中青年脑卒中患者心理社会适应的潜在剖面与生活质量的关系研究

doi:10.3761/j.issn.0254-1769.2025.15.008

摘要/Abstract

摘要：

目的探讨中青年脑卒中患者心理社会适应的不同潜在类型与生活质量的关系，为后续制订精准干预措施提供参考。方法采用便利抽样法，选取2023年6月—2024年6月在苏州市4所三级甲等医院住院的406例中青年脑卒中患者作为调查对象。采用一般资料调查表、疾病心理社会适应量表、欧洲五维健康量表进行调查。采用潜在剖面分析探索中青年脑卒中患者心理社会适应的不同潜在类型，以生活质量为因变量进行广义线性回归分析。结果共纳入380例中青年脑卒中患者，其心理社会适应可分为3个潜在类型：高适应水平型（23.90%）、中等适应水平-健康困扰型（46.40%）、低适应水平-心理障碍型（29.70%）。广义线性回归分析结果显示，心理社会适应潜在类型是中青年脑卒中患者生活质量的影响因素（P<0.05）。结论中青年脑卒中患者心理社会适应存在群体异质性，心理社会适应潜在类型是患者生活质量的重要影响因素。医护人员应重点关注低适应水平-心理障碍型患者，并结合不同类型患者的特点，制订精准干预措施，提高其生活质量。

关键词: 中青年脑卒中, 心理社会适应, 潜在剖面分析, 生活质量, 护理

Abstract:

Objective To explore the different potential subtypes of psychosocial adaptation among young and middle-aged stroke patients，and analyze the relationship between different potential subtypes and quality of life，so as to provide references for the subsequent development of targeted interventions. Methods A total of 406 young and middle-aged stroke patients in 4 tertiary hospitals in Suzhou from June 2023 to June 2024 were recruited by convenience sampling. The General Information Questionnaire，the Self-Report Psychosocial Adjustment to Illness Scale and the EuroQol five-dimensional questionnaire were conducted for investigation. Latent profile analysis was used to explore the potential subtypes of psychosocial adaptation among young and middle-aged stroke patients. Generalized linear regression analysis was conducted with quality of life as dependent variables. Results A total of 380 young and middle-aged stroke patients were included. The psychosocial adaptation of patients could be classified into 3 potential subtypes：high adaptation level type（23.90%），medium adaptation level with health concerns type（46.40%），and low adaptation level with psychological barriers type（29.70%）. The results of generalized linear regression analysis showed that potential subtypes of psychosocial adaptation were the influencing factors for quality of life in young and middle-aged stroke patients（P<0.05）. Conclusion There was group heterogeneity in psychosocial adaptation among young and middle-aged stroke patients，and the potential subtype of psychosocial adaption was an important factor affecting the quality of life of patients. It is suggested that medical staff should focus on patients with low adaptation level with psychological barriers type，and take targeted interventions according to characteristics of different subtypes of patients，so as to improve their quality of life.

Key words: Young and Middle-Aged Stroke, Psychosocial Adaptation, Latent Profile Analysis, Quality of Life, Nursing Care

李佳璇, 潘习, 徐岚, 王稚, 仲伟莹, 张祎, 陈蕾, 姚林. 中青年脑卒中患者心理社会适应的潜在剖面与生活质量的关系研究[J]. 中华护理杂志, 2025, 60(15): 1843-1849.

LI Jiaxuan, PAN Xi, XU Lan, WANG Zhi, ZHONG Weiying, ZHANG Yi, CHEN Lei, YAO Lin. Latent profile analysis of psychosocial adaptation among young and middle-aged stroke patients and its relationship with quality of life[J]. Chinese Journal of Nursing, 2025, 60(15): 1843-1849.

图/表 4

表1 中青年脑卒中患者心理社会适应潜在剖面模型拟合信息（n=380）

Table 1 Model fit information for latent profile analysis of psychosocial adaptation among young and middle-aged stroke patients（n=380）

图1 中青年脑卒中患者的心理社会适应潜在剖面

Figure 1 Potential subtypes of psychosocial adaptation among young and middle-aged stroke patients

表2 自变量赋值情况

Table 2 Assignment of independent variables

表3 中青年脑卒中患者心理社会适应潜在类型与生活质量的广义线性回归分析（n=380）

Table 3 Generalized linear regression analysis of potential subtypes of psychosocial adaptation and quality of life among young and middle-aged stroke patients（n=380）

参考文献 23

[1]	Ekker MS, Boot EM, Singhal AB, et al. Epidemiology,aetiology,and management of ischaemic stroke in young adults[J]. Lancet Neurol, 2018, 17(9):790-801.
[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 on quality of life of patients with initial stroke in Pearl River Delta region and analysis of its influencing factors[D]. Zunyi: Zunyi Medcial College, 2018.
[3]	Schneider S, Taba N, Saapar M, et al. Determinants of long-term health-related quality of life in young ischemic stroke patients[J]. J Stroke Cerebrovasc Dis, 2021, 30(2):105499.
[4]	Londono Y, McMillan DE. Psychosocial adaptation:an evolutionary concept analysis exploring a common multidisciplinary language[J]. J Adv Nurs, 2015, 71(11):2504-2519. DOI PMID
[5]	Gurková E, Štureková L, Mandysová P, et al. Factors affecting the quality of life after ischemic stroke in young adults:a scoping review[J]. Health Qual Life Outcomes, 2023, 21(1):4.
[6]	刘啟, 孙家蓉. 中青年脑卒中患者心理社会适应现状及其影响因素的路径分析[J]. 临床护理杂志, 2024, 23(6):30-35.
	Liu Q, Sun JR. Path analysis of psychosocial adaptation and its influencing factors in young and middle-aged stroke patients[J]. J Clin Nurs, 2024, 23(6):30-35.
[7]	Xiong JM, Su J, Ke QQ, et al. Psychosocial adaptation profiles in young and middle-aged patients with acute myocardial infarction:a latent profile analysis[J]. Eur J Cardiovasc Nurs, 2024, 23(3):267-277.
[8]	Yoon S, Kim HY, Kim SR. A prediction model of health-related quality of life in young adult patients with stroke[J]. J Clin Nurs, 2021, 30(13/14):2023-2035.
[9]	王孟成, 毕向阳. 潜变量建模与Mplus应用-进阶篇[M]. 重庆: 重庆大学出版社,2018:1-15.
	Wang MC, Bi XY. Latent variable modeling and Mplus application-advanced chapter[M]. Chongqing: Chongqing University Press,2018:1-15.
[10]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志. 2019, 52(9):710-715.
	Chinese Medical Association Neurology Branch, Chinese Medical Association Neurology Branch,Cerebrovascular Diseases Group. Diagnostic criteria of cerebrovascular diseases in China(version 2019)[J]. Chin J Neurol, 2019, 52(9):710-715.
[11]	倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4):378-380.
	Ni P, Chen JL, Liu N. The sample size estimation in quantitative nursing research[J]. Chin J Nurs, 2010, 45(4):378-380.
[12]	Derogatis LR. The psychosocial adjustment to illness scale (PAIS)[J]. J Psychosom Res, 1986, 30(1):77-91. DOI PMID
[13]	姚静静. 癌症患者适应水平的横断面调查及其预测因素分析[D]. 上海: 第二军医大学, 2013.
	Yao JJ. Cross-sectional survey of adaptation level of cancer patients and analysis of its predictive factors[D]. Shanghai: Second Military Medical University, 2013.
[14]	Herdman M, Gudex C, Lloyd A, et al. Development and preliminary testing of the new five-level version of EQ-5D(EQ-5D-5L)[J]. Qual Life Res, 2011, 20(10):1727-1736. DOI PMID
[15]	邢亚彬, 马爱霞. 欧洲五维健康量表EQ-5D-5L中文版的信效度研究[J]. 上海医药, 2013, 34(9):40-43.
	Xing YB, Ma AX. Study on reliability and validity of Chinese version of EQ-5D-5L[J]. Shanghai Med Pharm J, 2013, 34(9):40-43.
[16]	Luo N, Liu G, Li MH, et al. Estimating an EQ-5D-5L value set for China[J]. Value Health, 2017, 20(4):662-669. DOI PMID
[17]	Huang HT, Zhang L, Dong WL, et al. Stigma and loneliness among young and middle-aged stroke survivors:a moderated mediation model of interpersonal sensitivity and resilience[J]. J Psychiatr Ment Health Nurs, 2024, 31(4):596-606.
[18]	徐菲. 中青年脑卒中患者心理社会适应的影响因素及路径分析[D]. 新乡: 新乡医学院, 2023.
	Xu F. Influencing factors and path analysis of psychosocial adaptation in young and middle-aged stroke patients[D]. Xin-xiang: Xinxiang Medical University, 2023.
[19]	孙倩倩, 梅永霞, 刘清玄, 等. 中青年脑卒中患者创伤后成长潜在类别及与反刍性沉思和抑郁的关系[J]. 中国慢性病预防与控制, 2024, 32(7):522-526.
	Sun QQ, Mei YX, Liu QX, et al. Potential categories of post-traumatic growth in young and middle-aged stroke patients and their relationship with ruminant meditation and depression[J]. Chin J Prev Contr Chronic Dis, 2024, 32(7):522-526.
[20]	汤诗恒, 林璟珊, 王乙洋, 等. 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. DOI
	Tang SH, Lin JS, Wang YY, et al. Path analysis of quality of life in stroke patients based on structural equation model[J]. Chin J Nurs, 2023, 58(22):2747-2753. DOI
[21]	张傲, 赵培玉, 胡楠楠, 等. 脑卒中患者积极心理体验质性研究的Meta整合[J]. 中华护理杂志, 2022, 57(5):617-624. DOI
	Zhang A, Zhao PY, Hu NN, et al. Positive psychological experience of stroke patients:a qualitative meta-synthesis[J]. Chin J Nurs, 2022, 57(5):617-624.
[22]	朱金凤, 蔡卫新, 陶子荣, 等. 中青年出血性脑卒中患者康复运动依从性现状及其影响因素分析[J]. 中华护理杂志, 2023, 58(5):580-586. DOI
	Zhu JF, Cai WX, Tao ZR, et al. Analysis of rehabilitation exercise compliance and its influencing factors in young and middle-aged patients with hemorrhagic stroke[J]. Chin J Nurs, 2023, 58(5):580-586. DOI
[23]	弓少华, 孙超, 杨姮, 等. 中青年脑卒中患者疾病体验的Meta整合[J]. 中华护理杂志, 2021, 56(6):843-851. DOI
	Gong SH, Sun C, Yang H, et al. The real experience of stroke patients in young and middle-age adults:a qualitative meta-synthesis[J]. Chin J Nurs, 2021, 56(6):843-851.