脊髓损伤患者认知功能的影响因素分析

doi:10.3761/j.issn.0254-1769.2021.07.010

摘要/Abstract

摘要：

目的通过构建结构方程模型分析各因素对脊髓损伤患者认知功能的影响路径。方法采用便利抽样法,于2019年10月—2020年11月选取安徽省8所三级甲等综合医院的357例脊髓损伤患者作为研究对象。采用一般情况调查问卷、长沙版蒙特利尔认知评估量表、汉密顿抑郁量表、康复锻炼自我效能量表、社会支持评定量表、Piper疲乏修订量表、匹兹堡睡眠指数量表对其进行调查,运用结构方程模型分析各影响因素的作用路径。结果抑郁程度、自我效能水平、疲乏程度、睡眠质量、社会支持程度通过不同路径对患者认知功能产生影响,其中抑郁程度负向影响认知功能,直接、间接效应分别为-0.245、-0.282;自我效能水平正向影响认知功能,直接、间接效应分别为0.503、0.012;疲乏程度负向影响认知功能,直接效应为-0.131;睡眠质量负向影响认知功能,直接、间接效应分别为-0.353、-0.210;社会支持程度正向影响认知功能,直接、间接效应分别为0.110、0.874。结论脊髓损伤患者认知功能受到多个因素的交互影响,医护人员在临床工作中需要重视对患者认知功能及其影响因素的评估,并及时针对影响因素采取有效措施以提高患者的认知功能。

关键词: 脊髓损伤, 认知功能, 影响因素, 心理护理

Abstract:

Objective To construct a structural equation model of cognitive function of patients with spinal cord injury（SCI） and its influencing factors,and to analyze the path of action of each factor on the cognitive function of SCI patients,so as to provide a basis for targeted cognitive function intervention programs. Methods From October 2019 to November 2020,the convenience sampling method was adopted to include 357 patients with SCI from 8 tertiary hospitals in Anhui Province. The General Situation Questionnaire,the Montreal Congnitive Assessment,and Hamilton Depression Table,Self-Efficacy Rehabilitation Outcome Scale,Social Support Rating Scale,the Revised Piper Fatigtle Scale,Pittsburgh Sleep Index Scale were employed,and a structural equation model was used to analyze the path of action of each influencing factor. Results Depression,self-efficacy,fatigue,sleep,and social support all affect the cognitive function of patients through different pathways. Depression negatively affects cognitive function with the direct and indirect effects of -0.245 and -0.282 respectively;self-efficacy positively affects cognitive function with the direct and indirect effects of 0.503 and 0.012,respectively;fatigue negatively affects cognitive function with a direct effect of -0.131;sleep negatively affects cognitive function with the direct and indirect effects of -0.353 and -0.210,respectively;social support positively affects cognitive function with direct and indirect effects of 0.110 and 0.874,respectively. Conclusion The cognitive function of patients with SCI is affected by the interaction of multiple factors. Medical staff should pay attention to the evaluation of the patient’s cognitive function and its influencing factors in clinical work,and take effective measures to improve the patient’s cognitive function in time.

Key words: Spinal Cord Injury, Cognitive Function, Influencing Factors, Psychological Nursing

廖晨霞,李伦兰,戴晴,刘静,祁金梅,汪晶,高馨,黄慧,袁昊炜. 脊髓损伤患者认知功能的影响因素分析[J]. 中华护理杂志, 2021, 56(7): 1015-1022.

LIAO Chenxia,LI Lunlan,DAI Qing,LIU Jing,QI Jinmei,WANG Jing,GAO Xin,HUANG Hui,YUAN Haowei. Influencing factors analysis of cognitive function in patients with spinal cord injury[J]. Chinese Journal of Nursing, 2021, 56(7): 1015-1022.

图/表 7

表1 调查对象的一般资料（n=357）

Table 1 General information of the research objects（n=357）

表2 脊髓损伤患者长沙版蒙特利尔认知评估量表总分及各维度得分情况

Table 2 The scores of each dimension of Montreal Con-gnitive Assessment in patients with spinal cord injury

表3 脊髓损伤患者认知功能与其影响因素的相关性分析（r值）

Table 3 Correlation analysis among influencing factors of cognitive function in patients with spinal cord injury（r value）

表4 结构方程模型的适配度检验结果（n=357）

Table 4 Test result of fit degree of structural equation model（n=357）

图1 脊髓损伤患者认知功能影响因素结构方程模型图

Fig 1 Structural equation model diagram of factors affecting cognitive function in patients with spinal cord injury

表5 脊髓损伤患者认知功能影响因素间的路径分析

Table 5 Path analysis of factors affecting cognitive function in patients with spinal cord injury

表6 抑郁程度、自我效能水平、疲乏程度、睡眠质量、社会支持程度对脊髓损伤患者认知功能影响的标准化效应

Table 6 Standardized effects of depression,self-efficacy, fatigue,sleep and social support on the cognitive function of patients with spinal cord injury

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