日间肺癌手术患者出院后症状纵向变化轨迹及影响因素研究

doi:10.3761/j.issn.2096-7446.2025.11.009

摘要/Abstract

摘要：

目的探讨日间肺癌手术患者出院后症状的动态变化，并分析其影响因素。方法采用纵向研究设计，采用便利抽样法选取浙江省某三级甲等医院2023年10月—2024年1月的日间肺癌手术患者，通过肺癌患者术后症状量表评估其出院第1、3、14、30天的症状。使用组轨迹模型（Group-Based Trajectory Modeling，GBTM）识别患者的出院后症状轨迹类别，分析不同轨迹组的患者特征差异，并使用人均症状指数分析单个术后反应症状的纵向变化。结果共纳入206例患者，识别出3个轨迹组：轻微症状—缓慢减轻组（n=184，89.32%）、严重症状—快速减轻组（n=19，9.22%）、轻微症状—加重组（n=3，1.46%）。年龄、手术方式、病理类型在不同出院后症状轨迹组中存在差异（P<0.05）。在出院第1天咳嗽和疼痛是最常见症状，分别为180例（87.38%）和197例（95.63%），出院第30天咳嗽仍是主要症状（n=129，62.62%）。人均症状反应指数中，便秘由第1天的7.9上升至第3天的9.2，气促从第1天的2.7到第14天增至6.7。结论日间肺癌患者出院后的症状动态变化存在异质性，医护人员可根据不同轨迹组患者特征差异及单一症状的人均症状反应指数变化，制订针对性的护理策略，提升患者康复进度，从而提供高质量的全病程护理服务。

关键词: 日间, 肺癌, 术后症状, 组轨迹模型, 护理

Abstract:

Objective To explore the dynamic changes of symptoms after discharge among patients undergoing daytime lung cancer surgery and analyze their influencing factors. Methods A longitudinal study was conducted in a tertiary hospital in Zhejiang Province，enrolling patients who underwent daytime lung cancer surgery between October 2023 and January 2024. Postoperative symptoms were assessed using a lung cancer symptom scale on days 1，3，14，and 30 after discharge. Group-Based Trajectory Modeling（GBTM） was used to identify the post-discharge symptom trajectory categories among patients. Patient characteristics among different trajectory groups were compare，and the mean symptom response index was used to analyze the longitudinal changes of individual postoperative symptoms. Results Three trajectory groups were identified：mild symptoms-slowly decreasing group（n=184， 89.32%），severe symptoms-rapidly decreasing group（n=19，9.22%），and mild symptoms-worsening group（n=3，1.46%）. Significant differences were observed among these post-discharge symptom trajectory groups in terms of age，surgical approach，and tumor type（P<0.05）. On the first day after discharge，cough and pain were the most common symptoms，occurring in 180 cases（87.38%） and 197 cases（95.63%） respectively. Cough remained the predominant symptom on day 30 post-discharge（n=129，62.62%）. In the mean symptom response index，constipation increased from 7.9 on day 1 to 9.2 on day 3，while dyspnea increased from 2.7 on day 1 to 6.7 on day 14. Conclusion There is significant heterogeneity in the dynamic symptom changes after discharge among daytime lung cancer surgery patients. Medical and nursing staff can formulate targeted care strategies based on differences in patient characteristics across the trajectory groups and changes in the mean symptom response index for individual symptoms，thereby improving patient rehabilitation and providing high-quality，whole-course nursing care.

Key words: Day Surgery, Lung Neoplasms, Postoperative Symptoms, Group-Based Trajectory Modeling, Nursing Care

韩娜菲, 安传波, 袁华娣, 兰美娟, 贺红, 吴小燕, 柳利, 高丽燕, 辛鼎杰, 徐小林. 日间肺癌手术患者出院后症状纵向变化轨迹及影响因素研究[J]. 中华急危重症护理杂志, 2025, 6(11): 1335-1341.

HAN Nafei, AN Chuanbo, YUAN Huadi, LAN Meijuan, HE Hong, WU Xiaoyan, LIU Li, GAO Liyan, XIN Dingjie, XU Xiaolin. Study on the longitudinal change trajectory and influencing factors of symptoms in patients undergoing daytime lung cancer surgery after discharge[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(11): 1335-1341.

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