脑卒中患者自我管理行为潜在剖面及其影响因素分析

Analysis of the Latent Profile and Influencing Factors of Self-management Behaviors in Stroke Patients

目的分析脑卒中患者自我管理行为潜在类别,并探究不同类别的影响因素。方法选取2023年1月至2023年12月在成都市两家三级甲等医院就诊的362例首发脑卒中患者为研究对象,收集患者一般资料,并通过卒中健康知识量表、慢病管理自我效能量表、卒中自我管理行为量表进行相关现状调查。采用Mplus 8.0软件对卒中患者自我管理行为进行潜在分类,并通过Logistic回归分析明确各类别的相关影响因素。结果共纳入362例患者,最终识别出3种自我管理行为的潜在组别,分别为中水平-用药管理不良组(7%,n=24)、中水平-情绪管理不佳组(24%,n=84)和高水平-生活习惯良好组(69%,n=254)。二元Logistic回归分析结果表明,独居(OR=0.368,95%CI:0.144~0.938)是自我管理行为的危险因素,BI指数较高(OR=1.013,95%CI:1.004~1.022)、卒中健康知识得分较高(OR=1.092,95%CI:1.033~1.154)和慢病管理自我效能得分较高(OR=1.058,95%CI:1.003~1.117)是自我管理行为的保护因素。结论脑卒中患者自我健康管理行为存在3种不同类别,且受多种因素影响;医务人员应从整体考虑,对不同自我管理行为特征的脑卒中患者开展个性化干预,以改善其生活质量。

Objective To analyze the latent classes of self-management behaviors in stroke patients and explore the influencing factors of different classes.Methods A total of 362 first-episode stroke patients in two tertiary grade A hospitals in Chengdu from January 2023 to December 2023 were selected as the study objects.The general data of patients were collected.Stroke health knowledge questionnaire,Self-efficacy for Managing Chronic Disease,and stroke self-management behavior scale were used for the investigation.Mplus 8.0 was used to classify the self-management behaviors of stroke patients.And Logistic regression analysis was used to analyze the relevant influencing factors of each class.Results A total of 362 patients were included,and three latent classes of self-management behaviors were identified:moderate self-health management level with poor medication management(7%,n=24),moderate self-health management level with poor emotional management(24%,n=84),and relatively good self-health management level with good disease management(69%,n=254).Binary Logistic regression analysis showed that living alone(OR=0.368,95%CI:0.144-0.938)was a risk factor for self-management behaviors,while higher Barthel Index(BI)(OR=1.013,95%CI:1.004-1.022),higher stroke health knowledge score(OR=1.092,95%CI:1.033-1.154),and higher chronic disease management self-efficacy score(OR=1.058,95%CI:1.003-1.117)were protective factors for self-management behaviors.Conclusion There are three different classes of self-health management behaviors in stroke patients,which are affected by multiple factors.Medical staff should consider the overall situation and provide personalized interventions for stroke patients with different characteristics of selfmanagement behavior to improve their quality of life.