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目的 探讨老年慢性心力衰竭患者易损期自我护理状况的潜在类别，并分析其影响因素。方法 采用便利抽样法，于2023年6月—2024年1月选取上海市某三甲医院心脏中心就诊的225例老年慢性心力衰竭患者为研究对象，采用一般资料调查表、心力衰竭自我护理指数V7.2、简易疾病感知问卷、慢性病管理自我效能量表和领悟社会支持量表进行问卷调查。采用潜在剖面分析识别老年慢性心力衰竭患者易损期自我护理状况的潜在特征类别，并通过单因素和有序logistic回归分析其影响因素。结果 老年慢性心力衰竭患者易损期自我护理状况分为3个潜在类别，分别为自我护理低下组(8.0%)、自我护理潜力激发组(43.1%)和自我护理良好组(48.9%)。有序logistic回归分析结果显示：学历为大专及以上(OR=2.375,95%CI:1.101～5.124)、退休前从事脑力劳动(OR=1.986,95%CI:1.134～3.476)、高自我效能(OR=1.052,95%CI:1.024～1.081)和高社会支持(OR=1.039,95%CI:1.004～1.076)是老年慢性心衰患者易损期自我护理状况表现良好的保护因素(P<0.05)。结论 老年慢性心力衰竭患者易损期自我护理状况存在显著的类别特征，且症状感知能力较差。医护人员和研究者应特别关注患者在易损期的自我护理状况，针对其显著的类别特征和较差的症状感知能力，制订以患者为中心、以需求为导向的干预措施，从而提高患者的自我护理能力。
Abstract：Objective To identify the latent classes of self-care status of elderly patients with chronic heart failure during the vulnerable phase, and to explore their influencing factors. Methods Using convenience sampling, 225 elderly patients with chronic heart failure from the cardiology center of a tertiary A hospital in Shanghai between June 2023 and January 2024 were selected as the research subjects, and were conducted a questionnaire by a general information questionnaire, the heart failure self-care index V7.2, the brief illness perception questionnaire, the chronic disease self-efficacy scale, and the perceived social support scale.Latent profile analysis was used to identify the latent classes of self-care status in elderly patients with chronic heart failure during the vulnerable phase, and univariate and ordinal logistic regression analysis were used to explore the influencing factors. Results The self-care status in elderly patients with chronic heart failure during the vulnerable phase were individed into 3 latent classes, which were poor self-care group(8.0%), self-care potential development group(43.1%), and good self-care group(48.9%). The results of ordinal logistic regression analysis showed that educational attainment at college level or above(OR=2.375,95%CI was 1.101-5.124), mental labor before retirement(OR=1.986,95%CI was 1.134-3.476), high self-efficacy(OR=1.052,95%CI was 1.024-1.081), and strong social support(OR=1.039,95%CI was 1.004-1.076) were protective factors for better self-care status of elderly patients with chronic heart failure during the vulnerable phase(P<0.05).Conclusion There are significant latent class characteristics in self-care status of elderly patients with chronic heart failure during the vulnerable phase. Moreover, these patients have poor symptom perception ability. Healthcare professionals and researchers should pay special attention to the self-care status of elderly patients with chronic heart failure during the vulnerable phase, develop patient-centered and demand-oriented interventions based on their latent class characteristics and poor symptom perception ability, so as to improve their self-care ability.
[1] 国家心血管病中心，国家心血管病专家委员会心力衰竭专业委员会，中国医师协会心力衰竭专业委员会，等.国家心力衰竭指南2023[J].中华心力衰竭和心肌病杂志，2023,7(4):215-311.
[2] 中华医学会心血管病学分会，中国医师协会心血管内科医师分会，中国医师协会心力衰竭专业委员会，等.中国心力衰竭诊断和治疗指南2024[J].中华心血管病杂志，2024,52(3):235-275.
[3] 李倩宇.八段锦对心力衰竭患者易损期生活质量影响的研究[D].南宁：广西中医药大学，2023.
[4] VELLONE E,CHIALA O,BOYNE J,et al.Cognitive impairment in patients with heart failure:an international study[J].ESC Heart Fail,2020,7(1):46-53.
[5] 吴冬，林颖，董忻悦，等.基于理论域框架的老年慢性心力衰竭患者自我管理行为的质性研究[J].军事护理，2025,42(6):40-43.
[6] 王孟成，毕向阳.潜变量建模与Mplus应用：进阶篇[M].重庆：重庆大学出版社，2018:3-34.
[7] 杨雪梅，王红玉，唐永华，等.精神障碍患者口腔健康相关生活质量及影响因素分析[J].华西口腔医学杂志，2025,43(1):84-91.
[8] NYLUND K L,ASPAROUHOV T,MUTHEN B O.Deciding on the number of classes in latent class analysis and growth mixture modeling:a monte carlo simulation study[J].Struct Equ Modeling,2007,14(4):535-569.
[9] RIEGEL B,DICKSON V V,FAULKNER K M.The situation-specific theory of heart failure self-care:revised and updated [J].J Cardiovasc Nurs,2016,31(3):226-235.
[10] LI F,LIN L,SUN X,et al.Psychometric testing of the Chinese version of the self-care of heart failure index version 7.2 [J].J Cardiovasc Nurs,2023,38(6):528-536.
[11] BROADBENT E,PETRIE K J,MAIN J,et al.The brief illness perception questionnaire[J].J Psychosom Res,2006,60(6):631-637.
[12] DING Y M,LIU C P,XU H X,et al.Effect of social support on illness perception in patients with atrial fibrillation during "Blanking Period":mediating role of sense of mastery[J].Nurs Open,2023,10(1):115-122.
[13] LORIG K R,SOBEL D S,RITTER P L,et al.Effect of a self-management program on patients with chronic disease[J].Eff Clin Pract,2001,4(6):256-262.
[14] 杜世正，胡玲莉，柏亚妹，等.自我效能和恐惧-回避信念与应对方式对慢性腰背痛患者生命质量的影响路径研究[J].中国全科医学，2017,20(35):4397.
[15] BLUMENTHAL J A,BURG M M,BAREFOOT J,et al.Social support,type A behavior,and coronary artery disease[J].Psychosom Med,1987,49(4):331-340.
[16] WANG P,XIONG J,ZHENG J,et al.Perceived social support and depression among people living with HIV in China:roles of stigma and adherence self-efficacy[J].BMC Psychiatry,2023,23(1):544.
[17] RIEGEL B,DICKSON V V,LEE C S,et al.A mixed methods study of symptom perception in patients with chronic heart failure [J].Heart Lung,2018,47(2):107-114.
[18] VILLRINGER A,LAUFS U.Heart failure,cognition,and brain damage [J].Eur Heart J,2021,42(16):1579-1581.
[19] XIONG J,QIN J,ZHENG G,et al.The relationship between symptom perception and fear of progression in patients with chronic heart failure:a multiple mediation analysis [J].Eur J Cardiovasc Nurs,2023,22(6):638-646.
[20] SANTOS G C,LILJEROOS M,DWYER A A,et al.Symptom perception in heart failure:a scoping review on definition,factors and instruments [J].Eur J Cardiovasc Nurs,2020,19(2):100-117.
[21] ANDERSON K M,MURPHY D,GRONINGER H,et al.Perceived symptoms as the primary indicators for 30-day heart failure readmission [J].Plos One,2022,17(5):e0267820.
[22] SEID M A,ABDELA O A,ZELEKE E G.Adherence to self-care recommendations and associated factors among adult heart failure patients.From the patients' point of view[J].PLoS One,2019,14:e0211768.
[23] 喻晓娇，董亚菲，田甜，等.泸州市老年人认知功能与社会支持和抑郁的相关性[J].中华疾病控制杂志，2020,24(5):607-609.
[24] 樊敏娜，蒋颜.慢性心力衰竭病人资源利用情况影响因素的路径分析[J].中国卫生统计，2023,40(5):754-757.
[25] POBROTYN P,MAZUR G,KALUZNA-OLEKSY M,et al.The level of self-care among patients with chronic heart failure [J].Healthcare,2021,9(9):1179.
[26] SON Y J,CHOI J Y,LEE H J.Effectiveness of nurse-led heart failure self-care education on health outcomes of heart failure patients:a systematic review and meta-analysis[J].Int J Environ Res Public Health,2020,17(18):6559.
[27] ZHANG Z,KOIRALA B,GONG G,et al.Predictors of self-care among Chinese patients with chronic heart failure:a situation-specific theory-guided structural equation model analysis[J].J Cardiovasc Nurs,2023,38(3):E87-E97.
[28] CAGGIANELLI G,IOVINO P,REBORA P,et al.A motivational interviewing intervention improves physical symptoms in patients with heart failure:a secondary outcome analysis of the motivate-HF randomized controlled trial[J].J Pain Symptom Manag,2022,63(2):221-229.
[29] YOON M,LEE S,CHOI J Y,et al.Effectiveness of a smartphone App-based intervention with bluetooth-connected monitoring devices and a feedback system in heart failure (SMART-HF Trial):randomized controlled trial[J].J Medical Internet Res,2024,26:e52075.
[30] KITKO L,MCILVENNAN C K,BIDWELL J T,et al.Family caregiving for individuals with heart failure:a scientific statement from the American Heart Association [J].Circulation,2020,141(22):e864-e878.
[31] PERERA M,HALAHAKONE U,SENANAYAKE S,et al.Components of home-based palliative and supportive care for adults with heart failure:a scoping review[J].Palliat Med,2025,39(1):86-98.
[32] MYHRE P L,TROMP J,OUWERKERK W,et al.Digital tools in heart failure:addressing unmet needs[J].Lancet Digit Health,2024,6(10):e755-e766.
[33] ZARE-KASEB A,ZEYDI A E,BAKHTIARI-DOVVOMBAYGI H,et al.Effects of education based on teach-back methods on self care and quality of life of the patients with heart failure:a systematic review[J].BMC Cardiovasc Disord,2024,24(1):591.
基本信息:
DOI：10.16821/j.cnki.hsjx.2025.23.001
中图分类号:R473.5
引用信息:
[1]曾柃烨,林颖,董忻悦,等.老年慢性心力衰竭患者易损期自我护理状况的潜在类别及影响因素分析[J].护士进修杂志,2025,40(23):2465-2471.DOI:10.16821/j.cnki.hsjx.2025.23.001.
基金信息:
国家自然科学基金资助项目(编号：72104056); 复旦-复星护理科研基金面上项目(编号：FNF202354)