乳腺癌相关淋巴水肿患者身体意象障碍影响因素的路径研究 [中文引用][英文引用]

目的  探讨乳腺癌相关淋巴水肿（breast cancer related lymphedema，BCRL）患者应对方式和自我护理行为在自我关怀与身体意象障碍间的链式中介作用，为实施针对性护理干预提供理论依据。方法  采用便利抽样方法，选取 2024 年6 月至 2025 年 5 月苏北人民医院医院淋巴水肿专病门诊接诊的 230 例 BCRL 患者为研究对象，采用一般资料调查表、自我关怀量表简版（self-compassion scale-short form，SCS-SF）、医学应对方式问卷（medical coping modes questionnaire，MCMQ）、BCRL自我护理量表（breast cancer related lymphedema self-care scale，BCRL-SS）、乳腺癌患者体象自评问卷（body image self-ratingquestionnaire for breast cancer，BISQ-BC）进行调查。通过 AMOS 23.0 构建结构方程模型。结果  215 例患者完成研究，其身体意象障碍得分为（79.68±14.85）分。路径分析显示，自我关怀对面对应对方式具有正向影响（β=0.825，P<0.001），面对应对方式对自我护理行为具有正向影响（β=0.550，P<0.001），自我护理行为对身体意象障碍具有负向影响（β=-0.436，P<0.001）。面对应对方式和自我护理行为在自我关怀与身体意象障碍间起链式中介作用，总间接效应占总效应的 64.40%。结论  乳腺癌患者身体意象障碍处于中等水平。自我关怀可直接减轻 BCRL 患者身体意象障碍，也可通过面对应对方式和自我护理行为间接减轻身体意象障碍。临床实践中应注重提升患者自我关怀水平，引导患者采取积极应对策略，并强化淋巴水肿相关自我护理行为，以改善患者身体意象障碍，促进患者整体康复。

Objective To explore the chain mediating effect of coping styles and self-care behaviours on the relationship between self-compassion and body image disturbance in patients with breast cancer-related lymphedema（BCRL），and to provide a theoretical basis for developing targeted nursing interventions. Methods A convenience sampling was used to recruit 230 BCRL patients from the lymphedema clinic of Northern Jiangsu People’s Hospital between June 2024 and May 2025. Data were collected using a general information questionnaire，the self-compassion scale-short form（SCS-SF），medical coping modes questionnaire（MCMQ）， breast cancer related lymphedema self-care scale（BCRL-SS），and body image self-rating questionnaire for breast cancer（BISQ-BC）. A structural equation model was established using AMOS 23.0. Results A total of 215 BCRL patients completed the study，with a mean body image disturbance score of 79.68±14.85. Path analysis showed that self-compassion had a significant positive effect on the confronting coping style（β=0.825，P<0.001），where the confronting coping style significantly positively influenced self-care behaviours （β=0.550，P<0.001），while the self-care behaviours had a significant negative effect on body image disturbance（β=-0.436，P<0.001）. The confronting coping style and self-care behaviours were found to played a chain mediating role between self-compassion and body image disturbance，accounting for 64.40% of the total effect. Conclusion Body image disorder in BCRL patients is at a moderate level. Self-compassion can directly alleviate body image disturbance in BCRL patients and also indirectly alleviates it by promoting the confronting coping style and self-care behaviours. In clinical practice，efforts should be made to improve the self-compassion of patients， guide the patients to adopt positive coping strategies and strengthen the lymphedema-related self-care behaviours，so as to improve body image disturbance and promote overall rehabilitation.