目的 探讨元认知信念和担忧在耳鸣患者的耳鸣困扰与焦虑、抑郁间的中介作用,为临床诊疗与护理提供参考。方法 2024年10月至2025年8月,采用便利抽样法选取在山东省某三级甲等医院门诊就诊的耳鸣患者278例为研究对象,采用耳鸣致残量表、简化版元认知问卷、宾州担忧问卷、焦虑自评量表和抑郁自评量表等对其进行调查。基于结构方程模型分析耳鸣困扰、元认知信念、担忧及焦虑、抑郁之间的作用路径。结果 耳鸣患者耳鸣致残量表、焦虑自评量表、抑郁自评量表、宾州担忧问卷评分分别为(41.79±19.38)分、(47.80±11.60)分、(47.77±10.46)分和(41.34±10.45)分,简化版元认知问卷中得分最低的维度为控制想法的需要[(11.31±0.95)]分。除元认知问卷的认知自信维度,其余维度与耳鸣困扰及焦虑、抑郁和担忧情绪均呈正相关(P<0.01)。耳鸣困扰对焦虑、抑郁情绪有直接效应(β=0.72,β=0.57);而元认知和担忧可在耳鸣困扰与焦虑及抑郁情绪间起链式中介作用,中介效应值分别为0.30和0.11。结论 耳鸣困扰可通过直接作用和间接作用对患者的焦虑、抑郁情绪产生影响;医护人员应纠正患者的认知偏差并提高认知能动性,以积极应对耳鸣及其伴随的不良情绪。

Objective To explore the mediating effect of metacognitive beliefs and worries between tinnitus distress and anxiety as well as depression among tinnitus patients,so as to provide evidence for clinical diagnosis,treatment and nursing intervention. Methods A total of 278 tinnitus patients admitted to the outpatient department of a tertiary A hospital in Shandong Province were enrolled by the convenience sampling method from October 2024 to August 2025.All participants were investigated using the Tinnitus Handicap Inventory,Metacognition Questionnaire-30 (MCQ-30),Penn State Worry Questionnaire (PSWQ),Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS).Structural equation model was adopted to analyze the action paths among tinnitus distress,metacognitive beliefs,worry,anxiety and depression.Results The scores of Tinnitus Handicap Inventory,SAS,SDS and PSWQ were (41.79±19.38),(47.80±11.60),(47.77±10.46) and (41.34±10.45) respectively.Among all dimensions of MCQ-30,the need to control thoughts obtained the lowest score [(11.31±0.95)].Except for the cognitive confidence dimension of MCQ-30,other dimensions were positively correlated with tinnitus distress,worry,anxiety and depression (P<0.01).Tinnitus distress exerted direct effects on anxiety and depression (β=0.72,β=0.57).Metacognitive beliefs and worry played a chain mediating role between tinnitus distress and negative emotions,with the mediating effect values of 0.30 and 0.11 respectively.Conclusions Tinnitus distress affects patients' anxiety and depression through direct and indirect pathways.Medical staff should correct patients' cognitive bias and improve their cognitive initiative to help them cope positively with tinnitus and accompanying adverse emotions.

R473.76