感恩情绪、社会支持和觉知压力对慢性乙型肝炎肝纤维化患者疾病自我管理的影响

Effects of gratitude, social support and perceived stress on disease self-management in patients with chronic hepatitis B liver fibrosis

目的调查慢性乙型肝炎肝纤维化患者疾病自我管理能力的临床现状，分析感恩情绪、社会支持和觉知压力对其的影响路径。方法2016年1月-2017年6月，采用便利抽样法选择广州市红十字会医院诊疗的慢性乙型肝炎肝纤维化患者236例，应用患者一般资料调查表、慢性乙型肝炎抗病毒治疗患者自我管理量表、多维感恩量表（GRAT）、社会支持评定量表和中文版知觉压力量表（CPSS）进行调查，应用PASWStatistics18．0和AMOS18．0软件分析其具体影响路径。结果慢性乙型肝炎肝纤维化患者的疾病自我管理得分为（94．41±16．78）分。相关分析显示，患者感恩情绪、社会支持与疾病自我管理呈正相关（r值分别为0．327、0．339；P〈0．05），知觉压力与疾病自我管理呈负相关（r=0．574，P〈0．05）。多元线性回归分析和模型拟合表明，感恩情绪对疾病自我管理具有直接影响作用（β=0．314），社会支持具有直接影响作用（β=0．354）和间接影响作用（β=0．199），觉知压力具有直接影响作用（β=-O．567）和间接影响作用（β=-O．058）。结论慢性乙型肝炎肝纤维化患者的疾病自我管理能力相对较差，临床医护人员应该培养患者的感恩情绪，调动社会支持力量以及降低知觉压力水平，以改善其疾病管理水平。

Objective To investigate the clinical status of disease self-management ability in patients with chronic hepatitis B liver fibrosis and to analyze the effect of gratitude, social support and perceived stress on the ability. Methods Totally 236 patients with chronic hepatitis B liver fibrosis were selected from Guangzhou Red Cross Hospital by convenient sampling from January 2016 to June 2017 and investigated with the general information questionnaire, the Chronic Hepatitis B Self-Management Scale, the Gratitude Resentment and Appreciation Test （GRAT）, the Social Support Rating Scale and the Perceived Stress Scale-Chinese （CPSS）. PASW Statistics 18.0 and AMOS 18.0 were used to analyze the effects. Results The disease self-management score in patients with chronic hepatitis B liver fibrosis was （94.41 ± 16.78）. According to correlation analysis, gratitude, social support and perceived stress were positively correlated with disease self-management （r=0.327, 0.339; P 〈 0.05） ; while perceived stress was negatively correlated with disease self-management （r=-0.574, P 〈 0.05）. The multiple linear regression analysis and model fitting showed that gratitude had direct effect on disease self-management （β=0.314） ; social support had direct influence （β=0.354） and indirect （β=0.199） effect on it; and perceived stress bad direct （β=-0.567） and indirect （β=-0.058） on it. Conclusions The patients with chronic hepatitis B liver fibrosis show a relatively poor disease self-management ability. Clinical medical and nursing staff shall cultivate the patients＇ gratitude, mobilize their social support, reduce their perceived stress and improve their disease self-management ability.