目的 探讨缺血性脑卒中(ischemic stroke，IS)患者急性住院期至出院后6个月心理社会适应变化轨迹，分析其影响因素。 方法 2023年2-7月，便利抽取上海市某三级甲等医院神经内科住院的180例IS患者为研究对象，使用一般资料调查表、疾病心理社会适应量表和社会支持评定量表在患者急性住院期间进行调查，并于出院后1、3、6个月追踪随访其心理社会适应。采用潜类别增长模型识别患者心理社会适应变化轨迹潜在类别，通过多元Logistic回归分析影响因素。 结果 共识别出IS患者4种心理社会适应变化轨迹类别，分别为持续高心理社会适应组(10.0%)、中心理社会适应-改善组(41.1%)、低心理社会适应-进展组(37.8%)和持续低心理社会适应组(11.1%)。Logistic回归分析显示，年龄、急性住院期生活自理能力、性格类型和社会支持是不同轨迹的影响因素(均P＜0.05)。 结论 IS患者心理社会适应变化轨迹存在群体异质性，医护人员应关注性格内向、年龄大、急性住院期生活自理能力较差患者，给予及时心理社会适应评估与针对性干预措施，促进患者早日适应社会生活。

Objective To investigate the psychosocial adaptation in IS patients from their acute hospitalization period to 6 months post-discharge,and to analyze the influencing factors.Methods 180 IS patients from the department of neurology in a tertiary A hospital in Shanghai were selected by convenience sampling from February to July 2023.Data were collected with the general information questionnaire,the self-report psychosocial adjustment to illness scale,and the social support rating scale during the acute hospitalization period,and the psychosocial adaptation was followed up at 1,3,and 6 months post-discharge.The latent class growth model was used to identify the latent categories of psychosocial adaptation,and disordered multinomial logistic regression analysis used to determine the influencing factors.Results 4 distinct types of psychosocial adaptation were identified:consistently high psychosocial adaptation group(10.0%),moderate-to-improved psychosocial adaptation group(41.1%),low-to-progressed psychosocial adaptation group(37.8%),and consistently low psychosocial adaptation group(11.1%).Logistic regression analysis indicated that age,self-help ability during acute hospitalization,personality and social support were significant factors (all P＜0.05).Conclusions Differences exist in the psychosocial adaptation among IS patients.Medical staff should pay attention to patients who are introverted,in an old age,with poor self-help ability during acute hospitalization,and provide timely assessment on their psychosocial adaptation and specific intervention to facilitate their adaptation to social life.

R473.54

复旦大学附属上海市第五人民医院院内护理科研课题(2022WYHLZT02)；上海现代护理职业教育集团特聘兼职教师资助计划(hlzjtpgr202305)