目的 探讨鼻咽癌(nasopharyngeal carcinoma,NPC）患者同步放化疗期间心理一致感的纵向发展轨迹，分析其影响因素。方法 2022年11月至2023年6月,便利抽样选取广西某三级甲等综合医院同步放化疗患者225例作为研究对象，在放疗第1次、15次、30次时采用一般资料调查表、症状困扰量表、心理一致感量表-13对其进行调查，使用潜变量增长混合模型识别其心理一致感发展轨迹，采用Logistic回归分析其影响因素。结果 NPC同步放化疗患者，其心理一致感存在3种轨迹，分别为持续低平组（20.00%）、持续下降组（28.00%）、持续上升组（52.00%）。 Logistic回归分析显示，症状严重程度、年龄、学历、居住地、照护者和肿瘤分期是鼻咽癌患者心理一致感的独立影响因素（均P＜0.05）。结论 鼻咽癌同步放化疗患者心理一致感存在群体异质性，应基于患者心理一致感变化轨迹有针对性地进行评估和干预。

Objective To investigate the longitudinal development trajectory of sense of coherence during concurrent chemoradiotherapy in patients with nasopharyngeal carcinoma (NPC),and to analyze its influencing factors.Methods From November 2022 to June 2023,225 patients with concurrent radiotherapy and chemotherapy in a tertiary A general hospital in Guangxi province were selected by the convenience sampling method,and the general data questionnaire,M.D.Anderson Symptom Inventory-Head and Neck module,MDASI-HN,and Sense of Coherence scale-13 were used to collect data at the 1st,15th,and 30th radiotherapy sessions.The latent variable growth mixed model was used to identify their development trajectories,and the influencing factors of the trajectories were analyzed by logistic regression.Results There were 3 trajectories of sense of coherence in patients with NPC concurrent chemoradiotherapy,which were the persistent low flat group (20.00%),the continuous decline group (28.00%),and the continuous rise group (52.00%).Logistic regression analysis showed that symptom severity,age,education,place of residence,caregiver and tumor stage were independent influencing factors of sense of coherence in patients with nasopharyngeal carcinoma (all P＜0.05).Conclusions There is group heterogeneity in the sense of coherence in patients with concurrent radiotherapy and chemotherapy,which should be evaluated and intervened based on the change trajectory of the sense of coherence in patients.

R473.76

中华护理学会2019年度科研课题（ZHKY201919）；2020年广西医科大学第一附属医院自设科研培育项目-护理临床研究攀登计划项目 （YYZS2020030）