心力衰竭患者自我损耗潜在类别及其对自我管理行为的影响研究

doi:10.3761/j.issn.0254-1769.2025.16.002

摘要/Abstract

摘要：

目的探究心力衰竭患者自我损耗潜在类别特征，分析不同潜在类别对患者自我管理行为的影响。方法便利选取2024年4—10月在南京市某三级甲等综合医院住院的心力衰竭患者280例作为调查对象，采用一般资料调查表、心力衰竭患者自我损耗量表、心力衰竭患者自我管理量表及慢性疾病自我效能感量表进行调查。探索心力衰竭患者自我损耗的潜在剖面类别，并通过单因素分析、多元Logistic回归分析等探讨不同潜在剖面的影响因素及各类别对患者自我管理水平的影响。结果 255例心力衰竭患者自我损耗可分为3个潜在剖面，包括自适应低损耗组（35.29%）、症状困扰中损耗组（43.53%）、社会生活改变高损耗组（21.18%）。多元Logistic回归分析结果显示，居住地、主要照顾者、文化程度、心功能分级及自我效能得分是心力衰竭患者自我损耗潜在剖面分类的影响因素（P<0.05）。不同自我损耗潜在剖面类别的患者自我管理得分比较，差异有统计学意义（P<0.05）。结论心力衰竭患者的自我损耗水平较高且具有明显的异质性，医护人员应及时关注患者自我损耗异质性特征及其影响因素，制订个性化的干预策略，以缓解患者的自我损耗，提高其自我管理能力。

关键词: 心力衰竭, 自我损耗, 潜在剖面分析, 自我管理行为, 影响因素分析, 护理

Abstract:

Objective To explore the characteristics of latent profiles of ego depletion in patients with heart failure，and analyze the impacts of these profiles on patients’ self-management behavior. Methods 280 heart failure patients who were hospitalized in a tertiary grade A hospital were conveniently selected in Nanjing from April to October 2024 as study subjects. The investigation utilized a general information questionnaire，the Ego-Depletion Scale for Heart Failure Patients，the Self-Management Scale of Heart Failure Patients，and the Chronic Disease Self-Efficacy Scale. The latent profile categories of ego depletion was explored in heart failure patients. Univariate analysis and multiple Logistic regression analysis were used to investigate the influencing factors of different latent profile categories and the impact of each category on patients’ self-management levels. Results The ego depletion of 255 heart failure patients could be classified into 3 latent profiles：self-adaptive low depletion group（35.29%），symptom distressed moderate depletion group（43.53%），and social life change high depletion group（21.18%）. Multiple Logistic regression analysis showed that residence，primary caregiver，education level，New York Heart Association cardiac function grade，and self-efficacy score were factors influencing the potential profile of ego depletion in heart failure patients（P<0.05）. The comparison of self-management scores among patients in different latent profiles of ego depletion showed statistically significant differences（P<0.05）. Conclusion The level of ego depletion in patients with heart failure is high with significant heterogeneity. Medical staff should pay attention to the heterogeneity and influencing factors of ego depletion in patients with heart failure in time，and develop personalized comprehensive intervention strategies to alleviate ego depletion and improve their self-management levels.

Key words: Heart Failure, Ego Depletion, Latent Profile Analysis, Self-Management Behavior, Root Cause Analysis, Nursing Care

陶秀, 高敏, 吴凡, 孙姝怡, 卢静, 温高芹, 王琴, 孙国珍. 心力衰竭患者自我损耗潜在类别及其对自我管理行为的影响研究[J]. 中华护理杂志, 2025, 60(16): 1933-1940.

TAO Xiu, GAO Min, WU Fan, SUN Shuyi, LU Jing, WEN Gaoqin, WANG Qin, SUN Guozhen. Latent profile analysis of ego depletion in patients with heart failure and its influence on self-management behavior[J]. Chinese Journal of Nursing, 2025, 60(16): 1933-1940.

图/表 6

表1 心力衰竭患者的一般资料及自我损耗潜在剖面的单因素分析[例（百分比，%）]

Table 1 General data and univariate analysis of potential profiles of ego depletion in patients with heart failure [cases（percentage，%）]

表2 心力衰竭患者自我损耗潜在剖面模型拟合指标（n=255）

Table 2 Potential profile model fitting index for ego depletion in heart failure patients（n=255）

图1 心力衰竭患者自我损耗3个潜在剖面的特征分布

Figure 1 Characteristic distribution of 3 potential profiles of ego depletion inpatients with heart failure

表3 变量赋值方式

Table 3 Assignment of variables

表4 心力衰竭患者自我损耗潜在剖面影响因素的多元Logistic回归分析

Table 4 Multivariate Logistic analysis of factors influencing the potential profiles of ego depletion in patients with heart failure

表5 心力衰竭患者自我损耗不同亚组的自我管理得分比较[分，M（P25，P75）]

Table 5 Comparison of the self-management scores of heart failure patients with different potential profiles of ego depletion[scores，M（P25，P75）]

参考文献 22

[1]	中华医学会心血管病学分会, 中国医师协会心血管内科医师分会, 中国医师协会心力衰竭专业委员会, 等. 中国心力衰竭诊断和治疗指南2024[J]. 中华心血管病杂志, 2024, 52(3):235-275.
	Chinese Society of Cardiology of Chinese Medical Association,Chinese College of Cardiovascular Physician, Chinese Heart Failure Association of Chinese Medical Doctor Association, et al. Chinese guidelines for the diagnosis and treatment of heart failure 2024[J]. Chin J Cardiol, 2024, 52(3):235-275.
[2]	安嬿. 慢性心力衰竭患者社会隔离现状及其影响因素研究[D]. 济南: 山东大学, 2021.
	An Y. Study on the current situation and influencing factors of social isolation in patients with chronic heart failure[D]. Jinan: Shandong University, 2021.
[3]	Baumeister RF. Self-regulation,ego depletion,and inhibition[J]. Neuropsychologia, 2014, 65:313-319. DOI PMID
[4]	秦叶兰, 韦荣泉, 梁湘, 等. 慢性疼痛病人自我损耗的研究进展[J]. 护理研究, 2023, 37(22):4038-4042.
	Qin YL, Wei RQ, Liang X, et al. Research progress on ego-depletion in patients with chronic pain[J]. Chin Nurs Res, 2023, 37(22):4038-4042.
[5]	Li XM, Gao Q, Sun LX, et al. Effect of self-control on health promotion behavior in patients with coronary heart disease:mediating effect of ego-depletion[J]. Psychol Health Med, 2022, 27(6):1268-1276.
[6]	尹奎, 彭坚, 张君. 潜在剖面分析在组织行为领域中的应用[J]. 心理科学进展, 2020, 28(7):1056-1070. DOI
	Yin K, Peng J, Zhang J. The application of latent profile analysis in organizational behavior research[J]. Adv Psychol Sci, 2020, 28(7):1056-1070. DOI
[7]	施小青, 曹伟新, 吴蓓雯, 等. 心力衰竭病人自我管理量表的初步构建[J]. 护理研究, 2012, 26(35):3347-3350.
	Shi XQ, Cao WX, Wu BW, et al. Preliminary construction of self-management scale of heart failure patients[J]. Chin Nurs Res, 2012, 26(35):3347-3350.
[8]	Lorig KR, Sobel DS, Ritter PL, et al. Effect of a self-management program on patients with chronic disease[J]. Eff Clin Pract, 2001, 4(6):256-262. PMID
[9]	董晓雨. 慢性心衰患者自我调节疲乏现状及其影响因素研究[D]. 济南: 山东大学, 2023.
	Dong XY. The self-regulatory fatigue and associated factors in patients with chronic heart failure[D]. Jinan: Shandong University, 2023.
[10]	孟庆丽, 郭凯. 慢性心力衰竭患者自我调节疲劳现状及其影响因素分析[J]. 实用心脑肺血管病杂志, 2024, 32(7):26-30.
	Meng QL, Guo K. Self-regulatory fatigue status and its influencing factors in patients with chronic heart failure[J]. Pract J Card Cereb Pneumal Vasc Dis, 2024, 32(7):26-30.
[11]	樊欣娜, 李萍, 陈金良, 等. 慢性心力衰竭患者心身症状综合征、焦虑抑郁状态和影响因素分析[J]. 中国循证心血管医学杂志, 2022, 14(1):42-45.
	Fan XN, Li P, Chen JL, et al. Psychosomatic symptom syndrome,anxiety,depression and influence factors in patients with chronic heart failure[J]. Chin J Evid Based Cardiovasc Med, 2022, 14(1):42-45.
[12]	刘博文, 王珊珊, 孙倩倩, 等. 脑卒中患者及其配偶二元心理资本的潜在剖面分析及护理对策[J]. 中华护理杂志, 2025, 60(3):332-339.
	Liu BW, Wang SS, Sun QQ, et al. Latent profile analysis of dyadic psychological capital among stroke patients and their spouses and nursing countermeasures[J]. Chin J Nurs, 2025, 60(3):332-339.
[13]	Honda N, Shiroshita Y, Miyazaki A, et al. Factors associated with cancer disclosure in adolescent and young adult cancer survivors:an integrative review from the social-ecological model perspective[J]. Eur J Oncol Nurs, 2024, 69:102542.
[14]	付逗, 张丽丽, 王鑫梅, 等. 老年共病患者心理危机自我表露阻碍和促进因素的质性研究[J]. 护理学杂志, 2024, 39(5):83-86.
	Fu D, Zhang LL, Wang XM, et al. A qualitative study of impediments and facilitators to self-expression of psychological crisis in the elderly multimorbidity[J]. J Nurs Sci, 2024, 39(5):83-86.
[15]	Shan YW, Lu HY, Liu XY, et al. Predictors of self-regulation fatigue patterns in patients before total knee arthroplasty:a cross-sectional study[J]. Geriatr Nurs, 2024, 55:21-28.
[16]	Ji XF, Yu HY. Factors associated with self-regulatory fatigue in Chinese older patients with coronary heart disease:a cross-sectional survey[J]. Patient Prefer Adherence, 2023, 17:941-949.
[17]	孙姝怡, 孙国珍, 高敏, 等. 心力衰竭患者心理资源损耗与恢复过程的质性研究[J]. 中华护理杂志, 2024, 59(6):706-712. DOI
	Sun SY, Sun GZ, Gao M, et al. The process of mental resource depletion and recovery in patients with heart failure:a qualitative research[J]. Chin J Nurs, 2024, 59(6):706-712.
[18]	Kühnel J, Bledow R, Feuerhahn N. When do you procrastinate? Sleep quality and social sleep lag jointly predict self-regulatory failure at work[J]. J Organ Behavior, 2016, 37(7):983-1002.
[19]	Lin CH, Zhang FZ, Yang FF, et al. Factors influencing self-regulatory fatigue in patients undergoing chemotherapy for gynecologic cancer:a cross-sectional study[J]. Front Psychiatry, 2024, 15:1273151.
[20]	王清玉, 林征, 雷阳, 等. 炎症性肠病患者恐惧疾病进展潜在类别的影响因素分析及护理启示[J]. 中华护理杂志, 2024, 59(3):308-316. DOI
	Wang QY, Lin Z, Lei Y, et al. Influencing factors and nursing enlightenment of the fear of progression in patients with inflammatory bowel disease:a latent profile analysis[J]. Chin J Nurs, 2024, 59(3):308-316.
[21]	沈支佳, 陈新宇, 钱志杰, 等. 反复低血糖患者血糖管理行为退化特征的混合研究[J]. 中华护理杂志, 2024, 59(9):1043-1050.
	Shen ZJ, Chen XY, Qian ZJ, et al. Behavioral characteristics of patients with recurrent hypoglycemia in the degeneracy of blood glucose management:a mixed-methods study[J]. Chin J Nurs, 2024, 59(9):1043-1050.
[22]	张振铎. 帮助行为对职业发展的影响路径及实证研究[D]. 哈尔滨: 哈尔滨工业大学, 2021.
	Zhang ZD. Research on the influences of helping behavior on career development and empirical studies[D]. Harbin: Harbin Institute of Technology, 2021.