基于结构方程模型的脑卒中患者生活质量影响路径分析

doi:10.3761/j.issn.0254-1769.2023.22.009

摘要/Abstract

摘要：

目的构建结构方程模型，分析各影响因素对脑卒中患者生活质量的影响路径。方法通过横断面研究，采用便利抽样法，选取2021年3月—2022年1月上海市2所三级甲等医院门诊或病房的657例脑卒中患者作为研究对象，采用一般资料调查问卷、心理一致感量表、领悟社会支持量表、医学应对方式问卷、美国国立卫生研究院卒中量表、自尊量表和脑卒中专门化生活质量量表进行调查；应用Mplus 7.4构建结构方程模型。结果脑卒中患者生活质量得分为（178.30±30.30）分，神经功能状态、自尊与生活质量呈负相关（P<0.05），心理一致感、社会支持、应对方式与生活质量呈正相关（P<0.05）；心理一致感、面对、屈服、神经功能状态对生活质量有直接影响（路径系数分别为0.471、0.169、0.135、-0.089，均P<0.05），社会支持、自尊、心理一致感和神经功能状态对生活质量有间接影响（路径系数分别为0.232、0.108、0.058、-0.058，均P<0.001）。结论脑卒中患者的生活质量受多种因素交互影响，心理一致感是生活质量的重要影响因素；采取面对的应对方式、良好的社会支持与较高的自尊能够改善其生活质量水平。

关键词: 脑卒中, 生活质量, 影响因素分析, 结构方程模型, 护理

Abstract:

Objective To construct a structural equation model to analyze the effect of various factors on the quality of life in stroke patients. Methods In this cross-sectional study, a total of 657 stroke patients from 2 tertiary A hospitals in Shanghai were enrolled as investigation subjects via convenience sampling methodology. General information questionnaire，Sense of Coherence Scale-13，Perceived Social Support Scale，Medical Coping Modes Questionnaire，National Institutes of Health Stroke Scale，Self-Esteem Scale and Stroke-Specific Quality of Life were utilized as the investigating tools；Mplus 7.4 was used to construct a structural equation model. Results The average score of quality of life in stroke patients was（178.30±30.30）；neurological status，self-esteem were negatively cor-related with quality of life（P<0.05）；sense of coherence，social support，coping style were positively correlated with quality of life（P<0.05）；sense of coherence，taking a confrontational approach for coping，yielding and neurological status had a direct impact on quality of life（path coefficients were 0.471，0.169、0.135，-0.089，P<0.05）；social sup-port，self-esteem，sense of coherence and neurological status had an indirect impact on quality of life（path coefficients were 0.232，0.108，0.058，-0.058，P<0.001）. Conclusion The quality of life in stroke patients is influenced by multi- ple factors interactively，and sense of coherence is an important factor affecting the quality of life；adopting a confron-tational approach as coping styles，good social support and high self-esteem can improve the level of quality of life.

Key words: Stroke, Quality of Life, Root Cause Analysis, Structural Equation Model, Nursing Care

汤诗恒, 林璟珊, 王乙洋, 乔潇萱, 李玉霞. 基于结构方程模型的脑卒中患者生活质量影响路径分析[J]. 中华护理杂志, 2023, 58(22): 2747-2753.

TANG Shiheng, LIN Jingshan, WANG Yiyang, QIAO Xiaoxuan, LI Yuxia. Path analysis of quality of life in stroke patients based on structural equation model[J]. Chinese Journal of Nursing, 2023, 58(22): 2747-2753.

图/表 5

表1 调查对象的一般资料（n=657）

Table 1 General demographic characteristics of study subjects（n=657）

表2 调查对象脑卒中专门化生活质量量表总分及各维度得分（n=657）

Table 2 The total score of quality of life and the scores of each dimension item in stroke patients（n=657）

表3 调查对象的社会支持、自尊和应对方式得分（n=657）

Table 3 The scores of social support, self-esteem and coping style of the subjects （n=657）

表4 调查对象的生活质量与影响因素的相关性分析（r 值，n=657）

Table 4 Correlation analysis between quality of life and influencing factors of study subjects（r value，n=657）

图1 调查对象生活质量影响因素的结构方程模型

Figure 1 Structural equation model of the factors affecting the quality of life of the research subjects

参考文献 33

[1]	王陇德, 彭斌, 张鸿祺, 等. 《中国脑卒中防治报告2020》概要[J]. 中国脑血管病杂志, 2022, 19(2):136-144.
	Wang LD, Peng B, Zhang HQ, et al. Brief report on stroke prevention and treatment in China,2020[J]. Chin J Cerebro-vasc Dis, 2022, 19(2):136-144.
[2]	张成剑. 珠三角地区初发脑卒中患者生活质量现况调查及影响因素分析[D]. 遵义: 遵义医学院, 2018.
	Zhang CJ. Investigation and analysis of influencing factors on quality of life of stroke patients in the delta of pearl river[D]. Zunyi: Zunyi Medcial College, 2018.
[3]	邓燕, 唐彤. 早期康复护理联合心理护理对脑卒中患者运动功能及认知功能的影响[J]. 心理月刊, 2020, 15(18):107-108. DOI
	Deng Y, Tang T. Efficacy of early rehabilitation nursing combined with psychological nursing on motor function and cognitive function of stroke patients[J]. Psychol Monthly, 2020, 15(18):107-108.
[4]	吴欣娟, 李真, 曹晶, 等. 住院脑卒中患者卧床常见并发症与出院后生活质量的相关性研究[J]. 中华护理杂志, 2019, 54(10):1445-1449. DOI
	Wu XJ, Li Z, Cao J, et al. The correlation between complications of bed rest and quality of life after discharge among hospitalized stroke patients[J]. Chin J Nurs, 2019, 54(10):1445-1449. DOI
[5]	武海环. 肾移植患者社会支持、家庭功能、心理一致感与生活质量的相关性研究[D]. 济南: 山东大学, 2018.
	Wu HH. Correlation between social support,family function,sense of coherence and quality of life in renal transplant patients[D]. Jinan: Shandong University, 2018.
[6]	Bragstad LK, Hjelle EG, Zucknick M, et al. The effects of a dialogue-based intervention to promote psychosocial well-being after stroke:a randomized controlled trial[J]. Clin Rehabil, 2020, 34(8):1056-1071. DOI PMID
[7]	周美景, 罗丹, 林征, 等. 炎症性肠病患者自我管理行为的影响因素分析[J]. 中华护理杂志, 2021, 56(4):550-555. DOI
	Zhou MJ, Luo D, Lin Z, et al. Analysis of influencing factors of self-management behavior in patients with inflammatory bowel disease[J]. Chin J Nurs, 2021, 56(4):550-555. DOI
[8]	王拥军, 李子孝, 谷鸿秋, 等. 中国卒中报告2019(中文版)(1)[J]. 中国卒中杂志, 2020, 15(10):1037-1043.
	Wang YJ, Li ZX, Gu HQ, et al. China stroke statistics 2019(1)[J]. Chin J Stroke,2020, 15(10):1037-1043.
[9]	吴明隆. 结构方程模型:AMOS的操作与应用[M]. 重庆: 重庆大学出版社, 2012.
	Wu ML. Structural equation model:operation and application of AMOS[M]. Chongqing: Chongqing University Press, 2012.
[10]	Antonovsky A. The structure and properties of the Sense of Coherence Scale[J]. Soc Sci Med, 1993, 36(6):725-733. DOI PMID
[11]	Shiu ATY. The significance of sense of coherence for the perceptions of task characteristics and stress during interrup-tions amongst a sample of public health nurses in Hong Kong:implications for nursing management[J]. Public Health Nurs, 1998, 15(4):273-280. PMID
[12]	朱义如, 刘延锦, 郭丽娜. 脑卒中患者的主要照顾者心理一致感的研究进展[J]. 中华护理杂志, 2019, 54(7):995-998. DOI
	Zhu YR, Liu YJ, Guo LN. Research progress on psychological coherence of main caregivers of stroke patients[J]. Chin J Nurs, 2019, 54(7):995-998.
[13]	Kristofferzon ML, Engström M, Nilsson A. Coping mediates the relationship between sense of coherence and mental quality of life in patients with chronic illness:a cross-sectional study[J]. Qual Life Res, 2018, 27(7):1855-1863. DOI PMID
[14]	汪向东. 心理卫生评定量表手册[M]. 增订版. 北京: 中国心理卫生杂志社,1999.
	Wang XD. Rating scales for mental health[M]. updated ed.ed. Beijing: China Journal of Mental Health,1999.
[15]	沈晓红, 姜乾金. 医学应对方式问卷中文版701例测试报告[J]. 中国行为医学科学, 2000(1):22-24.
	Shen XH, Jiang QJ. Medical Coping Modes Questionnaire Chinese Version and its 701 cases test report[J]. Chin Behavi Med, 2000(1):22-24.
[16]	Blumenthal JA, Burg MM, Barefoot J, et al. Social support,type A behavior,and coronary artery disease[J]. Psychosom Med, 1987, 49(4):331-340. PMID
[17]	姜乾金. 领悟社会支持量表[J]. 中国行为医学科学, 2001, 10(10):41-43.
	Jiang QJ. Comprehension Social Support Scale[J]. Chin J Be-havioral Med Sci, 2001, 10(10):41-43.
[18]	Brott T, Adams HP Jr, Olinger CP, et al. Measurements of acute cerebral infarction:a clinical examination scale[J]. Stroke, 1989, 20(7):864-870. DOI PMID
[19]	侯东哲, 张颖, 巫嘉陵, 等. 中文版美国国立卫生院脑卒中量表的信度与效度研究[J]. 中华物理医学与康复杂志, 2012, 34(5):372-374.
	Hou DZ, Zhang Y, Wu JL, et al. Study on reliability and validity of Chinese version of National Institutes of Health Stroke Scale[J]. Chin J Phys Med Rehabil, 2012, 34(5):372-374.
[20]	Rosenberg M. Society and the adolescent self-image[M]. Prin-ceton, NJ: University Press,1965.
[21]	季益富, 于欣. 自尊量表[J]. 中国心理卫生杂志, 1999:318-320.
	Ji YF, Yu X. The Self-Esteem Scale[J]. Chin Mental Health J, 1999:318-320.
[22]	Williams LS, Weinberger M, Harris LE, et al. Development of a Stroke-specific Quality of Life Scale[J]. Stroke, 1999, 30(7):1362-1369. DOI PMID
[23]	李军涛, 王伊龙, 于进洪, 等. 脑卒中专门化生存质量量表(SS-QOL)中译本在冀南地区效度的研究[J]. 脑与神经疾病杂志, 2007, 15(3):177-179.
	Li JT, Wang YL, Yu JH, et al. The study on validity of the Chinese version of Stroke-specific Quality of Life in the south of Ji[J]. J Brain Nerv Dis, 2007, 15(3):177-179.
[24]	Wilson IB. Linking clinical variables with health-related quality of life[J]. JAMA, 1995, 273(1):59-65. DOI URL
[25]	杨凤枝. 心理一致感在青光眼患者睡眠障碍和生活质量之间的中介作用研究[D]. 沈阳: 中国医科大学, 2021.
	Yang FZ. The mediating role of sense of coherence on the association between sleep disturbance and quality of life among glaucoma patients[D]. Shenyang: China Medical University, 2021.
[26]	Mowla F, Khanjari S, Haghani S. Effect of the combination of Benson’s relaxation technique and brief psychoeducational intervention on religious coping,sense of coherence,and quality of life of family caregivers[J]. J Educ Health Promot, 2020, 9:117. DOI URL
[27]	高杰. 疾病不确定感对急性缺血性脑卒中患者生活质量的影响及中介效应分析[D]. 新乡: 新乡医学院, 2021.
	Gao J. Effect of uncertainty in illness on quality of life of patients with acute ischemic stroke and mediating effect analysis[D]. Xinxiang: Xinxiang Medical University, 2021.
[28]	Rodgers H, Bosomworth H, Krebs HI, et al. Robot assisted training for the upper limb after stroke(RATULS):a multicentre randomised controlled trial[J]. Lancet, 2019, 394(10192):51-62. DOI PMID
[29]	徐丽, 杨丹, 骆东妹. 积极心理干预配合健康宣教对乳腺癌根治术患者希望水平、心理一致感与生活质量的影响[J]. 护理实践与研究, 2019, 16(13):87-90.
	Xu L, Yang D, Luo DM. Effect of positive psychological intervention and health education on hope level,psychological consistency and quality of life in patients undergoing radical mastectomy[J]. Nurs Pract Res, 2019, 16(13):87-90.
[30]	刘倩, 于晓丽, 费燕, 等. 心理韧性和领悟社会支持在首发缺血性脑卒中患者感恩与健康促进行为间的中介效应[J]. 解放军护理杂志, 2021, 38(11):12-16.
	Liu Q, Yu XL, Fei Y, et al. Gratitude and health promotion behaviors among patients with first-ever ischemic stroke:the mediating role of resilience and perceived social support[J]. Nurs J Chin PLA, 2021, 38(11):12-16.
[31]	刘欢, 李津. 大肠癌肠造口病人心理一致感与自尊、应对方式的关系模型研究[J]. 护理研究, 2019, 33(17):2964-2968.
	Liu H, Li J. Structural equation model of the relationship between sense of coherence,self-esteem and coping style in colostomy patients with colorectal cancer[J]. Chin Nurs Res, 2019, 33(17):2964-2968.
[32]	Nuccitelli C, Valentini A, Caletti MT, et al. Sense of coherence,self-esteem,and health locus of control in subjects with type 1 diabetes mellitus with/without satisfactory metabolic control[J]. J Endocrinol Invest, 2018, 41(3):307-314. DOI PMID
[33]	侯佳坤, 周宏珍, 刘杨杨, 等. 叙事护理对脑卒中病人病耻感及自尊的影响[J]. 护理研究, 2022, 36(4):654-658.
	Hou JK, Zhou HZ, Liu YY, et al. Effect of narrative nursing on the stigma and self-esteem of stroke patients[J]. Chin Nurs Res, 2022, 36(4):654-658.