急性缺血性脑卒中溶栓代理决策者决策心理特征聚类及影响因素研究

doi:10.3761/j.issn.1672-9234.2024.10.018

摘要/Abstract

摘要：

目的探索急性缺血性脑卒中溶栓代理决策者不同决策心理特征的类别,并分析不同类别的影响因素,为制订溶栓决策辅助策略提供参考。方法便利选取2019年9月—2021年12月在河南省郑州市某综合性三级甲等医院急诊科就诊的急性缺血性脑卒中患者及其代理决策者为调查对象,采用一般资料问卷、决策参与期待量表、决策困境量表、维克森林医师信任量表在患者入院后48 h内收集调查对象的相关信息,使用误差平方和与轮廓系数确定最佳聚类簇数,采用K-means聚类分析完成最终聚类,通过无序多分类Logistic回归分析其影响因素。结果急性缺血性脑卒中溶栓代理决策者可分为“低信任—被动型—决策延迟”(9.1%)、“中等信任—合作型—决策冲突”(42.6%)、“非常信任—合作型—决策有效”(48.3%)3种类别,其影响因素包括决策者性别、参与决策人数(除代理决策者外)、决策者文化程度、决策者关于卒中知识的掌握程度、是否与患者同住、发病前患者月收入、美国国立卫生院神经功能缺损评分、患者发病时段(均P<0.05)。结论不同溶栓代理决策者的决策心理特征存在差异,医护人员应针对其心理特征提供个性化决策辅助措施,提高溶栓决策效率,加快溶栓知情同意进程,为挽救患者神经功能争取宝贵时机。

关键词: 急性缺血性脑卒中, 溶栓, 聚类分析, 影响因素分析, 决策困境

Abstract:

Objective To explore the categories of different decision-making psychological characteristics of thrombolytic agent decision makers in acute ischemic stroke and to analyze the influencing factors so as to provide reference for the development of thrombolytic decision aid strategies. Methods Acute ischemic stroke patients and their agent decision makers attending the emergency department of a comprehensive tertiary hospital in Zhengzhou City,Henan Province,from September 2019 to December 2021 were recruited as participants. General Information Questionnaire,Decision-making Participation Expectancy Scale,Decision Dilemma Scale,and the Wake Forest Physician Trust Scale were adopted to collect relevant information from participants within 48 hours of their admission. The optimal number of clusters was determined using sum of the squared errors and silhouette coefficients,the final clustering was completed using K-means cluster analysis,and the influencing factors were analyzed by unordered multicategorical logistic regression. Results Acute ischemic stroke thrombolytic agent decision makers were classified in to three types namely “low trust-passive-decision delay”(9.1%),“moderate trust-cooperative-decision conflict”(42.6%),and “very trust-cooperative-decision effective”(48.3%). Factors influencing the three categories included gender of the decision maker,number of decision makers,education level of decision makers,knowledge of the decision maker about stroke,whether the decision maker lived with the patient,patient’s income before the onset of stroke,NIHSS score,and time to onset of stroke(all P<0.05). Conclusion The psychological characteristics of decision makers differ among thrombolysis agents. Healthcare professionals should provide individualized decision aids to improve the efficiency of thrombolysis decision making,accelerate the process of informed consent for thrombolysis,and strive for valuable time to maintain patients’ neurological function.

Key words: Acute ischemic stroke, Thrombolysis, Cluster analysis, Influence factor analysis, Decision dilemma

范文凤, 马珂珂, 杨彩侠, 董小方, 郭丽娜, 魏苗, 曹镡雨, 郭园丽. 急性缺血性脑卒中溶栓代理决策者决策心理特征聚类及影响因素研究[J]. 中华护理教育, 2024, 21(10): 1263-1270.

FAN Wenfeng, MA Keke, YANG Caixia, DONG Xiaofang, GUO Lina, WEI Miao, CAO Tanyu, GUO Yuanli. Characteristic clustering and factor analysis of thrombolytic agent decision making in acute ischemic stroke[J]. Chinese Journal of Nursing Education, 2024, 21(10): 1263-1270.

图/表 4

参考文献 31

[1]	《中国脑卒中防治报告》编写组. 《中国脑卒中防治报告2020》概要[J]. 中国脑血管病杂志, 2022, 19(2):136-144.
[2]	中华护理学会内科专业委员会, 首都医科大学宣武医院. 急性缺血性脑卒中静脉溶栓护理指南[J]. 中华护理杂志, 2023, 58(1):10-15. doi: 10.3761/j.issn.0254-1769.2023.01.001
[3]	Wang YJ, Li SY, Pan YS, et al. Tenecteplase versus alteplase in acute ischaemic cerebrovascular events(TRACE-2):a phase 3,multicentre,open-label,randomised controlled,non-inferiority trial[J]. Lancet, 2023, 401(10377):645-654.
[4]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志, 2018, 51(9):666-682.
[5]	Darehed D, Blom M, Glader EL, et al. In-hospital delays in stroke thrombolysis:every minute counts[J]. Stroke, 2020, 51(8):2536-2539. doi: 10.1161/STROKEAHA.120.029468 pmid: 32586222
[6]	Thomalla G, Boutitie F, Fiebach JB, et al. Effect of informed consent on patient characteristics in a stroke thrombolysis trial[J]. Neurology, 2017, 89(13):1400-1407. doi: 10.1212/WNL.0000000000004414 pmid: 28842449
[7]	Weintraub MI, Colello AD, Johnson SA, et al. Informed consent for intravenous tissue plasminogen activator in New York State designated stroke centers[J]. J Stroke Cerebrovasc Dis, 2017, 26(6):1274-1279. doi: S1052-3057(17)30039-3 pmid: 28189569
[8]	Gong JJ, Zhang Y, Feng J, et al. How best to obtain consent to thrombolysis:individualized decision-making[J]. Neurology, 2016, 86(11):1045-1052.
[9]	郭园丽, 杨彩侠, 郭丽娜, 等. 急性缺血性脑卒中溶栓代理决策者的决策困境及影响因素[J]. 中华护理杂志, 2023, 58(1):23-30. doi: 10.3761/j.issn.0254-1769.2023.01.003
	Guo YL, Yang CX, Guo LN, et al. The decisional conflict and influence factors of proxies of patients with acute ischemic stroke in thrombolysis decision-making[J]. Chin J Nurs, 2023, 58(1):23-30. doi: 10.3761/j.issn.0254-1769.2023.01.003
[10]	郭园丽, 马珂珂, 杨彩侠, 等. 急性缺血性脑卒中患者及代理决策者溶栓决策的质性研究[J]. 护理学杂志, 2021, 36(16):43-46.
	Guo YL, Ma KK, Yang CX, et al. Decision-making of throm-bolytic therapy among acute ischemic stroke patients and their surrogates:a qualitative study[J]. J Nurs Sci, 2021, 36(16): 43-46.
[11]	Guo YL, Liu YJ, Guo LN, et al. Decision-making psychological state and characteristic of proxies of thrombolytic patients:a pilot study[J]. Sci Rep, 2022, 12(1):10345.
[12]	Skolarus LE, O’Brien A, Meurer WJ, et al. Getting the gist across is enough for informed consent for acute stroke thrombolytics[J]. Stroke, 2019, 50(6):1595-1597. doi: 10.1161/STROKEAHA.119.024653 pmid: 31084320
[13]	徐小琳. 患者对医疗决策参与的满意度量表的编制及信效度考评[D]. 长沙: 中南大学, 2010.
	Xu XL. Development and reliability and validity evaluation of patients’ satisfaction scale with medical decision-making participation[D]. Changsha: Central South University, 2010.
[14]	李玉. 早期原发性肝癌患者治疗决策辅助方案的构建与应用研究[D]. 上海: 第二军医大学, 2017.
	Li Y. Construction and application of treatment decision-making assistant scheme for patients with early primary liver cancer[D]. Shanghai: Second Military Medical University, 2017.
[15]	吴广建, 章剑林, 袁丁. 基于K-means的手肘法自动获取K值方法研究[J]. 软件, 2019, 40(5):167-170.
[16]	朱连江, 马炳先, 赵学泉. 基于轮廓系数的聚类有效性分析[J]. 计算机应用, 2010(S2):139-141,198.
[17]	李亚男, 仇丽霞, 李合欣, 等. 无序多分类logistic回归的SPSS软件实现及参数释义[J]. 山西医科大学学报, 2021, 52(9):1242-1246.
	Li YN, Qiu LX, Li HX, et al. SPSS software implementation and parameter interpretation of multinomial logistic regression[J]. J Shanxi Med Univ, 2021, 52(9):1242-1246.
[18]	Madrigal VN, Hill DL, Shults J, et al. Trust in physicians,anxiety and depression,and decision-making preferences among parents of children with serious illness[J]. J Palliat Med, 2022, 25(3):428-436.
[19]	刘朦朦, 孙小越, 郝雨, 等. 医患共同决策中的信任和沟通[J]. 医学与哲学, 2021, 42(14):26-29.
	Liu MM, Sun XY, Hao Y, et al. Trust and communication in shared decision-making[J]. Med Philos, 2021, 42(14):26-29.
[20]	Sun T, Chen HL, Gao Y, et al. Best-worst scaling survey of inpatients’ preferences in medical decision-making participa-tion in China[J]. Healthcare, 2023, 11(3):323.
[21]	吴清. 房颤患者参与治疗决策过程、影响因素及信息加工特征的研究[D]. 上海: 海军军医大学, 2019.
[22]	Kraetschmer N, Sharpe N, Urowitz S, et al. How does trust affect patient preferences for participation in decision-making[J]. Health Expect, 2004, 7(4):317-326. doi: 10.1111/j.1369-7625.2004.00296.x pmid: 15544684
[23]	张冉冉, 黄列玉, 陈永, 等. 大学生人格特质与性别因素和风险决策行为的关系[J]. 中国心理卫生杂志, 2020, 34(1):56-60.
	Zhang RR, Huang LY, Chen Y, et al. Relation of personality trait and gender factor to risk decision-making behavior in college students[J]. Chin Ment Health J, 2020, 34(1):56-60.
[24]	荣可欣. 急性脑梗死患者静脉溶栓治疗决策延迟现状及影响因素分析[D]. 沈阳: 中国医科大学, 2022.
[25]	潘远航, 吴群红, 郝艳华, 等. 基于因子分析法的医患信任危机成因研究[J]. 中国医院管理, 2017, 37(1):62-65.
[26]	Shamy MC, Jaigobin CS. The complexities of acute stroke decision-making:a survey of neurologists[J]. Neurology, 2013, 81(13):1130-1133.
[27]	杨洁, 谢小华, 连万成, 等. 急性缺血性脑卒中静脉溶栓后出血预测模型的构建与验证[J]. 护理学报, 2022, 29(5):10-14.
	Yang J, Xie XH, Lian WC, et al. Construction and verification of predictive model of hemorrhage after intravenous throm-bolysis in acute ischemic stroke[J]. J Nurs(China), 2022, 29(5):10-14.
[28]	郝吉轮, 付怀栋. 急性缺血性脑卒中病人血清Netrin-1水平与NIHSS评分、预后的关系[J]. 中西医结合心脑血管病杂志, 2021, 19(21):3782-3786.
[29]	田智斌, 姬利, 赵掌权, 等. 急性脑梗死患者静脉溶栓效果的影响因素分析[J]. 临床医学研究与实践, 2020, 5(18):1-3.
[30]	Sharobeam A, Jones B, Walton-Sonda D, et al. Factors delaying intravenous thrombolytic therapy in acute ischaemic stroke:a systematic review of the literature[J]. J Neurol, 2021, 268(8):2723-2734.
[31]	赵香梅, 杨先芝, 李法良, 等. 河南某医院脑梗死静脉溶栓治疗依从性分析[J]. 中华急诊医学杂志, 2017, 26(7):784-789.