青年脑卒中病人交流恐惧变化轨迹及预测因素  

Study of change trajectory and predictive factors of communication fear in young stroke patients

作　　者：张滢滢 王海芳[1] 蔡建政 蔡萍[1] 喻伟霞 陆妮妮 牛春燕 ZHANG Yingying;WANG Haifang;CAI Jianzheng;CAI Ping;YU Weixia;LU Nini;NIU Chunyan(The First Affiliated Hospital of Soochow University,Jiangsu 215006 China)

机构地区：[1]苏州大学附属第一医院,江苏215006

出　　处：《护理研究》2023年第21期3820-3825,共6页Chinese Nursing Research

基　　金：苏州市医疗卫生科技创新项目,编号:SKY2022120;苏州市“科教兴卫”青年科技项目,编号:KJXW2020011。

摘　　要：目的:探讨青年脑卒中病人交流恐惧变化轨迹及预测因素,为早期识别高度交流恐惧病人及构建干预策略提供依据。方法:采用便利抽样法,选取2021年6月—2022年10月入住苏州市某三级甲等医院康复医学科、神经内科的青年脑卒中病人,采用交流恐惧自陈量表(PRCA-24)调查病人发病后2周、1个月、3个月的交流恐惧水平,采用潜类别增长模型拟合交流恐惧发展轨迹类型,运用Logistic回归分析不同交流恐惧轨迹的影响因素。结果:识别出“持续高交流恐惧”和“交流恐惧下降”2种轨迹。婚姻状况、脑卒中类型、Barthel指数、焦虑、抑郁、经口摄食功能、嗓音障碍程度等是青年脑卒中病人交流恐惧发展轨迹的影响因素(P<0.05)。与“交流恐惧下降组”相比,完全或部分依赖管饲和存在抑郁、焦虑负性情绪被归属为“持续高交流恐惧”的可能性较大。结论:青年脑卒中病人对交流的恐惧呈现不同的变化轨迹,医务人员应重视完全或部分依赖管饲和存在抑郁、焦虑负性情绪病人的早期吞咽功能康复及心理认知干预。Objective:To explore the change trajectory and predictive factors of communication fear in young stroke patients,and to provide a basis for early identification of patients with high communication fear and construction of intervention strategies.Methods:Young stroke patients,admitted to the Department of Rehabilitation Medicine and Department of Neurology of a tertiary grade A hospital in Suzhou from June 2021 to October 2022 selected using a convenience sampling method,were investigated the level of communication fear at 2 weeks,1 month,and 3 months after the onset of stroke using the Communication Fear Self-Statement Inventory(PRCA-24),and the latent category growth model was used to fit the types of trajectories of communication fear development.Logistic regression was used to analyze the predictors of different trajectories of communication fear.Results:The trajectories of"persistently high fear of communication"and"declining fear of communication"were identified.Marital status,stroke type,self-care ability,anxiety status,depression status,FOIs and GRBAS affected the developmental trajectory of communication fear(P<0.05).Compared with the"declining fear of communication group",full or partial dependence on tube feeding,depression,and negative anxiety were more likely to be classified as"persistently high fear of communication".Conclusion:Young stroke patients have different trajectories of communication fear,and medical professionals should pay attention to early swallowing rehabilitation and psycho-cognitive interventions in patients who are fully or partially dependent on tube feeding and have depression and anxiety.

关 键 词：青年 脑卒中 交流恐惧 焦虑 抑郁 影响因素 潜类别增长模型 变化轨迹 

分 类 号：R473.74[医药卫生—护理学]