Abstract:

Objective To explore the development trajectory of ego depletion in patients with heart failure and analyze the influencing factors，aiming to provide a basis for the implementation of targeted intervention measures. Methods Convenience sampling was adopted to select heart failure patients who were hospitalized in a tertiary hospital in Nanjing from July 2024 to March 2025 as the survey subjects. The general information questionnaire，the Ego-Depletion Scale for Heart Failure Patients，the Symptom Status Questionnaire-Heart Failure，the Perceived Social Support Scale，and the Chinese version of the Distress Disclosure Index were used to collect baseline（T0） data. The Ego-Depletion Scale for Heart Failure Patients was used to assess the ego-depletion level of the patients 1 month（T1），3 months（T2），and 6 months（T3） after discharge. The latent class growth model was used to analyze the change trajectory of ego depletion in heart failure patients，and multiple Logistic regression was used to analyze the influencing factors of different trajectory categories. Results A total of 338 patients were included. During the T1 to T3 periods，20，17，and 14 patients were lost to follow-up respectively. Eventually，a total of 287 patients were included. The ego depletion scores of heart failure patients at the 4 time points were 52.00（42.00，61.00），43.00 （34.00，53.00），40.00（34.00，54.00），39.00（33.00，51.00） points. The 3 subgroups of ego depletion change trajectories were identified： moderate depletion-slow adaptation type（63.07%），moderate depletion-rebound increase type （24.04%），and high depletion-fluctuating improvement type（12.89%）. The results of Logistic regression analysis showed that the number of comorbidities，the level of fatigue or lack of energy and perceived social support were the influencing factors of the ego depletion change trajectory of heart failure patients（all P<0.05）. Conclusion The ego depletion of patients with heart failure shows a gradually decreasing trend in the short term after discharge，but there is a population heterogeneity development trajectory. Healthcare professionals should formulate precise nursing interventions based on the characteristics of these trajectories and the influencing factors，in order to improve the ego depletion level of heart failure patients and enhance their self-management ability.

Key words: Heart Failure, Ego Depletion, Development Trajectory, Analysis of Influence Factors, Nursing Care

摘要：

目的 探讨心力衰竭患者自我损耗的发展轨迹并分析其影响因素，旨在为临床开展针对性干预提供依据。 方法 采用便利抽样法，选取2024年7月至2025年3月在南京市某三级甲等医院住院治疗的心力衰竭患者为调查对象。使用一般资料调查表、心力衰竭患者自我损耗量表、心力衰竭症状状态问卷、领悟社会支持量表及中文版痛苦表露指数收集基线（T0）资料后，于患者出院后1个月（T1）、3个月（T2）及6个月（T3）使用心力衰竭患者自我损耗量表评估其自我损耗水平。运用潜类别增长模型分析心力衰竭患者自我损耗的变化轨迹，采用多元Logistic回归分析不同轨迹类别的影响因素。 结果 T0纳入338例，T1~T3分别失访20、17、14例，最终共纳入287例。心力衰竭患者4个时间点自我损耗得分分别为52.00（42.00，61.00）、43.00（34.00，53.00）、40.00（34.00，54.00）、39.00（33.00，51.00）分。共识别出中损耗-缓慢适应型（63.07%）、中损耗-反弹升高型（24.04%）及高损耗-波动改善型（12.89%）3个自我损耗变化轨迹亚组。Logistic回归分析结果显示，合并症数量、疲劳或精力不足症状得分及领悟社会支持得分是心力衰竭患者自我损耗变化轨迹的影响因素（均P<0.05）。 结论 心力衰竭患者出院后短期内自我损耗总体呈下降趋势，但发展轨迹存在异质性，医护人员应针对轨迹特征及影响因素制订精准的护理措施，以改善其自我损耗水平、提高自我管理能力。

关键词: 心力衰竭, 自我损耗, 发展轨迹, 影响因素分析, 护理