青少年特发性脊柱侧凸患者术后延续性自我康复管理障碍因素的质性研究 [中文引用][英文引用]

目的  探讨青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者术后延续性自我康复管理的障碍因素，为制定针对性护理干预策略提供理论依据。方法  采用目的抽样法，选取 2023 年 7 月 -10 月广州市某三级甲等医院收治的 12 例行手术治疗后已出院的 AIS 患者及其照顾者（共 12 对）作为研究对象，开展半结构式访谈，运用 Colaizzi 7 步分析法进行资料分析、归纳及主题提炼。结果  共提炼出 4 个主题及 12 个亚主题，包括术后生理功能失衡与症状困扰：①躯体症状：发热、头晕、睡眠障碍；②胃肠功能紊乱：便秘、胃纳差、消化不良、腹胀等；③症状困扰：疼痛、麻木、长短腿和高低肩等。心理社会适应障碍：①自我形象困扰：因外观畸形自卑、回避社交；②负担感：认为自己给家庭增加了照护负担和经济负担；③情绪障碍：焦虑康复效果、抑郁心理。居家自我康复管理维持困难：①居家环境与康复需求不匹配；②康复锻炼依从性差；③异常征象识别与就医决策困难。延续性康复管理支持系统不完善：①出院指导形式单一、内容较为笼统，缺乏个体化、分阶段康复指导；②与医生和护士的持续沟通渠道不顺畅；③医院 - 家庭 - 学校 - 社区协同不足。结论  AIS 患者术后延续性自我康复管理受生理、心理、行为及支持系统多维度因素交互影响，医护人员应围绕症状管理、心理支持、患者 - 家庭协同和跨场景支持 4 个方面，提供个体化、分阶段、可操作的延续性康复服务。

Objective To explore the barriers to continuous self-rehabilitation management among patients with adolescent idiopathic scoliosis（AIS）after surgery，so as to provide a theoretical basis for formulating targeted nursing intervention strategies. Methods Purposive sampling was adopted. A total of 12 pairs of post-discharged AIS patients who underwent surgical treatment and their caregivers were recruited from a tertiary-A hospital in Guangzhou between July and October 2023.Semi-structured interviews were conducted，and Colaizzi’s seven step phenomenological analysis was applied for data analysis，induction and theme extraction. Results Four themes together with 12 sub-themes were extracted. The first theme was postoperative physiological dysfunction and symptomdistress，including ① physical symptoms such as fever，dizziness and sleep disturbance；② gastrointestinal disorders including constipation，poor appetite，dyspepsia and abdominal distension；③ symptom-related distress manifested as pain，numbness，leg-length discrepancy and shoulder height asymmetry.The seco-nd theme referred to psychosocial adaptation barriers，covering ① self-image disturbance：inferiority complex due to physical deformity and social avoidance；② sense of burden：perceived care-giving and economic burden imposed on families；③ emotional disorders including anxiety about rehabilitation outcomes and depressive mood. The third theme was poor sustainability of home-based self-rehabilitation management，which consisted of ① mismatch between household environment and rehabilitation requirements；② low compliance with rehabilitation exercises；③ difficulties in identifying abnormal signs and making medical seeking decisions. The fourth theme was imperfect supportive system for continuous rehabilitation management，including ① simplistic and generalized discharge guidance，lacking individualized and staged instructions；② poor accessibility of continuous communication with medical staff；③ insufficient collaboration among hospitals，families，schools and communities. Conclusion Continuous self-rehabilitation management of postoperative AIS patients is interactively affected by multi-dimensional factors covering physiology，psychology， behaviorand support system. Medical and nursing staff should deliver individualized，staged and operable continuous rehabilitation services from four perspectives：symptom management，psychological support，patient-family collaboration and cross scenario support.