基于潜类别增长模型分析首发脑卒中患者创伤后成长发展轨迹

Posttraumatic growth development trajectory of first stroke patients based on latent class growth model

目的调查首发脑卒中患者创伤后成长水平,分析其动态发展轨迹。方法采用便利抽样法,选取2022年1-12月在新乡市中心医院住院的180例脑卒中患者为研究对象,在发病第1个月末(M_(1))第2个月末(M_(2))第3个月末(M_(3))第4个月末(M_(4))第5个月末(M_(5))第6个月末(M_(6))动态评估创伤后成长(PTGI)评分,采用潜类别增长模型(LCGM)分析其发展轨迹类别,采用多因素Logistic回归分析脑卒中患者创伤后成长轨迹类别的影响因素。结果本研究共发放问卷180份,回收有效问卷177份,问卷有效回收率为98.33%(177/180)。6个月内患者PTGI得分逐渐升高,M,时PTGI得分最低,为(29.11±5.65)分,低水平成长比例最高,占85.31%(151/177);M_(6)时PTGI得分为(42.14±13.04)分,低水平成长比例为40.68%(72/177)。识别出持续低成长型和成长改善型2个创伤后成长潜在类别,其中持续低成长型72例、成长改善型105例。性别(OR=2.648,P=0.008)年龄(OR=1.055,P=0.002)文化程度(OR=6.403,P<0.001)脑卒中类型(OR=2.863,P=0.014)是脑卒中患者创伤后成长轨迹类别差异的影响因素。结论脑卒中患者创伤后成长是一个动态变化状态,整体水平不高,且持续低成长型较为普遍。不同创伤后成长轨迹类别患者社会人口学和疾病特征存在差异,可为临床护理策略制订提供参考,但需要进一步研究。

Objective To explore the posttraumatic growth of first stroke patients and analyze its dynamic development trajectory.Methods From January to December 2022,180 stroke patients admitted to Xinxiang Central Hospital were selected as research subjects by convenience sampling.The Posttraumatic Growth Inventory(PTGI)score was dynamically evaluated at the end of the first month(M_(1)),second month(M_(2)),third month(M_(3)),fourth month(M_(4)),fifth month(M_(5)),and sixth month(M_(6))of onset.The latent class growth model(LCGM)was used to analyze the developmental trajectory categories,and multiple Logistic regression was used to analyze the influencing factors of posttraumatic growth trajectory categories.Results A total of 180 questionnaires were distributed,and 177 valid questionnaires were collected,with a valid response rate of 98.33%(177/180).Within six months,the patient's PTGI score gradually increased,with the lowest PTGI score(29.11±5.65)at M,and the highest proportion of low-level growth,accounting for 85.31%(151/177).At Me,the PTGI score was(42.14±13.04),and the proportion of low-level growth was 40.68%(72/177).Two latent categories of posttraumatic growth,namely sustained low growth type and growth improvement type,were identified,with 72 cases of sustained low growth type and 105 cases of growth improvement type.Gender(OR=2.648,P=0.008),age(OR=1.055,P=0.002),education level(OR=6.403,P<0.001),and stroke type(OR=2.863,P=0.014)were the influencing factors for posttraumatic growth trajectories among stroke patients.Conclusions Post traumatic growth in stroke patients is a dynamic state of change,with low overall levels and a common type of sustained low growth.There may be differences in the sociodemographic and disease characteristics of patients with different types of posttraumatic growth trajectories,providing reference for the development of clinical nursing strategies,but further research is still needed.