广西医学

目的探讨应对方式在老年脑卒中住院患者社会支持水平与疾病不确定感之间的中介效应。方法采用疾病不确定感成人量表（MUIS⁃A）、社会支持评定量表（SSRS）和医学应对方式问卷（MCMQ）对208例老年脑卒中住院患者进行问卷调查。分析各量表得分之间的相关性，并采用线性回归模型分析应对方式在老年脑卒中住院患者社会支持水平与疾病不确定感之间的中介效应。结果患者的MUIS⁃A总得分为（90.79±14.60）分，SSRS总得分为（37.89±6.95）分，MCMQ面对、回避、屈服维度得分分别为（15.91±4.14）分、（15.88±2.75）分、（9.44±3.83）分。MUIS⁃A总得分与MCMQ面对维度得分、SSRS总得分均呈负相关，与MCMQ屈服维度得分呈正相关（P <0.05）；SSRS总得分与MCMQ中的面对维度、回避维度得分呈正相关，与MCMQ屈服维度得分呈负相关（P <0.05）。中介效应结果显示，面对应对方式在社会支持水平与疾病不确定感间不存在中介效应，而屈服应对方式在两者之间存在完全中介效应。结论老年脑卒中住院患者的社会支持水平与疾病不确定感水平呈负相关，屈服应对方式在两者之间存在完全中介效应。医护人员不仅应注意评估患者应对疾病的方式，采取针对性的干预措施以改变患者对疾病的消极应对方式，还应关注患者的社会支持状况，为患者提供充足的社会支持，进而降低疾病不确定感。

Objective To explore the mediating effect of coping modes between social support level and disease uncertainty in elderly inpatients with cerebral stroke. Methods Questionnaire investigation was performed on 208 elderly inpatients with cerebral stroke by using the Mishel Uncertainty in Illness Scale⁃Adult (MUIS⁃A), Social Support Rating Scale (SSRS), and the Medical Coping Modes Questionnaire (MCMQ). The correlations between the scores of various scales were analyzed, and the linear regression model was used to analyze the mediating effect of coping modes between social support level and disease uncertainty in elderly inpatients with cerebral stroke. Results Patients obtained the total score of MUIS⁃A of 90.79±14.60, total score of SSRS of 37.89±6.95, and scores of confrontation, avoidance, and yielding dimensions of MCMQ of 15.91±4.14, 15.88±2.75, and 9.44±3.83, respectively. The total score of MUIS⁃A negatively correlated with score of confrontation dimension of MCMQ and SSRS total score, and positively correlated with MCMQ yielding dimension score (P<0.05); furthermore, SSRS total score positively correlated with scores of confrontation dimension and avoidance dimension of MCMQ, and negatively correlated with score of yielding dimension of MCMQ (P<0.05). The results of mediating effect revealed that there was no mediating effect of confrontation coping mode between social support level and disease uncertainty, while there was a perfect mediating effect of yielding coping mode between the two. Conclusion Social support level negatively correlates with disease uncertainty in elderly inpatients with cerebral stroke, and there is a perfect mediating effect of yielding coping mode between the two as above. Medical and nursing staff should not only pay attention to evaluate coping modes on diseases in patients and take targeted interventions to change patients' negative coping modes on diseases, but also pay attention to patients' social support status and provide adequate social support for patients, so as to reduce disease uncertainty.