基于有调节的中介效应分析缺血性脑卒中患者神经功能和生命质量的关系  

The relationship between neurological function and quality of life in patients with ischemic stroke based on the mediated effect of regulation

作　　者：宋爱峰 万崇华 张惠婷 潘海燕 SONG Ai-feng;WAN Chong-hua;ZHANG Hui-ting;PAN Hai-yan(Department of epidemiology and health statistics,Guangdong Medical University,Dongguan,Guangdong 523808,China;不详)

机构地区：[1]广东医科大学流行病与卫生统计学教研室,广东东莞523808 [2]广东医科大学人文与管理学院 [3]广东医科大学附属医院神经内科

出　　处：《现代预防医学》2023年第12期2276-2283,共8页Modern Preventive Medicine

基　　金：国家自然科学基金(81402771,71373058)。

摘　　要：目的 探究缺血性脑卒中患者神经功能与生命质量的作用关系中,残疾程度的中介效应及自理能力的调节效应。方法 2021年9月至2022年3月,采用便利抽样法选取广东医科大学附属医院收治的187例缺血性脑卒中患者为研究对象。使用一般情况调查问卷、神经功能缺损评分量表(National Institute of Health Stroke Scale, NIHSS)、改良兰金量表(Modified Rankin Scale, mRS)、日常生活基本活动量表(Barthel Index, BI)、脑卒中生命质量测定量表(Quality of Life Instruments for Chronic Diseases-Stroke, QLICD-ST)分别调查患者的社会人口学情况、神经功能损害程度、预后神经功能独立性、自理能力水平以及生命质量主观感受,利用PROCESS 4.1分析中介效应和调节效应。结果 (1)NIHSS、mRS、BI和QLICD-ST之间呈显著相关(r=0.71,-0.61,-0.44,-0.62,-0.41,0.52,P<0.01)。(2)神经功能缺损程度越大,缺血性脑卒中患者生命质量越低(β=-4.20,P<0.01),残疾程度起到了中介作用(β=-2.71,P<0.05)。(3)自理能力能够调节中介效应的前半段及后半段路径(β=0.18,P<0.001;β=-2.83,P<0.01),其中高自理能力者的中介效应更显著(β=-3.48,95%CI:-6.62~-0.72)。结论 神经功能缺损程度与缺血性脑卒中患者的生命质量呈现负相关,还通过残疾对其产生间接影响。自理能力调节了残疾的中介作用,应给予缺血性脑卒中患者残疾和自理方面更多的帮助和关注,从而有效提高其生命质量。Objective To explore the mediating effect of disability and the moderating effect of self-care in the relationship between neurological function and quality of life in patients with ischemic stroke.Methods From September 2021 to March 2022,187 patients with ischemic stroke treated in the Affiliated Hospital of Guangdong Medical University were selected as the research objects by convenient sampling method.The general situation questionnaire,National Institute of Health Stroke Scale(NIHSS),modified Rankin Scale(mRS),Barthel Index(BI)and Quality of Life Instruments for Chronic Diseases-Stroke(QLICD-ST)were used to investigate patients'social demographic profile,degree of neurological impairment,prognosis neurological functional independence,level of self-care and subjective perception of quality of life,respectively.The PROCESS 4.1 was used to analyze the mediating and moderating effects.Results There was a significant correlation between NIHSS,mRS,BI and QLICD-ST(r=0.71,-0.61,-0.44,-0.62,-0.41,0.52,P0.01).The greater the degree of neurological deficit,the lower the quality of life of patients with ischemic stroke(β=-4.20,P<0.01).The degree of disability played a mediating role(β=-2.71,P0.05).Self-care ability could moderate the first half and second half of the mediating pathway(β=0.18,P0.001;β=-2.83,P<0.01),while the mediating effect was more significant for those with high self-care ability(β=-3.48,95%CI:-6.62--0.72).Conclusion The degree of neurological deficits is negatively correlated with the quality of life of patients with ischemic stroke,but also indirectly impact them through the disability.Self-care moderated the mediating role of disability,and more help and attention should be given to ischemic stroke patients in terms of disability and self-care,so as to effectively improve their quality of life.

关 键 词：缺血性脑卒中 生命质量 神经功能 残疾程度 自理能力 

分 类 号：R743.3[医药卫生—神经病学与精神病学]