目的 探讨慢性心力衰竭（chronic heart failure,CHF)患者及配偶相依关系在二元应对及自我管理间的中介作用。方法 2021年1月至2022年1月，采用方便抽样法选取在合肥市某三级甲等医院心内科住院的CHF患者及其配偶共212对为研究对象，采用一般资料调查表、二元应对量表、CHF自我管理量表、配偶对患者自我管理的贡献量表、夫妻相依关系量表对其进行调查。构建结构方程模型，从二元水平分析主体效应、客体效应以及中介效应。结果 CHF患者及配偶自我管理得分率分别为（53.24±14.62）%、（57.46±14.55）%，二元应对总分分别为（119.30±14.14）分、（118.89±14.41）分，相依关系得分分别为（2.96±0.92）分、（2.66±0.97）分。患者及配偶的二元应对、相依关系与自我管理均正相关（均 P＜0.01）。主体效应中自身相依关系在自身二元应对和自我管理之间起部分中介作用，占总效应的47.23%和24.07%。客体效应中自身相依关系在配偶二元应对与自身自我管理之间的起部分中介作用，占总效应的50.0%、50.14%。结论 临床干预中需要将CHF患者和配偶作为整体，关注二元应对、相依关系进行干预，以提高患者的自我管理水平。

Objective To explore the mediating effect of mutuality between patients with chronic heart failure(CHF) and their spouses in dyadic coping and self-management.Methods The convenience sampling method was used to select a total of 212 pairs of CHF patients and their spouses hospitalized in the Department of Cardiology of a tertiary A hospital in Hefei City in China from January 2021 to January 2022 as the research subjects.The general information questionnaire ,dyadic coping scale，CHF self-management scale，spouse’s contribution to patient’s self-management scale and mutuality scale were administered.Structural equation modelling was also used to analyze the subject effect，object effect，and mediating effect from the binary level.Results The self-management scores of patients and spouses were (53.24±14.62)% and (57.46±14.55)%，respectively.The total scores of dyadic coping were (119.30±14.14) and (118.89±14.41)，and the scores of mutuality were (2.96±0.92) and (2.66±0.97)，respectively.Dyadic coping and mutuality were positively correlated with self-management for both patients and spouses (all P＜0.01).In terms of subject effects，mutuality played a mediating role between patients’ dyadic coping and self-management，accounting for 47.23% and 24.07% of the total effect.In terms of object effects，it played a mediating role between spouses’ dyadic coping and own self-management，accounting for 50.0% and 50.14% of the total effect.Conclusions In clinical intervention, CHF patients and their spouses should be regarded as a whole, and the binary coping and interdependent relationship should be focused on for intervention, so as to improve the patients’ self-management level.

R473.54

安徽省高校自然科学研究重大项目（2023AH040085）；安徽医科大学科研基金培育项目（hlpy2021002）；安徽医科大学卫生政策研究中心开放项目（2022wszc10）