认知障碍患者抗拒照护行为现状及影响因素和对免陪照护实践的启示 [中文引用][英文引用]

目的  探讨认知障碍患者抗拒照护行为现状及影响因素，为临床免陪照护实践提供依据。方法  采用便利抽样法，选取 2024 年 9 月— 2025 年 5 月在新疆某三级甲等综合医院神经内科住院的 220 例认知障碍患者及照护者为研究对象，使用一般资料调查表、认知障碍患者抗拒照护行为量表、中文版痴呆知识评估量表（Chinese dementia knowledge assessment scale，C-DKAS）、中文版老年患者家庭照护能力量表（family care giving competence scale for the elderly，FCCSE）对其照护者进行调查。采用多重线性回归分析患者抗拒照护行为的影响因素。结果  206 例患者及照护者完成研究。认知障碍患者抗拒照护行为占比 30.6%，抗拒照护行为总分为（69.9±15.3）分。多重线性回归分析结果显示，患者病程、认知障碍程度、婚姻状况、照护者年龄、与患者关系、照护者痴呆知识水平、家庭照护能力是认知障碍患者抗拒照护行为的影响因素，共解释总变异度的 58.6%（均P<0.001）。结论  认知障碍患者抗拒照护行为处于中等偏低水平，受多因素影响。未来在免陪照护实践中应根据患者病程、认知障碍程度提供个性化护理对策，同时应提高医疗护理员的照护知识与技能水平，以降低患者照护中抗拒照护行为的发生及危害。

Objective To investigate the current situation of care resistive behaviors in patients with cognitive impairment and its influencing factors，to provide a basis for formulating measures in unaccompanied care practices. Methods A total of 220 patients with cognitive impairment and caregivers from the Department of Neurology at a tertiary first-class hospital in Xinjiang between September 2024 and May 2025 were selected by convenience sampling. The caregivers were investigated using a general information questionnaire，the care resistance behavior scale for patients with cognitive impairment，Chinese dementia knowledge assessment scale （C-DKAS），and family care giving competence scale for the elderly（FCCSE）. Multiple linear regression analysis was performed to identify factors influencing care resistive behaviors. Results A total of 206 patients and caregivers completed the study. The results showed that the proportion of care resistive behaviors was 30.6%. The mean total score of care resistive behaviors was（69.9±15.3） points. Multiple linear regression analysis revealed that patient disease duration，the level of cognitive impairment，marital status in patients，caregiver age，relationship with the patient，caregiver dementia knowledge level，and family caregiving competence were factors influencing care resistance in patients with cognitive impairment，collectively explaining 58.6% of the total variance（All P<0.01）. Conclusion Care resistive behaviors in patients with cognitive impairment were at a moderately low level. It is influenced by multiple factors. In the future, personalized care strategies should be provided based on the patient's disease course and the degree of cognitive impairment for unaccompanied care. At the same time, the care knowledge and skills of medical nursing assistant should be improved.