膝关节假体周围感染患者就医决策历程的质性研究

doi:10.3761/j.issn.0254-1769.2026.08.013

摘要/Abstract

摘要：

目的探索膝关节假体周围感染患者的就医决策历程，为帮助患者就医决策提供参考。方法采用目的抽样法，于2025年8—9月选取在浙江省杭州市某三级甲等综合医院骨科关节病区住院的11例膝关节假体周围感染术后患者进行半结构式访谈，采用Colaizzi 7步分析法进行资料分析。结果共提炼出4个主题和12个亚主题：初感不适与问题觉察阶段（身体症状的反复出现、心理担忧与归因困惑、自我处理与信息局限、医患信息不对称的影响），就医决策与诊断确立阶段（焦虑情绪与就诊驱动、诊断困难与就医后转诊），确诊后的治疗决策与应对阶段（信息搜集与决策依据、治疗选择中的心理权衡），康复期反思与行为调整阶段（基于经验的康复行为改善、对既往就医决策的反思、康复过程中的身心挑战、创伤记忆影响下的满意度与持续警觉）。结论膝关节假体周围感染患者就医决策过程复杂，其症状判断、就医选择及最终决策需求明显。建议提供清晰症状管理手册，建立便捷沟通渠道，开发决策辅助工具，设定阶段性康复目标并建立全程化心理支持体系，进一步优化医疗资源配置，满足患者的就医决策需求。

关键词: 膝关节骨性关节炎, 假体周围感染, 就医决策, 质性研究, 护理

Abstract:

Objective To explore the healthcare decision-making journey of patients with periprosthetic joint infection（PJI） after knee arthroplasty，and to provide references for facilitating patients’ decision-making processes. Methods Using purposive sampling，11 patients with postoperative knee PJI hospitalized in the orthopedic joint ward of a tertiary general hospital in Hangzhou，Zhejiang Province were selected for semi-structured in-depth interviews from August to September 2025. Data were analyzed using the Colaizzi seven-step analysis method. Results Totally 4 main themes and 12 sub-themes were identified：the initial stage of discomfort and problem awareness（repeated physical symptoms，psychological concerns and attribution confusion，self-handling and information limitations，the impact of doctor-patient information asymmetry），the stage of medical decision-making and diagnosis establishment（anxiety and visit motivation，difficulty in diagnosis and referral after visit），the stage of treatment decision-making and response after diagnosis（information collection and decision basis，psychological weighing in treatment choice），and the stage of reflection during the recovery period and behavioral adjustment（improvement of rehabilitation behaviors based on experience，reflection on previous medical decisions，physical and mental challenges during the recovery process，satisfaction and continuous vigilance under the influence of traumatic memories）. Conclusion The healthcare decision-making process for knee PJI patients is complex，with distinct needs in symptom assessment，healthcare choices，and final decision-making. Recommendations include providing clear symptom management guidelines，establishing efficient communication channels，developing decision aids，setting phased rehabilitation goals，and implementing comprehensive psychological support systems to optimize medical resource allocation and address patients’ decision-making needs.

Key words: Knee Osteoarthritis, Periprosthetic Joint Infection, Medical Decision-Making, Qualitative Research, Nursing Care

许国萍, 胡欢婷, 李丽, 金静芬, 蒋佳奖, 任英. 膝关节假体周围感染患者就医决策历程的质性研究[J]. 中华护理杂志, 2026, 61(8): 1101-1106.

XU Guoping, HU Huanting, LI Li, JIN Jingfen, JIANG Jiajiang, REN Ying. A qualitative study on the medical decision-making process of patients with periprosthetic joint infection of the knee[J]. Chinese Journal of Nursing, 2026, 61(8): 1101-1106.

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