首发脑卒中患者疾病感知轨迹的混合研究

A Mixed Research of Disease Perception Trajectory in First-Episode Stroke Patients

摘要: 目的：本研究旨在调查首发脑卒中患者发病后不同时期疾病感知现状，探究首发脑卒中患者疾病感知纵向发展趋势及特征。在此基础上，通过对首发脑卒中患者进行半结构式访谈，深度探究患者发病后不同时期对疾病感知的感受和体验，补充问卷调查的结果，为相关部门提出群体化干预措施提供理论支撑。方法：采用便利抽样，选取240名首发脑卒中患者作为研究对象。分别在患者首次发病(T0)、发病后1个月(T1)、发病后3个月(T2)和发病后6个月(T3)四个时间点，采用一般资料调查表、中文版疾病感知问卷简化版、医学应对方式量表、社会支持评定量表、简易恐惧疾病进展量表、医院焦虑抑郁量表对患者进行随访调查，采用潜变量增长混合模型识别潜在变化轨迹亚组，并通过质性研究探究患者四个时间点的疾病感知情况。结果：首发脑卒中患者T0~T3四个时间点疾病感知得分为44.28 ± 13.07、39.91 ± 12.33、33.21 ± 10.42、27.11 ± 9.25分，各时间点得分差异有统计学意义(P < 0.001)；识别出C1 (高感知–缓速下降组)、潜在类别C2 (中感知–快速下降组)和潜在类别C3 (低感知–稳定组) 3个亚组，分别占22.27%、55.02%和22.71% (P < 0.001)。结论：首发脑卒中患者的疾病感知总体呈逐渐下降趋势，变化轨迹存在群体异质性，应根据预测指标早期并构建干预方案以降低患者疾病感知水平。

Abstract: Objective: This study aims to investigate the current situation of disease perception in different periods after the onset of initial stroke patients, and to explore the longitudinal development trend and characteristics of disease perception in initial stroke patients. On this basis, through semi-structured interviews with initial stroke patients, the patients’ feelings and experiences of disease perception in different periods after the onset of the disease, supplemented the results of the questionnaire survey, and provided theoretical support for relevant departments to propose mass intervention measures. Methods: Using convenience sampling, 240 first-episode stroke patients were selected as the study subjects. In four time points after the first onset (T0), 1 month (T1), 3 months (T2) and 6 months (T3), general data questionnaire, Chinese disease perception questionnaire simplified version, medical response scale, social support rating scale, simple fear disease progression scale, hospital anxiety and depression scale of patients, latent variable growth mixed model to identify potential change trajectory subgroup, and explore the disease perception at four-time points through qualitative research. Results: The disease perception scores of T0~T3 were 44.28 ± 13.07, 39.91 ± 12.33, 33.21 ± 10.42 and 27.11 ± 9.25, with a significant difference in scores at each time point (P < 0.001). Three subgroups: C1 (high perception-slow decline), potential C2 (middle perception-rapid decline), and potential C3 (low perception-stable group) were identified, accounting for 22.27%, 55.02%, and 22.71% (P < 0.001). Conclusions: The disease perception of patients with first stroke is gradually decreasing, and there is group heterogeneity in the change trajectory of patients. Early intervention programs should be constructed according to the predictive indicators to reduce the level of patients’ disease perception.