成人急性白血病患者化疗期间心理弹性的变化轨迹及影响因素研究

doi:10.3761/j.issn.0254-1769.2026.06.003

摘要/Abstract

摘要：

目的探究成人急性白血病患者化疗期间心理弹性的变化轨迹，并分析相关影响因素，为制订针对性的心理干预策略提供依据。方法采用便利抽样法，选取2023年1月—2024年8月新疆维吾尔自治区某三级甲等医院血液肿瘤科收治的260例成人急性白血病患者作为调查对象。在首次化疗入院第1天，采用心理弹性量表、正性负性情绪量表、领悟社会支持量表、简易版疾病认知问卷、医学应对方式问卷进行调查，并在化疗后第1、3、6个月时采用心理弹性量表再次评估患者的心理弹性。使用群组轨迹模型识别患者心理弹性的变化轨迹，运用多分类Logistic回归分析其影响因素。结果共244例患者完成随访。通过群组轨迹模型分析，识别出高心理弹性上升组（36.5%）、中心理弹性平稳组（39.3%）、低心理弹性组（14.8%）和心理弹性脆弱组（9.4%）4种变化轨迹。多分类Logistic回归分析结果显示，正性或负性情绪、社会支持水平、疾病认知水平、医学应对方式是成人急性白血病患者化疗期间心理弹性变化轨迹的影响因素（P<0.05）。结论成人急性白血病患者化疗期间的心理弹性存在4种变化轨迹，医护人员应根据其影响因素制订针对性的心理干预策略，以提升患者的心理弹性和生活质量。

关键词: 急性白血病, 化疗, 心理弹性, 纵向研究, 影响因素分析, 肿瘤护理

Abstract:

Objective This study aimed to investigate the trajectories of psychological resilience among adult patients with acute leukemia during chemotherapy and to identify influencing factors，in order to provide evidence for targeted psychological intervention strategies. Methods A total of 260 adult patients confirmed acute leukemia who received chemotherapy at Department of Hematology and Oncology of a tertiary hospital in XinJiang between January 2023 and August 2024 were enrolled using convenience sampling method. Data on psychological resilience，positive and negative emotion，perceived social support，illness perception，and medical coping styles were collected at the initiation of chemotherapy. Psychological resilience was reassessed at 1，3，and 6 months after chemotherapy. A group-based trajectory modeling（GBTM） was used to identify distinct trajectories of psychological resilience，and multinomial logistic regression was performed to explore the influencing factors. Results A total of 244 patients completed the follow-up. 4 trajectories of psychological resilience with GBTM were identified，high resilience-increasing group（36.5%），moderate-stable group（39.3%），low resilience group（14.8%），and resilience-vulnerable group（9.4%）. Multinomial logistic regression analysis revealed that positive and negative affect，level of social support，illness perception，and medical coping styles were significant influencing factors for the trajectory of psychological resilience during chemotherapy（P<0.05）. Conclusion There are 4 distinct psychological resilience trajectories among adult patients with acute leukemia during chemotherapy. Healthcare professionals should develop targeted psychological interventions based on the identified influencing factors to enhance patients’ psychological resilience and improve their quality of life.

Key words: Acute Leukemia, Chemotherapy, Psychological Resilience, Longitudinal Study, Root Cause Analysis, Oncology Nursing

朱静, 孙艳, 司惠芳, 李秀娟, 加米娜·瓦合甫, 常海霞. 成人急性白血病患者化疗期间心理弹性的变化轨迹及影响因素研究[J]. 中华护理杂志, 2026, 61(6): 741-748.

ZHU Jing, SUN Yan, SI Huifang, LI Xiujuan, GAMINA Wahefu, CHANG Haixia. Change trajectory and influencing factors of psychological resilience in adult patients with acute leukemia during chemotherapy[J]. Chinese Journal of Nursing, 2026, 61(6): 741-748.

图/表 4

表1 调查对象的一般资料及化疗期间心理弹性变化轨迹的单因素分析结果

Table 1 The general information of survey subjects and univariate analysis of the trajectory of psychological resilience changes during chemotherapy

表2 成人急性白血病患者化疗期间的心理弹性变化轨迹模型拟合结果

Table 2 Model fitting index results of psychological resilience trajectories in adult leukemia patients during chemotherapy

图1 成人急性白血病患者化疗期间的心理弹性变化轨迹注：T1为首次化疗入院第1天；T2为化疗后第1个月；T3为化疗后第3个月；T4为化疗后第6个月。

Figure 1 Trajectory of psychological resilience in adult leukemia patients during chemotherapy

表3 成人急性白血病患者化疗期间心理弹性变化轨迹的多分类Logistic回归分析（n=244）

Table 3 Multivariate Logistic regression analysis of psychological resilience trajectories in adult leukemia patients during chemotherapy（n=244）

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