老年脑卒中恢复期患者积极度及其影响因素分析

钱苑; 张希萍; 董奇敏

doi:10.16766/j.cnki.issn.1674-4152.004369

老年脑卒中恢复期患者积极度及其影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.004369

杭州市第一人民医院急诊科，浙江杭州 310006

基金项目:

浙江省医药卫生科技计划项目 2025KY1065

详细信息

通讯作者:
张希萍，E-mail: s1kmnp@163.com

中图分类号: R743
计量
- 文章访问数: 6
- HTML全文浏览量: 3
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2025-07-08
- 网络出版日期: 2026-04-11

Positivity and influencing factors of patients in the recovery period of stroke in the elderly

Emergency Department, First People ' s Hospital of Hangzhou City, Hangzhou, Zhejiang 310006, China

摘要

摘要: 目的探究老年脑卒中恢复期患者积极度的影响因素，便于临床制定更具针对性的患者积极度干预策略，以促进患者的自我管理。方法采用便利抽样法，选取2024年1—12月杭州市第一人民医院收治的241例脑卒中患者为调查对象，通过医院电子病历系统收集患者人口学信息、疾病资料；采用患者积极度量表(PAM-13)、领悟社会支持量表、脑卒中病耻感量表分别测量积极度、社会支持及病耻感；采用多重线性回归分析患者积极度的影响因素。结果老年脑卒中患者PAM-13得分为(59.22±9.36)分，社会支持得分为(59.06±10.31)分，病耻感得分为(46.10±9.17)分。积极度与领悟社会支持呈正相关关系(r=0.419, P＜0.01)，与病耻感呈负相关关系(r=-0.386, P＜0.01)。多重线性回归分析显示，年龄(70~岁，β=-0.103；≥80岁，β=-0.197)、文化程度(高中/中专，β=0.121；大专及以上，β=0.243)、家庭人均月收入(≥3 000元，β=0.262)、婚姻状况(已婚，β=0.110)、自理能力(部分自理，β=0.159；完全自理，β=0.270)、病耻感得分(β=-0.135)、社会支持得分(β=0.238)均是老年脑卒中恢复期患者积极度的影响因素(P < 0.05)。结论老年脑卒中恢复期患者积极度与年龄、经济状况、文化程度、婚姻状况、自理能力、病耻感及社会支持水平有关，建议临床针对性制定干预策略，提升患者积极度水平。
- 脑卒中 /
- 患者积极度 /
- 病耻感 /
- 社会支持 /
- 影响因素
Abstract: Objective To explore the influencing factors of positivity in elderly stroke patients during recovery period, and to develop more targeted intervention strategies for patient positivity in clinical practice and promote patients ' self-management. Methods Convenience sampling was used to select 241 stroke patients admitted to Hangzhou First People ' s Hospital from January to December 2024 as subjects. Demographic information and disease data were collected through the hospital ' s electronic medical record system. The patient activation measure-13 (PAM-13), perceived social support scale (PSSS), and stroke shame scale were used to measure positivity, social support, and shame, respectively. Multiple linear regression analysis was employed to determine the factors influencing the level of positivity. Results The PAM-13 scores for elderly stroke patients were (59.22±9.36) points, social support scores were (59.06±10.31) points, and shame scores were (46.10±9.17) points. Positivity was positively correlated with perceived social support (r=0.419, P < 0.01) and negatively correlated with shame (r=-0.386, P < 0.01). Multiple linear regression analysis revealed that age (70-80 years, β=-0.103; ≥80 years, β=-0.197), educational level (high school/vocational high school, β=0.121; college or above, β=0.243), per capita monthly household income (≥3 000 yuan, β=0.262), marital status (married, β=0.110), self-care ability (partially self-care, β=0.159; fully self-care, β=0.270), shame score (β=-0.135), and PSSS score (β=0.238) were factors affecting the positivity of elderly stroke patients in the recovery period (P < 0.05). Conclusion The positivity of elderly stroke patients in recovery period is related to age, economic status, educational level, marital status, self-care ability, stigma, and social support level. Targeted intervention strategies should be developed to enhance their levels of positivity.
- Stroke /
- Patient positivity /
- Stigma /
- Social support /
- Influencing factors

HTML全文

表 1 不同特征老年脑卒中患者PAM-13得分比较

Table 1. Comparison of PAM-13 scores in elderly stroke patients with different characteristics

项目	例数	PAM-13得分(x±s, 分)	统计量	P值
年龄(岁)			5.725^a	0.003
60~	125	60.85±9.02
70~	77	58.06±8.49
≥80	39	56.10±6.80
性别			2.001^b	0.047
男性	140	60.38±9.21
女性	101	58.02±8.94
文化程度			7.034^a	0.001
初中及以下	118	57.40±8.76
高中/中专	81	59.85±8.33
大专及以上	42	62.91±6.05
婚姻状况			2.415^b	0.009
已婚	196	60.16±8.91
离异/丧偶	45	57.04±7.54
居住地			2.320^b	0.021
城市	183	60.02±9.10
农村	58	56.98±7.63
医疗付费方式			1.986^a	0.139
城镇医保	172	59.65±9.02
自费	15	60.24±5.18
新农合	54	57.10±7.44
家庭人均月收入(元)			3.168^b	0.001
＜3 000	66	56.49±6.93
≥3 000	175	60.35±8.92
卒中类型			0.607^b	0.544
出血性	68	58.83±7.05
缺血性	173	59.61±9.18
病程			0.486^a	0.615
＜6个月	106	59.77±8.30
6~12个月	41	58.69±6.10
＞12个月	94	58.84±7.53
合并症			1.097^b	0.273
无	72	60.03±6.96
有	169	58.70±9.08
发病次数			2.003^b	0.046
首发	143	60.14±8.92
复发	98	57.90±7.61
主要照顾者			0.855^a	0.426
配偶	165	59.61±8.50
子女	49	58.94±7.06
其他	27	57.50±5.81
自理能力			7.439^b	＜0.001
完全自理	50	62.57±7.53
部分自理	148	58.82±9.18
不能自理	43	55.69±7.92
注：^a为F值, ^b为t值。

下载: 导出CSV

表 2 变量赋值情况

Table 2. Variable assignment situation

变量	赋值方法
性别	男性=1；女性=2
年龄	60~岁=1；70~岁=2；≥80岁=3
文化程度	初中及以下=1；高中/中专=2；大专及以上=3
婚姻状况	离异/丧偶=1；已婚=2
家庭人均月收入	＜3 000元=1；≥3 000元=2
居住地	农村=1；城市=2
卒中类型	缺血性=1；出血性=2
自理能力	不能自理=(0, 0)；部分自理=(1, 0)；完全自理=(0, 1)
领悟社会支持得分	以实际值赋值
病耻感得分	以实际值赋值

下载: 导出CSV

表 3 老年脑卒中恢复期患者积极度的多重线性回归分析

Table 3. Multiple linear regression analysis of the enthusiasm of elderly patients in the recovery period of stroke

变量	B	SE	β	t值	P值
年龄(岁)
70~	-1.511	0.693	-0.103	-2.180	0.030
≥80	-2.976	1.010	-0.197	-2.946	0.008
文化程度
高中/中专	1.260	0.531	0.121	2.372	0.018
大专及以上	3.014	0.956	0.243	3.152	0.003
家庭人均月收入(元)
≥3 000	2.691	0.833	0.262	3.230	0.002
婚姻状况
已婚	1.408	0.622	0.110	2.263	0.021
自理能力
部分自理	1.356	0.495	0.159	2.739	0.005
完全自理	3.623	1.109	0.270	3.267	< 0.001
病耻感得分	-0.159	0.061	0.135	-2.607	0.010
社会支持得分	0.231	0.075	0.238	3.080	0.001
注：年龄以60~组为参照；文化程度以初中及以下为参照；家庭人均月收入以＜3 000元为参照；婚姻状况以离异/丧偶为参照；自理能力以不能自理为参照。

下载: 导出CSV

参考文献(18)

[1]	王陇德, 彭斌, 张鸿祺, 等. 《中国脑卒中防治报告2020》概要[J]. 中国脑血管病杂志, 2022, 19(2): 136-144. WANG L D, PENG B, ZHANG H Q, et al. Brief report on stroke prevention and treatment in China, 2020[J]. Chinese Journal of Cerebrovascular Diseases, 2022, 19(2): 136-144.
[2]	李飞, 汪美霞, 徐磊. 脑卒中痉挛性瘫痪中西医康复策略及临床应用专家共识[J]. 中华全科医学, 2025, 23(2): 179-185. doi: 10.16766/j.cnki.issn.1674-4152.003862 LI F, WANG M X, XU L. Expert consensus on traditional Chinese and Western medicine rehabilitation strategy andclinical application for spastic paralysis after stroke[J]. Chinese Journal of General Practice, 2025, 23(2): 179-185. doi: 10.16766/j.cnki.issn.1674-4152.003862
[3]	苏晨之, 徐士婷, 姚秀钰. 患者积极度在慢性病管理领域应用情况的文献分析[J]. 医学与社会, 2025, 38(1): 41-47. SU C Z, XU S T, YAO X Y. Literature analysis of the application of patient activation in the field of chronic disease management[J]. Medicine and Society, 2025, 38(1): 41-47.
[4]	GOLUBINSKI V, OPPEL E M, SCHREYOGG J. A systematic scoping review of psychosocial and psychological factors associated with patient activation[J]. Patient Educ Couns, 2020, 103(10): 2061-2068. doi: 10.1016/j.pec.2020.05.005
[5]	王春丽, 王琼, 王晓丽, 等. 西安市住院老年2型糖尿病患者社会支持、病耻感与抑郁水平相关性研究[J]. 实用预防医学, 2023, 30(1): 81-84. WANG C L, WANG Q, WANG X L, et al. Correlation of social support and stigma with depression level in elderly inpatients with type 2 diabetes mellitus in Xi ' an City[J]. Practical Preventive Medicine, 2023, 30(1): 81-84
[6]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715. Neurology Branch of the Chinese Medical Association, Cerebrovascular Diseases Group of the Neurology Branch of the Chinese Medical Association. Diagnostic criteria of cerebrovascular diseases in China (version 2019)[J]. Chinese Journal of Neurology, 2019, 52(9): 710-715.
[7]	倪平, 陈京立, 刘娜. 临床研究中量性研究样本量估计[J]. 中华护理杂志, 2010, 45(4): 378-380. NI P, CHEN J L, LIU N. Sample size estimation for quantitative research in clinical studies[J]. Chinese Journal of Nursing, 2010, 45(4): 378-380.
[8]	洪洋. 腰椎融合术前患者积极度的现况调查及影响因素分析[D]. 南通: 南通大学, 2018. HONG Y. Patient motivation and its influencing factors of posterior lumber interbody fusion surgery[D]. Nantong: Nantong University, 2018.
[9]	朱敏芳, 周宏珍, 邓瑛瑛, 等. 脑卒中患者病耻感量表的编制及信效度检验[J]. 护理学杂志, 2019, 34(1): 70-73. ZHU M F, ZHOU H Z, DENG Y Y, et al. Development and reliability and validity test of stroke stigma scale[J]. Journal of Nursing Science, 2019, 34(1): 70-73.
[10]	姜乾金, 黄丽, 任蔚红. 应对方式、社会支持与癌症病人心身症状的相关性研究[J]. 中国心理卫生杂志, 1996, 10(4): 160-161. JIANG Q J, HUANG L, REN W H. A study on the correlation between coping strategies, social support, and psychosomatic symptoms in cancer patients[J]. Chinese Mental Health Journal, 1996, 10(4): 160-161.
[11]	IBRAHIM M A, GANO L E A F, AZIZ A R H, et al. Tailoring nursing interventions to empower patients: personal coping strategies and self-management in type 2 diabetes care[J]. BMC Nurs, 2024, 23(1): 926-926. doi: 10.1186/s12912-024-02573-w
[12]	吴蕾, 张力, 彭夏培, 等. 首发脑卒中患者积极度现状及影响因素[J]. 护理学杂志, 2020, 35(15): 15-17. WU L, ZHANG L, PENG X P, et al. Activation and its influencing factors among patients with first stroke[J]. Journal of Nursing Science, 2020, 35(15): 15-17.
[13]	周心语, 刘淑敏, 余可斐. 缺血性脑卒中患者积极度及其影响因素的纵向研究[J]. 湖北医药学院学报, 2023, 42(3): 319-325. ZHOU X Y, LIU S M, YU K F. A longitudinal study on patient engagement and its influencing factors in ischemic stroke patients[J]. Journal of Hubei University of Medicine, 2023, 42(3): 319-325.
[14]	CHAN E Y, GLASS G F, CHEONG R Q, et al. Patient activation and its predictors in hospitalized older adults in Singapore[J]. Geriatric Nursing, 2021, 42(2): 336-343. doi: 10.1016/j.gerinurse.2021.01.006
[15]	苏家怡, 张华. 癌症患者积极度的研究进展[J]. 现代医学, 2024, 52(10): 1633-1638. SU J Y, ZHANG H. Advances in research on cancer patients ' proactive engagement[J]. Modern Medical Journal, 2024, 52(10): 1633-1638.
[16]	严思思, 韩叶芬, 张照莉. 宫颈癌患者积极度影响因素的结构方程模型分析[J]. 安徽医学, 2023, 44(3): 329-335. YAN S S, HAN Y F, ZHANG Z L. Study on cervical cancer patients ' activation factors based on structural equation model[J]. Anhui Medical Journal, 2023, 44(3): 329-335.
[17]	WITT D, BENSON G, CAMPBELL S, et al. Measures of patient activation and social support in a peer-led support network for women with cardiovascular disease[J]. J Cardiopulm Rehabil Prev, 2016, 36(6): 430-437. doi: 10.1097/HCR.0000000000000196
[18]	李苗, 李红梅, 张俊, 等. 中青年乳腺癌术后患者积极度及影响因素分析[J]. 护理学杂志, 2024, 39(1): 52-55. LI M, LI H M, ZHANG J, et al. Determinants of patient activation in young and middle-aged breast cancer survivors after surgery[J]. Journal of Nursing Science, 2024, 39(1): 52-55.