理性评估与意义建构的整合：OSAHS患者CPAP治疗依从性双路径驱动模型的理论构建

Integration of Rational Assessment and Meaning Construction: Theoretical Construction of a Dual-Path-Driven Model for CPAP Treatment Compliance in OSAHS Patients

摘要: 持续气道正压通气(CPAP)是阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的首选治疗方式，但患者的治疗依从性长期处于偏低水平。现有研究表明，心理社会因素是影响CPAP依从性的关键变量，然而单一理论模型难以充分解释依从行为背后的复杂心理机制。本文基于健康信念模型(Health Belief Model, HBM)与自我调节常识模型(Common-Sense Model of Self-Regulation, CSM)的理论互补性，构建了OSAHS患者CPAP治疗依从性的双路径驱动模型。该模型提出，患者的CPAP使用行为受理性评估路径与疾病意义建构路径的双重驱动：前者以HBM的感知维度为核心，强调患者对疾病威胁与治疗收益的理性权衡；后者以CSM的疾病表征为核心，关注患者对疾病的认知、情感与应对意义建构。两条路径之间存在动态交互机制，共同塑造患者的治疗决策与行为维持。基于该模型，护理干预应同时作用于理性认知重塑与疾病意义重构两个层面，为提升OSAHS患者CPAP治疗依从性提供了新的理论框架与实践路径。

Abstract: Continuous positive airway pressure (CPAP) is the preferred treatment for obstructive sleep apnea-hypopnea syndrome (OSAHS), but the treatment compliance of patients has long been at a low level. Existing research indicates that psychosocial factors are key variables influencing CPAP compliance. However, a single theoretical model is difficult to fully explain the complex psychological mechanisms behind compliance behavior. This article is based on the theoretical complementarity of the Health Belief Model (HBM) and the Common-Sense Model of Self-Regulation (CSM). A dual-path-driven model for CPAP treatment compliance in patients with OSAHS was constructed. This model proposes that the CPAP usage behavior of patients is driven by both the rational assessment path and the disease meaning construction path: the former takes the perception dimension of HBM as the core, emphasizing the rational trade-off between disease threats and treatment benefits for patients; The latter takes the disease manifestations of CSM as the core and focuses on the cognitive, emotional and coping meaning construction of patients towards the disease. There exists a dynamic interaction mechanism between the two paths, jointly shaping the treatment decisions and behavioral maintenance of patients. Based on this model, nursing intervention should act simultaneously at the two levels of rational cognitive reshaping and disease meaning reconstruction, providing a new theoretical framework and practical path for improving the compliance of CPAP treatment in patients with OSAHS.