自我感受负担和医学应对方式在原发性青光眼患者家庭关怀度与生活质量间的链式中介作用

Chain mediating effect of self-perceived burden and medical coping styles between family APGAR and quality of life in primary glaucoma patients

摘要

目的 探讨原发性青光眼患者家庭关怀度、自我感受负担、医学应对方式和生活质量之间的关系,为提升原发性青光眼患者的生活质量提供参考。方法 2025年3月至2025年11月,采用便利抽样法选取芜湖市3所三级医院眼科住院的362例原发性青光眼患者作为研究对象,采用一般资料调查表、家庭关怀度指数量表、自我感受负担量表、医学应对方式问卷、视功能相关生活质量量表进行调查。结果 原发性青光眼患者家庭关怀度得分(5.13±2.08)分,自我感受负担得分(31.06±7.81)分,面对维度得分(18.41±4.15)分,回避维度得分(15.38±3.32)分,屈服维度得分(9.30±3.27)分,生活质量得分(58.57±13.96)分;Pearson相关性分析显示,生活质量与家庭关怀度、面对应对方式呈正相关(r=0.634,P<0.01;r=0.742,P<0.01),与自我感受负担、回避及屈服应对方式均呈负相关(r=-0.771,P<0.01;r=-0.386,P<0.01;r=-0.800,P<0.01);链式中介效应分析显示,家庭关怀度对生活质量的总效应值为0.456(95%CI:0.364~0.549,P<0.01);自我感受负担和面对应对在家庭关怀度和生活质量间的效应值为0.064(95%CI:0.039~0.094,P<0.01),占比14.04%;自我感受负担和屈服应对在家庭关怀度和生活质量间的效应值为0.092(95%CI:0.062~0.129,P<0.01),占比20.18%。结论 家庭关怀度不仅直接影响原发性青光眼患者的生活质量,还可通过自我感受负担和应对方式的中介效应间接影响其生活质量。医护人员要关注患者的家庭功能和心理状态,通过心理疏导和健康教育,提升家庭关怀度,减轻患者自我感受负担,帮助患者采取积极的应对方式,以提升原发性青光眼患者生活质量。

Abstract

Objective To explore the relationship between family APGAR,self-perceived burden,medical coping styles,and quality of life among primary glaucoma patients,to provide a reference to improve the quality of life in primary glaucoma patients. Methods A total of 362 primary glaucoma patients in the departments of three tertiary hospitals in Wuhu City from March 2025 to November 2025 were selected by a convenience sampling method.Data collection was conducted using a general information questionnaire,the family APGAR index,the Self-Perceived Burden Scale,the Medical Coping Modes Questionnaire,and the National Eye Institute-Vision Functioning Questionnaire. Results The family caregiving score for patients with primary glaucoma was 5.13±2.08;the self-perceived burden score was 31.06±7.81;the confrontation dimension score was 18.41±4.15;the avoidance dimension score was 15.38±3.32;and the resignation dimension score was 9.30±3.27,and the quality of life score was 58.57±13.96.Pearson correlation analysis revealed that quality of life was positively correlated with family care and confrontation (r=0.634,P<0.01;r=0.742,P<0.01),and was negatively correlated with perceived burden,avoidance,and submission coping styles (r=-0.771,P<0.01;r=-0.386,P<0.01;r=-0.800,P<0.01).Chain mediation analysis revealed that the total effect size of family care on quality of life was 0.456 (95%CI:0.364~0.549,P<0.01);The effect size of self-perceived burden and coping strategies on the relationship between family care and quality of life was 0.064 (95%CI:0.039~0.094,P<0.01),accounting for 14.04% of the total effect;The effect size of self-perceived burden and resignation coping on the relationship between family care and quality of life was 0.092 (95%CI:0.062~0.129,P<0.01),accounting for 20.18% of the total effect. Conclusion Family APGAR can not only directly affect the quality of life of primary glaucoma patients,but also indirectly affect their quality of life through the mediating effects of self-perceived burden and medical coping styles.Medical staff should pay attention to the family dynamics and psychological well-being of glaucoma patients.Through psychological counseling and health education,they can enhance family support,alleviate the patients′ emotional burden,and help them adopt positive coping strategies to improve their quality of life.

关键词

原发性青光眼 / 家庭关怀度 / 自我感受负担 / 医学应对 / 生活质量

Key words

Primary glaucoma / Family APGAR / Self-perceived burden / Medical coping / Quality of life

参考文献

[1] 中华医学会眼科学分会青光眼学组, 中国医师协会眼科医师分会青光眼学组 . 中国青光眼指南(2020年)[J]. 中华眼科杂志, 2020, 56(8): 573-586.DOI: 10.3760/cma.j.cn112142-20200313-00182.

[2] Flaxman SR, Bourne R, Resnikoff S, et al. Global causes of blindness and distance vision impairment 1990-2020:a systematic review and meta-analysis[J]. Lancet Glob Health, 2017, 5(12): e1221-e1234.DOI: 10.1016/S2214-109X(17)30393-5.

[3] Cheng CY, Wang N, Wong TY, et al. Prevalence and causes of vision loss in East Asia in 2015:magnitude,temporal trends and projections[J]. Br J Ophthalmol, 2020, 104(5): 616-622.DOI: 10.1136/bjophthalmol-2018-313308.

[4] 特日格勒, 姜振英, 曹楠, 等 . 慢性病患者自我感受负担干预研究进展[J]. 中国护理管理, 2018, 18(2): 245-248.DOI: 10.3969/j.issn.1672-1756.2018.02.022.

[5] 齐玉, 刘馨竹, 孙晓茹, 等 . 老年原发性青光眼患者灵性护理需求现状及其与自我感受负担、领悟社会支持的相关性分析[J]. 中国实用护理杂志, 2023, 39(6): 438-445.DOI: 10.3760/cma.j.cn211501-20221026-03287.

[6] 向俊玲, 陈红宇, 胡君娥, 等 . 医学应对方式在慢性病患者中应用的研究进展[J]. 当代护士, 2022, 29(3): 35-39.DOI: 10.19793/j.cnki.1006-6411.2022.03.010.

[7] 刘都晨, 丁梅, 贺媛, 等 . 老年人述情障碍与家庭关怀度关系的研究进展[J]. 赣南医学院学报, 2022, 42(5): 547-552.DOI: 10.3969/j.issn.1001-5779.2022.05.024.

[8] Smilkstein G . The family APGAR:a proposal for a family function test and its use by physicians[J]. J Fam Pract, 1978, 6(6): 1231-1239.

[9] 吕繁, 曾光, 刘松暖, 等 . 家庭关怀度指数问卷测量脑血管病病人家庭功能的信度和效度研究[J]. 中国公共卫生, 1999(11): 27-28.

[10] Cousineau N, McDowell I, Hotz S, et al. Measuring chronic patients' feelings of being a burden to their caregivers:development and preliminary validation of a scale[J]. Med Care, 2003, 41(1): 110-118.DOI: 10.1097/00005650-200301000-00013.

[11] 武燕燕, 姜亚芳 . 癌症患者自我感受负担的调查与分析[J]. 护理管理杂志, 2010, 10(6): 405-407.DOI: 10.3969/j.issn.1671-315X.2010.06.011.

[12] Feifel H, Strack S, Nagy VT . Coping strategies and associated features of medically ill patients[J]. Psychosom Med, 1987, 49(6): 616-625.DOI: 10.1097/00006842-198711000-00007.

[13] 沈晓红, 姜乾金 . 医学应对方式问卷中文版701例测试报告[J]. 中国行为医学科学, 2000(1): 22-24.DOI: 10.3760/cma.j.issn.1674-6554.2000.01.008.

[14] Mangione CM, Lee PP, Gutierrez PR, et al. Development of the 25-item national eye institute visual function questionnaire[J]. Arch Ophthalmol, 2001, 19(7): 1050-1058.DOI: 10.1001/archopht.119.7.1050.

[15] 王曾仪, 梁曦达, 郁艳萍, 等 . 特发性黄斑裂孔患者视网膜敏感度与视觉相关生活质量的关系[J]. 中华实验眼科杂志, 2019, 37(1): 35-39.DOI: 10.3760/cma.j.issn.2095-0160.2019.01.008.

[16] 秦小美, 梁远波, 原慧萍 . 原发性慢性青光眼患者双眼视觉和生活质量相关性研究[J]. 眼科学报, 2021, 36(6): 465-472.DOI: 10.3978/j.issn.1000-4432.2021.06.05.

[17] 周红薇, 张金玲, 唐广贤, 等 . 青光眼滤过泡针刺分离患者治疗前后视功能相关生存质量的研究[J]. 河北医药, 2022, 44(11): 1654-1657, 1662.DOI: 10.3969/j.issn.1002-7386.2022.11.012.

[18] 刘擎晴, 赵士燕, 王平, 等 . 青光眼患者自我感受负担现状与心理弹性的相关性研究[J]. 心理月刊, 2024, 19(16): 22-24,28.DOI: 10.19738/j.cnki.psy.2024.16.006.

[19] 张宏晨, 王艳红, 唐楠, 等 . 自我效能感和自我管理能力在农村老年冠心病患者家庭关怀度与生活质量间的中介作用[J]. 解放军护理杂志, 2021, 38(5): 13-16.DOI: 10.3969/j.issn.1008-9993.2021.05.004.

[20] 郑璐 . 老年青光眼患病现状及其影响因素调查[J]. 锦州医科大学学报, 2022, 43(1): 93-96.DOI: 10.13847/j.cnki.lnmu.2022.01.009.

[21] 张丽 . 家庭及同伴支持护理对改善青光眼患者自我效能及心理弹性的影响[J]. 护理实践与研究, 2022, 19(3): 452-455.DOI: 10.3969/j.issn.1672-9676.2022.03.033.

[22] 谭思娜, 陈文莺 . 家庭复原力对青光眼病人负性情绪与生活质量的影响[J]. 全科护理, 2020, 18(17): 2153-2155.DOI: 10.12104/ji.ssn.1674-4748.2020.17.032.

[23] Shtein RM, Newman-Casey PA, Herndon L, et al. Assessing the role of the family/support system perspective in patients with glaucoma[J]. J Glaucoma, 2016, 25(7): e676-e680.DOI: 10.1097/IJG.0000000000000332.

基金资助

安徽省社会科学创新发展研究课题(2023CX102)