脑卒中恢复期患者心理弹性的研究进展

Research Progress on Psychological Resilience of Stroke Patients in Recovery Period

摘要: 目的：系统梳理脑卒中恢复期患者心理弹性的测评工具、作用机制、影响因素及干预策略，为临床心理康复提供参考。方法：检索国内外数据库，整合核心测评工具、中介机制、多维影响因素与干预策略，并对各工具在卒中人群中的测量学证据及各类干预的证据等级作横向比较与分级评价。结果：心理弹性经自我效能与希望、积极应对、康复参与、情绪调节四条路径影响康复结局，其水平又受认知方式等内部因素、家庭与社会支持等外部因素及疾病特征共同制约。CD-RISC、RS、BRS三工具在理论取向、条目负担及卒中人群信效度上差异明显，且缺乏认知障碍或失语患者的头对头比较与统一临界值。认知行为干预的随机对照证据较多，家庭参与与社会支持类干预多依赖观察性证据，数字化与中医特色疗法对抑郁等情绪结局已有一定证据，但以心理弹性为结局的研究尚处探索阶段。据此提出“评估–分层–匹配–实施–评价”五环节个性化整合干预框架。结论：心理弹性是卒中恢复期患者全面康复的关键保护因素，未来应统一评估标准与临界值，强化干预证据强度，并以多中心研究验证分层匹配干预框架的可行性。

Abstract: Objective: To systematically review the assessment tools, mechanisms, influencing factors, and intervention strategies of psychological resilience in stroke patients during the recovery period, providing reference for clinical psychological rehabilitation. Methods: Relevant domestic and international databases were searched to integrate core assessment tools, mediating mechanisms, multidimensional influencing factors, and interventions; psychometric evidence of the tools in stroke populations and the evidence levels of different interventions were then compared and graded. Results: Resilience influences rehabilitation outcomes through four pathways—self-efficacy and hope, positive coping, rehabilitation participation, and emotion regulation—while its level is jointly shaped by internal factors (e.g., cognitive style), external factors (e.g., family and social support), and disease characteristics. CD-RISC, RS, and BRS differ notably in theoretical orientation, item burden, and stroke-population psychometrics, and head-to-head comparisons in patients with cognitive impairment or aphasia, as well as unified cut-offs, remain lacking. Cognitive-behavioral interventions have accumulated considerable RCT evidence, family-participation and social-support interventions rely mainly on observational evidence, and digital and TCM-specific therapies have yielded some evidence regarding emotional outcomes such as depression, though resilience-as-outcome studies are still exploratory. A five-step “assessment - stratification - matching - delivery - evaluation” individualized integrated intervention framework is therefore proposed. Conclusion: Resilience is a key protective factor for comprehensive rehabilitation of convalescent stroke patients; future work should unify assessment criteria and cut-offs, strengthen intervention evidence, and use multicenter studies to validate the feasibility of the stratified-matching intervention framework.