忧伤；P1=疼痛；P2=作呕/恶心；P3=呕吐；P4=精力不足/乏力；P5=难以入睡；R1=气促；R2=痰多；R3=发热。

, figureFileSmall=xtVHl3wDCK24dCfAd269CA==, figureFileBig=9sMX0iZWEzMUrH9eB2CnHg==, tableContent=null), ArticleFig(id=1241102824470270555, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, language=EN, label=Fig.2, caption=Centrality metrics of network nodes, figureFileSmall=RMm5X6XhxgG5qZ1YtRFtJw==, figureFileBig=7iFTjaU093ntkqstYv4TaA==, tableContent=null), ArticleFig(id=1241102824528990816, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, language=CN, label=图2, caption=网络节点的中心性指标, figureFileSmall=RMm5X6XhxgG5qZ1YtRFtJw==, figureFileBig=7iFTjaU093ntkqstYv4TaA==, tableContent=null), ArticleFig(id=1241102824612876906, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, language=EN, label=Table 1, caption=

General data of patients in the acute phase of hypertensive cerebral hemorrhage (n=423)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类例数
（例）		百分比
（%）
年龄<6019445.86
≥6022954.14
性别男28968.32
女13431.68
婚姻状况已婚36786.76
离婚/丧偶/未婚5613.24
文化程度小学及以下17140.43
初中15035.46
高中/中专7317.25
大学及以上296.86
医保类型职工医保16939.96
居民医保24758.39
自费71.65
高血压严重程度一级4911.58
二级10524.83
三级26963.59
出血部位幕上27364.54
幕下15035.46
NHISS得分正常或近乎正常153.55
轻度6314.89
中度20147.52
中重度13732.39
重度71.65
), ArticleFig(id=1241102824684180080, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, language=CN, label=表1, caption=

高血压脑出血急性期患者的一般资料（n=423）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类例数
（例）		百分比
（%）
年龄<6019445.86
≥6022954.14
性别男28968.32
女13431.68
婚姻状况已婚36786.76
离婚/丧偶/未婚5613.24
文化程度小学及以下17140.43
初中15035.46
高中/中专7317.25
大学及以上296.86
医保类型职工医保16939.96
居民医保24758.39
自费71.65
高血压严重程度一级4911.58
二级10524.83
三级26963.59
出血部位幕上27364.54
幕下15035.46
NHISS得分正常或近乎正常153.55
轻度6314.89
中度20147.52
中重度13732.39
重度71.65
), ArticleFig(id=1241102824784843383, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, language=EN, label=Table 2, caption=

Symptom clusters and factor loadings in the acute phase of hypertensive cerebral hemorrhage patients (n=423)

, figureFileSmall=null, figureFileBig=null, tableContent=
项目发生率
[例（%）]		严重程度（分）
M（P25，P75）		均数因子1因子2因子3因子4因子5因子6
疼痛83.53（2,3）2.290.8600.214-0.112-0.0170.018-0.127
作呕/恶心75.72（1,3）1.930.8370.200-0.0410.1000.0620.258
呕吐71.62（0,3）1.720.7780.188-0.0580.0780.0240.352
乏力64.12（0,3）1.640.6170.0410.0040.0030.004-0.186
难以入睡61.02（0,3）1.610.5280.167-0.1620.0390.054-0.504
吞咽困难47.50（0,2）0.940.0920.793-0.0810.043-0.0190.141
肢体功能障碍63.41（0,2）1.300.2100.7990.040-0.0390.1250.001
言语不利44.70（0,2）0.880.0670.782-0.0380.0960.0290.047
记忆力下降57.01（0,2）1.140.2310.7340.079-0.0980.078-0.075
气促39.00（0,1）0.62-0.0870.0100.8820.0040.0620.016
痰多46.60（0,1）0.75-0.057-0.0040.947-0.0370.0570.017
发热39.00（0,1）0.61-0.052-0.0170.897-0.057-0.007-0.035
食欲不振70.21（0,2）1.130.0210.003-0.0200.857-0.144-0.053
体重下降60.81（0,2）1.000.046-0.0040.0150.818-0.0900.023
便秘51.31（0,1）0.830.0410.018-0.0690.733-0.003-0.028
感到紧张74.52（0,3）1.750.0220.0880.036-0.0850.8390.036
烦躁不安49.20（0,2）1.07-0.0590.1010.062-0.0260.5140.210
感到忧伤63.81（0,3）1.450.105-0.0110.013-0.0840.764-0.167
担忧80.62（1,3）1.910.0430.006-0.004-0.0570.8480.043
难以集中精神46.60（0,2）0.970.0710.121-0.050-0.0470.1050.752
Cronbach α－－0.7990.8060.9030.7410.745－
特征根－－2.8552.6012.5542.0062.349－
方差贡献率－－14.27313.00612.76810.03211.743－
累计方差贡献率－－14.27927.27940.04750.07961.822－
), ArticleFig(id=1241102824923255426, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, language=CN, label=表2, caption=

高血压脑出血患者急性期症状群及因子载荷（n=423）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目发生率
[例（%）]		严重程度（分）
M（P25，P75）		均数因子1因子2因子3因子4因子5因子6
疼痛83.53（2,3）2.290.8600.214-0.112-0.0170.018-0.127
作呕/恶心75.72（1,3）1.930.8370.200-0.0410.1000.0620.258
呕吐71.62（0,3）1.720.7780.188-0.0580.0780.0240.352
乏力64.12（0,3）1.640.6170.0410.0040.0030.004-0.186
难以入睡61.02（0,3）1.610.5280.167-0.1620.0390.054-0.504
吞咽困难47.50（0,2）0.940.0920.793-0.0810.043-0.0190.141
肢体功能障碍63.41（0,2）1.300.2100.7990.040-0.0390.1250.001
言语不利44.70（0,2）0.880.0670.782-0.0380.0960.0290.047
记忆力下降57.01（0,2）1.140.2310.7340.079-0.0980.078-0.075
气促39.00（0,1）0.62-0.0870.0100.8820.0040.0620.016
痰多46.60（0,1）0.75-0.057-0.0040.947-0.0370.0570.017
发热39.00（0,1）0.61-0.052-0.0170.897-0.057-0.007-0.035
食欲不振70.21（0,2）1.130.0210.003-0.0200.857-0.144-0.053
体重下降60.81（0,2）1.000.046-0.0040.0150.818-0.0900.023
便秘51.31（0,1）0.830.0410.018-0.0690.733-0.003-0.028
感到紧张74.52（0,3）1.750.0220.0880.036-0.0850.8390.036
烦躁不安49.20（0,2）1.07-0.0590.1010.062-0.0260.5140.210
感到忧伤63.81（0,3）1.450.105-0.0110.013-0.0840.764-0.167
担忧80.62（1,3）1.910.0430.006-0.004-0.0570.8480.043
难以集中精神46.60（0,2）0.970.0710.121-0.050-0.0470.1050.752
Cronbach α－－0.7990.8060.9030.7410.745－
特征根－－2.8552.6012.5542.0062.349－
方差贡献率－－14.27313.00612.76810.03211.743－
累计方差贡献率－－14.27927.27940.04750.07961.822－
), ArticleFig(id=1241102825200079496, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, language=EN, label=Table 3, caption=

Parameters of the model for stratified regression analysis

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参数模型1模型2模型3模型4模型5模型6
F1.49344.690a41.614a39.919a38.374a36.300a
R20.0280.4930.5020.5170.5290.536
△R20.0280.465a0.009a0.014a0.012a0.007a
调整R20.0090.4820.4900.5040.5150.521
), ArticleFig(id=1241102825330102934, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, language=CN, label=表3, caption=

分层回归分析模型参数

, figureFileSmall=null, figureFileBig=null, tableContent=
参数模型1模型2模型3模型4模型5模型6
F1.49344.690a41.614a39.919a38.374a36.300a
R20.0280.4930.5020.5170.5290.536
△R20.0280.465a0.009a0.014a0.012a0.007a
调整R20.0090.4820.4900.5040.5150.521
), ArticleFig(id=1241102825418183324, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, language=EN, label=Table 4, caption=

Stratified regression analysis model 6 results (n=423)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量βSEβtPβ的95%CI
下限上限
常量224.91811.761-19.124<0.001201.798248.038
年龄-0.1922.468-0.003-0.0780.938-5.0434.659
性别-3.9422.664-0.051-1.4800.140-9.1791.295
婚姻状况5.7693.6710.0541.5720.117-1.44712.984
文化程度-1.0891.372-0.028-0.7930.428-3.7871.609
医保类型-0.1522.423-0.002-0.0630.950-4.9154.611
高血压严重程度-1.6771.768-0.032-0.9480.344-5.1521.799
出血部位-0.7502.589-0.010-0.2900.772-5.8414.340
NIHSS评分-4.1831.506-0.095-2.7780.006-7.143-1.223
病感症状群-4.6770.278-0.637-16.83<0.001-5.224-4.131
呼吸道症状群-1.2090.495-0.084-2.4410.015-2.183-0.235
功能障碍症状群-1.1260.356-0.118-3.1610.002-1.827-0.426
精神情绪症状群-1.1760.318-0.131-3.700<0.001-1.801-0.551
消化道症状群-1.2360.509-0.084-2.4290.016-2.236-0.236
), ArticleFig(id=1241102825548206755, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241102816912134367, language=CN, label=表4, caption=

分层回归分析模型6结果（n=423）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量βSEβtPβ的95%CI
下限上限
常量224.91811.761-19.124<0.001201.798248.038
年龄-0.1922.468-0.003-0.0780.938-5.0434.659
性别-3.9422.664-0.051-1.4800.140-9.1791.295
婚姻状况5.7693.6710.0541.5720.117-1.44712.984
文化程度-1.0891.372-0.028-0.7930.428-3.7871.609
医保类型-0.1522.423-0.002-0.0630.950-4.9154.611
高血压严重程度-1.6771.768-0.032-0.9480.344-5.1521.799
出血部位-0.7502.589-0.010-0.2900.772-5.8414.340
NIHSS评分-4.1831.506-0.095-2.7780.006-7.143-1.223
病感症状群-4.6770.278-0.637-16.83<0.001-5.224-4.131
呼吸道症状群-1.2090.495-0.084-2.4410.015-2.183-0.235
功能障碍症状群-1.1260.356-0.118-3.1610.002-1.827-0.426
精神情绪症状群-1.1760.318-0.131-3.700<0.001-1.801-0.551
消化道症状群-1.2360.509-0.084-2.4290.016-2.236-0.236
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高血压脑出血患者急性期核心症状群及与生活质量相关性研究
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高硕 1 , 郭思尧 1 , 孙延 1 , 李金鹿 2 , 郝习君 1 , 成杰 2
现代预防医学 | 临床与预防 2024,51(16): 3055-3061
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现代预防医学 | 临床与预防 2024, 51(16): 3055-3061
高血压脑出血患者急性期核心症状群及与生活质量相关性研究
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高硕1, 郭思尧1, 孙延1, 李金鹿2, 郝习君1, 成杰2
作者信息
  • 1.华北理工大学，河北 唐山 063210
  • 2.华北理工大学附属医院

    • 高硕（1999—），女，硕士在读，研究方向：神经外科

通讯作者:

成杰，E-mail：
Study on core symptom group and its correlation with quality of life in patients with hypertensive cerebral hemorrhage
Shuo GAO1, Si-yao GUO1, Yan SUN1, Jin-lu LI2, Xi-jun HAO1, Jie CHENG2
Affiliations
  • North China University of Science and Technology，Tangshan, Hebei 063210，China
出版时间: 2024-08-25 doi: 10.20043/j.cnki.MPM.202405225
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摘要
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目的

构建急性期高血压脑出血患者的症状网络，探索核心症状群，为医护人员开展个体化、精准化症状管理提供参考。

方法

2022年12月—2024年1月便利抽取河北省三所三级甲等医院神经外科住院的423例高血压脑出血患者为研究对象。采用一般资料调查表、中文版记忆症状评估量表、美国国立卫生院卒中量表、脑卒中专用生活质量量表收集资料。探索性因子析取症状群，R语言构建症状网络分析中心性指标，并通过分层回归明确对患者生活质量的影响最大的症状群，确定核心症状群。

结果

高血压脑出血患者最常见的症状是疼痛（83.5 %）、担忧（80.6%）、恶心（75.7%），最严重的症状是疼痛（2.29±0.05），其次是恶心（1.93±0.06）、担忧（1.72±0.06）。探索性因子分析出5个症状群，分别是病感症状群、功能障碍症状群、精神情绪症状群、呼吸道症状群和消化道症状群，累计方差贡献率为61.832%。症状网络中预期影响值最大的症状为疼痛（rs=1.17）。分层回归分析结果表明，病感症状群的对生活质量影响程度最大（β=-4.677，95%CI：-5.224 ~ -4.131，P<0.001），对模型解释度为46.5%。

结论

病感症状群为高血压脑出血患者急性期的核心症状群，医护人员可基于此采取相应的干预措施开展症状管理，进一步提高症状管理的效率。

高血压脑出血  /  症状网络  /  症状管理  /  临床评估
Objective

To construct a symptom network for patients with hypertensive cerebral hemorrhage in the acute phase, and to explore the core symptom clusters to provide reference for healthcare professionals to carry out individualized and precise symptom management.

Methods

From December 2022 to January 2024, 423 hypertensive cerebral hemorrhage patients hospitalized in the neurosurgery departments of three tertiary-level A hospitals in Hebei Province were conveniently selected for the study. General information questionnaire, Chinese version of Memory Symptom Assessment Scale, National Institutes of Health Stroke Scale, and Stroke Specific Quality of Life Scale were used to collect data. Symptom clusters were analyzed by exploratory factor analysis, symptom networks were constructed in R language to analyze the centrality indexes, and the symptom clusters that had the greatest impact on patients’ quality of life were clarified through stratified regression to determine the core symptom clusters.

Results

The most common symptoms in patients with hypertensive cerebral hemorrhage were pain (83.5 %), worry (80.6%), nausea (75.7%), and the most severe symptom was pain (2.29±0.05), followed by nausea (1.93±0.06) and worry (1.72±0.06). Exploratory factor analysis identified five symptom clusters, namely, sickness symptom cluster, dysfunction symptom cluster, mental-emotional symptom cluster, respiratory symptom cluster, and gastrointestinal symptom cluster, with a cumulative variance contribution of 61.832%. The symptom with the highest expected impact value in the symptom network was pain (rs=1.17). Stratified regression analyses showed that the cluster of sickness symptoms had the greatest impact on quality of life (β=-4.677，95%CI：-5.224 - -4.131，P<0.001), explaining 46.5% of the model.

Conclusion

The symptom cluster is the core symptom cluster in the acute phase of hypertensive cerebral hemorrhage patients, based on which healthcare professionals can take appropriate interventions to carry out symptom management and further improve the efficiency of symptom management.

Hypertensive intracerebral hemorrhage  /  Symptom network  /  Symptom management  /  Clinical assessment
高硕, 郭思尧, 孙延, 李金鹿, 郝习君, 成杰. 高血压脑出血患者急性期核心症状群及与生活质量相关性研究. 现代预防医学, 2024 , 51 (16) : 3055 -3061 . DOI: 10.20043/j.cnki.MPM.202405225
Shuo GAO, Si-yao GUO, Yan SUN, Jin-lu LI, Xi-jun HAO, Jie CHENG. Study on core symptom group and its correlation with quality of life in patients with hypertensive cerebral hemorrhage[J]. Modern Preventive Medicine, 2024 , 51 (16) : 3055 -3061 . DOI: 10.20043/j.cnki.MPM.202405225
正文
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高血压性脑出血（hypertensive intracerebral hemorrhage，HICH）约占我国所有原发性脑出血病例的75%，是目前病死率与致残率最高的卒中类型，对患者健康造成严重威胁[1]。研究表明急性期的高血压性脑出血患者因病理生理因素易受到多种症状困扰，具有复杂性和多样性的特点。发病期间轻则表现为恶心呕吐、头痛等症状，严重时可导致意识障碍或昏迷，甚至引起呼吸、循环衰竭或死亡等不良后果[2]，不仅阻碍患者的康复进程，更严重影响其生活质量。与单个症状相比，多个症状构成的症状群组间的协同作用使患者疾病负担更重，生活质量更差[3]，因此亟需对患者开展“症状群”管理，为进一步提高症状管理效率，本研究通过运用网络分析方法探索出患者的核心症状群，以为医护人员制定更为精准、高效的症状管理策略提供参考。
1　研究对象与方法
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1.1　研究对象
采用便利抽样法，选取2022年12月—2024年1月在河北省三所三级甲等医院神经外科住院的高血压脑出血患者作为调查对象。纳入标准：①均符合高血压脑出血临床诊断标准，经头颅CT或MRI检查及临床医师确诊[4]；②首次发病，并处在急性期内的患者；③意识清楚且能清楚表述自身症状者；④具备基本的沟通书写能力。排除标准：①存在严重意识障碍、认知障碍不能配合调查者；②严重精神疾病及合并脏器功能异常者。根据同期网络分析的最小样本量估算方法，最小样本量通常需要大于节点数的20倍或250～350例以上[5]，本研究可进入网络分析的有19个症状节点，样本量取20倍计算，并考虑10%脱落率，所需样本量应为418例，实际收取有效问卷为423例。本研究已通过伦理委员会审批（审批号：2021096），所有调查对象均知情同意并自愿参加本研究。
1.2　调查工具
1.2.1　一般资料调查表
由研究者自行设计，内容如下。①一般资料：包括年龄、性别、婚姻状况等。②疾病相关资料：包括高血压严重程度、出血部位、NHISS得分。
1.2.2　中文版记忆症状评估量表（Memorial Symptom Assessment Scale, MSAS）
由美国斯隆·凯特琳癌症中心研发，经香港学者Cheng等翻译成中文版[6]，目前被国内外学者广泛应用于各类疾病患者的研究中，是症状评估最常用的调查问卷之一[7-8]。量表包括生理、心理两个维度三个部分，其中第三部分在本研究中患者自身报告的症状有发热、痰多、言语不利、肢体功能障碍、记忆力下降5个症状，该量表用于评估高血压脑出血患者急性期的多种症状表现。
1.2.3　美国国立卫生院卒中量表（National Institute of Health Stroke Scale, NIHSS）
由Thomas等人编制，我国学者蔡业峰等人将其翻译成中文版[9]，量表包括意识水平，凝视等11个项目，总分在0～42分之间，目前在临床工作中被广泛应用，该量表在本研究中用于测量高血压脑出血患者急性期神经功能缺损情况。
1.2.4　脑卒中专用生活质量量表(Stroke Specifie Quality of Life, SS-QOL)
该量表由Williams等人编制，经我国学者王拥军等人汉化[10]，是专门为评估脑卒中患者的生活质量而设计，量表共包含精力、家庭角色、语言等12个维度，49个条目。采用5级评分法，评分越高表明生活质量水平越高，该量表在本研究中用于评价高血压脑出血患者急性期生活质量状况。
1.3　资料收集方法
调查者由本课题组研究生组成，调查之前统一对调查员进行问卷内容及问答技巧的培训。开展小范围的预调查以检验调查的实用性，通过预调查反馈的信息对调查表的内容、调查方法等做必要修改，经预调查发现条目19由于涉及患者隐私，超过95%的患者不予作答，咨询医学科研设计专家和课题组讨论后，在问卷收集时剔除该条目。预调查成功后开展大规模正式调查，在获其知情同意后，请患者当场填写或由调查者以面对面访谈的形式帮助填写问卷，问卷核验无误后回收。
1.4　统计学方法
采用SPSS 25.0进行统计描述及统计分析。参考Kim基于症状严重程度划分症状群，选取症状发生率≥30%的症状的方法[11]。探索性因子析取症状群采用主成分分析法，结合方差最大正交旋转法，提取特征值>1，因子载荷>0.5的症状组成症状群，每个症状群内至少包括2个因子载荷有意义[12]。利用分层回归方法探究对生活质量影响最大的症状群，P<0.05为差异有统计学意义。
采用R软件(4.3.1)中的qgraph包，基于EBICglasso函数和Spearman相关性分析构建症状网络图，通过计算网络节点的中心性指标，依据预期影响值（ExpectedInfluence）、紧密中心性（Closeness）、中介中心性（Betweeness）指标来识别核心症状群。使用bootnet包并计算相关性稳定系数(Correlation Stability Coemcient，CS-coefficient)检测网络的稳定性。
2　结果
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2.1　一般资料
本研究共发放问卷430份，回收有效问卷423份，有效问卷回收率为98.37%。其中年龄<60岁的194例，≥60岁的229例，详见表1。
2.2　高血压脑出血患者急性期症状发生情况及症状群提取
高血压脑出血急性期最常见的症状是疼痛、担忧、作呕/恶心，最严重的症状是疼痛，其次是恶心、担忧；本研究将症状发生率≥30%的20项症状纳入分析，其中KMO值=0.720，Bartlett’s球形检验χ2值=3 646.471（P<0.001）表明适合进行因子分析。最终提取出特征值>1的因子共6个，其中因子6仅包含“难以集中精神”这一个症状因此被排除，最终提取出5个症状群，按照群内症状组成将其分别命名为病感症状群、功能障碍症状群、呼吸道症状群、消化道症状群、精神情绪症状群，对总方差的累计贡献率为61.822%。详见表2。
2.3　高血压脑出血患者急性期的症状网络分析
高血压脑出血患者急性期的症状网络图如图1所示，呕吐症状位于网络的中心。症状间连线的粗细代表症状间的密切关系程度，由图可以看出，症状之间相关性最强的为作呕/恶心和呕吐（r=0.61）、其次是气促和痰多（r=0.56）、记忆力下降和肢体功能障碍（r=0.54）。进一步计算网络的中心性指标预期影响值、中介中心性、紧密中心性。研究表明，网络的中心性指标中预期影响值要优于其它指标[13]，因此以预期影响值作为网络图的评价指标，对症状网络中心性指标的稳定性进行检测，其中预期影响值的稳定性系数为0.749，稳定性良好。由图2可知预期影响值大的前3个症状为：疼痛（r=1.17）、痰多（r=1.06）、作呕/恶心（r=1.02）。
2.4　高血压脑出血患者急性期症状群对生活质量的影响
以生活质量总分为因变量，将可能影响患者生活质量的一般资料作为控制变量（年龄、性别、婚姻状况、文化程度、医保类型、高血压严重程度、出血部位、NIHSS评分）后，依次纳入病感症状群、呼吸道症状群、功能障碍症状群、精神情绪症状群和消化道症状群得分，进行分层回归分析。结果显示，5个症状群对生活质量的影响均有统计学意义，相较于其它症状群病感症状群的影响程度最高（β=-4.677，95%CI：-5.224 ~ -4.131，P<0.001），在模型中解释变异最多为46.5%，最终模型6中共解释生活质量总变异为52.1%。结果见表3、4。
3　讨论
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3.1　高血压脑出血患者急性期存在多个症状群
高血压脑出血患者急性期受多种症状的困扰，共分析出5个症状群，包括病感症状群、功能障碍症状群、精神情绪症状群、呼吸道症状群、消化道症状群，经网络分析识别出病感症状群为高血压脑出血患者急性期的核心症状群。
3.1.1　病感症状群
病感症状群包括头痛、作呕/恶心、呕吐、疲乏、难以入睡5个症状。本研究发现严重程度最高、预期影响值最大的症状为疼痛，由此可见疼痛为病感症状群的核心症状。研究表明可通过核心症状确定患者的核心症状群[14]，因此，可初步识别病感症状群为高血压脑出血患者急性期的核心症状群，提示医护人员应重点关注这一症状群，并采取针对性措施优先进行干预。患者出现该症状群的原因与高血压脑出血引起的血肿占位效应，以及出血周围形成的脑水肿导致颅内压升高使患者出现头痛、恶心呕吐症状有关。此外亦有研究表明脑卒中患者常伴随着疼痛和疲劳感[15]，而疲劳感越明显，睡眠障碍就越严重，睡眠障碍与疲劳之间存在明显的相关性[16]，由此可见，这些症状之间相互关联组成病感症状群阻碍患者的康复。因此，医护人员应该重视加强对患者该症状群的管理，从而帮助改善患者的预后。
3.1.2　功能障碍症状群
本研究中功能障碍症状群中有吞咽困难、肢体功能障碍、言语不利、记忆力下降4个症状。在急性期高血压脑出血患者的症状网络中，肢体功能障碍和记忆力下降（r=0.54）的相关性较强，此外，由网络图可知，吞咽困难和言语不利（r=0.44）两症状间关系密切。研究证实，60%的脑卒中患者会遗留有如肢体功能障碍、言语障碍、吞咽障碍等神经功能缺损症状，影响患者的康复[17]，因此把握患者功能障碍症状群的相关特征，有利于帮助医护人员及早制定个体化康复策略，以促进多种症状的协同改善，提升康复效果，有利于帮助家庭及社会减轻负担。
3.1.3　精神情绪症状群
精神情绪症状群在各类疾病患者的症状群中较为普遍，虽然症状群名称有所不同，但群内症状构成较为相似[18-19]。急性期高血压脑出血患者的精神情绪症状群主要包括感到紧张、烦躁不安、担心、感到忧伤4个症状。这些症状的出现可能与不同神经功能部位受损、5-羟色胺转运体基因多态性等多种致病机制有关[20]。因此提示医护人员需结合生理和社会因素全面评估患者的心理健康状况，以采取针对性干预措施缓解患者不良情绪，全面提高其治疗依从性并促进生活质量改善。
3.1.4　呼吸道症状群
呼吸道相关症状主要表现为气促、痰多、发热，本研究发现，在症状网络中气促和痰多两症状间的相关性较强，仅次于作呕/恶心和呕吐。究其原因与急性出血诱发机体免疫炎症，导致交感神经系统、副交感神经系统以及下丘脑-垂体-肾上腺素内分泌轴激活改变，加之患者自身免疫力下降，呼吸道防御功能降低，从而出现一系列呼吸道相关症状表现有关[21]。因此医护人员可通过熟知高血压脑出血患者呼吸道症状群的相关表现，在疾病早期对症干预，能够有效预防呼吸道感染的发生。
3.1.5　消化道症状群
急性期高血压脑出血患者消化系统症状群主要表现为便秘、食欲不振、体重下降。Li等[22]的研究表明高血压会导致肠道菌群失衡，且肠道菌群的改变也是高血压发展的致病因素，两者之间互为因果，影响患者的身体健康。由此可见，高血压脑出血患者是发生消化道症状群的高危人群，提示医护人员也应关注疾病本身因血压高引发的消化系统问题，帮助患者控制血压保持相对稳定，以减轻患者消化道相关的症状负担。此外，医护人员应对消化系统症状进行整体干预，给予患者科学的营养支持和饮食指导。
3.2　高血压脑出血患者急性期症状群与生活质量存在相关性
患者长期处于症状困扰之下，会对患者的预后产生负面影响，包括生活质量、情绪状态和功能状态，甚至可能阻碍治疗进展[23]。本研究结果显示，5个症状群均对患者生活质量产生负面影响，与既往研究结果一致，即症状群得分越高，其生活质量越差[24]。且经分层回归分析结果显示病感症状群对患者的影响最大，可进一步验证病感症状群为最困扰高血压脑出血急性期患者的核心症状群。因此提示医护人员有必要对高血压脑出血急性期患者症状群进行早期识别及干预，有利于促进医疗资源的优化配置及管理效率的提高，同时为改善患者生活质量、身心健康等多方面功能提供思路。
本研究的局限性在于受地域限制仅调查了河北省三所医院，且仅为横断面调查。未来可考虑扩大样本量开展多中心纵向研究或亚组分析，更深一步挖掘症状间的变化规律及影响机制，从而为个体化症状管理提供依据。
4　小结
收起
本研究通过对急性期高血压脑出血患者的症状表现调查发现，共存在5个症状群，并利用网络分析的方法构建症状网络，发现疼痛是预期影响值最大的核心症状，且对患者生活质量影响最大的症状群为病感症状群，因此病感症状群为急性期高血压脑出血患者的核心症状群。提示临床医护人员可通过把握核心症状群这一干预靶点，及早识别并采取针对性的症状管理策略，促进患者最佳功能康复，降低高血压脑出血致残率和病死率、复发率，改善其预后，提高生活质量。
基金
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  • 河北省重点研发计划项目(22377758D)
文献
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2024年第51卷第16期
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doi: 10.20043/j.cnki.MPM.202405225
  • 接收时间：2024-05-15
  • 首发时间：2026-03-18
  • 出版时间：2024-08-25
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  • 收稿日期：2024-05-15
基金
河北省重点研发计划项目(22377758D)
作者信息
    1.华北理工大学，河北 唐山 063210
    2.华北理工大学附属医院

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