青年脑卒中患者急性期至稳定期自我管理行为变化轨迹及其影响因素 [中文引用][英文引用]

目的  探讨基于潜类别增长模型（latent class growth model，LCGM）的青年脑卒中患者急性期至稳定期自我管理行为变化轨迹及其影响因素，为制定分阶段、持续性干预策略提供依据。方法  采用便利抽样法，选取 2023 年 11 月— 2024 年11 月本院神经系统片区就诊的 206 例青年脑卒中患者作为研究对象，采用一般资料调查问卷、青年脑卒中患者自我管理行为量表、慢性病管理自我效能量表（self-efficacy for managing chronic disease scale，SEMCD）、社会支持评定量表（social support ratingscale，SSRS）进行调查，在确诊后 1w（T1）、确诊后 1 个月（T2）、确诊后 3 个月（T3）和确诊后 6 个月（T4）4 个时间点评估患者自我管理行为，采用 LCGM 识别轨迹类别，多分类 Logistic 回归模型分析其影响因素。结果  172 例患者完成 4 次随访。共识别出患者 3 个轨迹类别：自我管理衰退型（n=85，49.4%）、自我管理稳定型（n=47，27.3%）、自我管理成长型（n=40，23.3%）；多因素分析显示，职业状况、文化程度、家庭人均月收入、家族遗传史、自我效能、社会支持是影响患者自我管理行为轨迹类别的因素（均P<0.05）。结论  青年脑卒中患者急性期至稳定期自我管理行为变化轨迹存在异质性，护理人员应针其特征及影响因素，制定个性化、分阶段的干预方案，提升其自我管理行为水平。

Objective To explore the change trajectory of self-management behaviour and its influencing factors in young stroke patients from the acute phase to a stable phase based on latent category growth model，and provide evidence for developing phased and sustained intervention strategies. Methods A convenient sample method was used to recruit 206 young stroke patients admitted to the Department of Neurology in our hospital from November 2023 to November 2024. Data were collected using a general demographic questionnaire，the stroke self-management behaviour scale for young patient，self-efficacy for managing chronic disease scale（SEMCD），and the social support rating scale（SSRS）. It was found that self-management levels were assessed at four time points： 1 week post-diagnosis（T1），1 month post-diagnosis（T2），3 months post-diagnosis（T3）and 6 months post-diagnosis（T4）. Latent class growth modelling was used to identify trajectory categories，and multinomial logistic regression was used to examine influencing factors. Results 172 patients completed 4 follow-ups. Three trajectory classes were identified：the declining group（n=85，49.4%）， the stable group（n=47，27.3%），and the improving group（n=40，23.3%）. Occupation，education，per capita monthly household income，family history of stroke，self-efficacy，and social support were found to be the main factors influencing the trajectory classes（all P<0.05）. Conclusion Young stroke patients exhibit heterogeneous trajectories of self-management behaviour from the acute phase to stable phase. Nursing professionals should develop individualised and phased intervention strategies based on the characteristics and the factors influencing trajectory classes，therefore to improve the self-management behaviours of patients.