目的 探讨慢性心力衰竭患者(chronic heart failure,CHF)失志轨迹并分析其影响因素,为早期识别高危人群、制订个体化干预策略提供依据。方法 2024年6月至2025年1月采用便利抽样法选取某院收治的CHF患者320例为研究对象,于入院48 h内(T0)采用一般资料问卷、失志量表、压力知觉量表、社会支持量表及心衰症状状态问卷收集基线资料,于出院后2个月(T1)、4个月(T2)、6个月(T3)时随访评估失志水平。通过增长混合模型识别轨迹并分析影响因素。结果 320例CHF患者T0~T3各时点失志得分总体差异有统计学意义(均P<0.05)。CHF患者可分为低水平持续上升(41.3%)、持续高水平(28.7%)、中水平先升后降(30.0%)3类失志轨迹。3类患者在年龄、文化程度、压力知觉等项目上的差异均有统计学意义(均P<0.05)。年龄、文化程度、经济来源、病程、心功能分级、压力知觉、社会支持是轨迹类别的独立影响因素(均P<0.05)。结论 CHF患者失志轨迹呈群体异质性,应基于不同轨迹制订精准干预措施。

Objective To explore the longitudinal trajectories of demoralization in patients with chronic heart failure (CHF) and analyze its influencing factors, so as to provide evidence for early identification of high-risk populations and development of individualized intervention strategies. Methods A total of 320 CHF patients admitted to a hospital from June 2024 to January 2025 were selected by convenience sampling method. Baseline data including general information, demoralization, perceived stress, social support and heart failure symptoms were collected within 48 hours after admission (T0). Demoralization was followed up at 2 months (T1), 4 months (T2) and 6 months (T3) after discharge. Latent growth mixture modeling was used to identify trajectories and analyze influencing factors. Results There were significant differences in demoralization scores among T0 to T3 time points in 320 CHF patients (all P<0.05). Three distinct demoralization trajectories were identified: low-level increasing group (41.3%), persistent high-level group (28.7%), and moderate-level rising-then-declining group (30.0%). There were significant differences in age, education level, perceived stress and other indicators among the three groups (all P<0.05). Age, education level, income, disease duration, NYHA functional class, perceived stress and social support were independent influencing factors for trajectory classification (all P<0.05). Conclusions Demoralization trajectories in CHF patients show group heterogeneity. Precise interventions should be formulated based on different trajectories.

R473.54;R471