神经源性肠道功能障碍对脊髓损伤患者生存质量影响的结构方程分析

Influence of neurogenic bowel dysfunction on quality of survival in patients with spinal cord injury:a structural equation analysis

目的通过构建结构方程模型探讨神经源性肠道功能障碍对脊髓损伤患者生存质量的影响及其作用关系。方法采用整群抽样方法,于2021年3月—2022年2月选取上海市4家医院脊髓损伤科患者作为研究对象。调查内容包含一般资料调查表、生存质量测定量表简表、神经源性肠道功能障碍量表、焦虑自评量表和患者积极度量表。采用AMOS 28.0软件构建结构方程模型。结果脊髓损伤患者生存质量总得分为(47.39±10.04),神经源性肠道功能障碍得分为8.00(3.00,11.00)。结构方程模型分析显示,神经源性肠道功能障碍对生存质量有直接消极作用(β=-0.146,P=0.021),并以积极度(β=0.202,P<0.05)、焦虑度(β=-0.007,P<0.05)为中介变量可间接预测生存质量。结论本研究脊髓损伤患者的生存质量水平呈现低水平,神经源性肠道功能障碍负向直接影响患者的生存质量。积极度、焦虑度在神经源性肠道功能障碍与生存质量之间发挥中介作用。医护人员需重视脊髓损伤患者的肠道护理与管理,关注患者的心理状态,提供积极的综合支持。

Objective To investigate the impact of neurogenic bowel dysfunction on the quality of survival in patients with spinal cord injury(SCI)and understand its role through a structural equation model.Methods Using a cluster sampling,patients from the spinal cord injury department of four hospitals in Shanghai were selected as the study subjects from March 2021 to February 2022.Patients were surveyed using the General Information Questionnaire,the World Health Organization Quality of Life-BREF,the Neurogenic Bowel Dysfunction score,and the Self-Rating Anxiety Scale and Patient Activation Measure.A structural equation model was established by using AMOS 28.0.Results The score of the quality of survival for patients with spinal cord injury was 47.39±10.04 and that of neurogenic bowel dysfunction 8.00(3.00,11.00).Structural equation model showed that neurogenic bowel dysfunction had a direct negative effect on the quality of survival(β=-0.146,P=0.021),and indirectly predicted the quality of survival with positivity(β=0.202,P<0.05)and anxiety(β=-0.007,P<0.05)as mediating variables.Conclusion In this study,the quality of survival of SCI patients remains low,and neurogenic intestinal dysfunction negatively and directly affects the quality of survival of patients.Positivity and anxiety play a mediating role between neurogenic intestinal dysfunction and the quality of survival.Positive comprehensive support including intestinal care and management of patients with SCI and the psychological state of patients should be provided.