健康生态学视域下慢性阻塞性肺疾病急性加重期患者无法忍受不确定性现状及影响因素研究

doi:10.12114/j.issn.1007-9572.2025.0251

中国全科医学 ›› 2026, Vol. 29 ›› Issue (11): 1434-1440.DOI: 10.12114/j.issn.1007-9572.2025.0251

• 论著 • 上一篇

健康生态学视域下慢性阻塞性肺疾病急性加重期患者无法忍受不确定性现状及影响因素研究

杨芳婷¹, 徐俊风², 杨琴², 马英芝³, 周玲², 肖江琴⁴^,⁵^,^*()

1．830017　新疆维吾尔自治区乌鲁木齐市，新疆医科大学护理学院
2．832003　新疆维吾尔自治区石河子市，石河子大学医学院护理系
3．830001　新疆维吾尔自治区乌鲁木齐市，新疆维吾尔自治区人民医院重症医学科
4．830001　新疆维吾尔自治区乌鲁木齐市，新疆维吾尔自治区人民医院护理部
5．830000　新疆维吾尔自治区乌鲁木齐市，新疆区域人群疾病与健康照护研究中心

收稿日期:2025-07-14 修回日期:2025-09-18 出版日期:2026-04-15 发布日期:2026-03-12
通讯作者: 肖江琴
作者贡献：
杨芳婷和肖江琴负责构思、方案设计和提出核心观点；徐俊风、杨琴负责进行研究对象筛选、数据收集和核对；杨芳婷负责数据分析和论文撰写；马英芝负责对文章进行修改；周玲负责对文献资料进行整理；肖江琴负责把控论文整体情况，对论文负责。
基金资助:
新疆维吾尔自治区自然科学基金资助项目(2022DC111); 新疆第二医学院2025年校级科研基金项目资助(ZR202561)

Analysis of the Current Situation and Influencing Factors of Intolerance of Uncertainty in AECOPD Patients under the Perspective of Health Ecology

YANG Fangting¹, XU Junfeng², YANG Qin², MA Yingzhi³, ZHOU Ling², XIAO Jiangqin⁴^,⁵^,^*()

1. School of Nursing, Xinjiang Medical University, Urumqi 830017, China
2. Department of Nursing, School of Medicine, Shihezi University, Shihezi 832003, China
3. Department of Critical Care Medicine, Xinjiang Uygur Autonomous Region People's Hospital, Urumqi 830001, China
4. Nursing Department, Xinjiang Uygur Autonomous Region People's Hospital, Urumqi 830001, China
5. Health Care Research Center for Xinjiang Regional Population, Urumqi 830000, China

Received:2025-07-14 Revised:2025-09-18 Published:2026-04-15 Online:2026-03-12
Contact: XIAO Jiangqin

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摘要/Abstract

摘要： 背景慢性阻塞性肺疾病急性加重期（AECOPD）患者长期面临疾病不确定性，处于高应激状态，其无法忍受不确定性的心理特质与不良健康结局密切相关，但现有研究缺乏基于多层级生态系统的综合分析。目的健康生态学视域下分析AECOPD患者无法忍受不确定性现状及影响因素，为制定针对性干预策略提供参考依据。方法选取2024年11月—2025年6月新疆维吾尔自治区人民医院呼吸与危重症医学中心AECOPD患者为调查对象，收集患者的一般资料，采用简版无法忍受不确定性量表、接纳与行动问卷第二版、慢性阻塞性肺疾病健康素养量表、领悟社会支持量表等进行横断面调查，分别测量患者的无法忍受不确定性、心理灵活性、健康素养和社会支持水平。采用Pearson相关性分析探讨心理灵活性、健康素养、社会支持与无法忍受不确定性的相关性；采用多元线性回归分析探讨AECOPD患者无法忍受不确定性的影响因素。结果共发放问卷360份，回收有效问卷342份，有效回收率为95.0%。342例AECOPD患者无法忍受不确定性总分为（32.2±7.1）分，心理灵活性、健康素养、社会支持得分分别为（24.7±8.6）、（6.9±2.4）、（54.7±11.8）分。相关分析结果显示，无法忍受不确定性得分与心理灵活性得分呈正相关（r=0.648，P<0.001）；与健康素养和社会支持得分呈负相关（r=-0.548、-0.643，P<0.001）。多元线性回归分析结果显示，合并症数量（B=1.057，95%CI=0.552~1.563）、入院次数（B=1.646，95%CI=0.409~2.882）、是否规律锻炼（B=1.670，95%CI=0.551~2.789）、月均服药费用（B=2.962，95%CI=1.623~4.300）、心理灵活性（B=0.151，95%CI=0.065~0.238）、健康素养（B=-0.754，95%CI=-0.992~-0.517）、社会支持（B=-0.128，95%CI=-0.188~-0.068）是AECOPD患者无法忍受不确定性的主要影响因素（P<0.05）。结论 AECOPD患者无法忍受不确定性处于中等偏高水平，其无法忍受不确定性受多层次因素影响，应根据患者病情及心理、家庭、社会等多角度对AECOPD患者进行综合干预。

关键词: 慢性阻塞性肺疾病急性加重期, 无法忍受不确定性, 影响因素分析, 健康生态学

Abstract:

Background

Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are chronically exposed to disease uncertainty and high stress, and their psychological trait of intolerance of uncertainty is strongly associated with poor health outcomes, but existing research lacks comprehensive analyses based on multilevel ecosystems.

Objective

To analyze the current situation and influencing factors of intolerance of uncertainty in patients with AECOPD under the perspective of health ecology, and to provide reference for formulating targeted intervention strategies.

Methods

From November 2024 to June 2025, patients with AECOPD in the Respiratory and Critical Care Medicine Center of Xinjiang Uygur Autonomous Region People's Hospital were conveniently selected as the survey objects. The Intolerance of Uncertainty Scale-12, the Acceptance and Action Questionnaire-Ⅱ, the COPD Knowledge Questionnaire, and the Perceived Social Support Scale were used to conduct a cross-sectional survey. Pearson correlation analysis was used to explore the correlations among psychological flexibility, health literacy, social support and intolerance of uncertainty. Multiple linear regression analysis was adopted to investigate the influencing factors of intolerance of uncertainty in patients with AECOPD.

Results

A total of 360 questionnaires were distributed in this study. 342 valid questionnaires were recovered, with an effective recovery rate of 95.0%. 342 patients with AECOPD had a total score of intolerance of uncertainty (32.2±7.1). The scores of psychological flexibility, health literacy and social support were (24.7±8.6), (6.9±2.4), (54.7±11.8). The results of the correlation analysis indicated that the score of intolerance of uncertainty was positively correlated with the score of psychological flexibility (r=0.648, P<0.001), and negatively correlated with the scores of health literacy and social support (r=-0.548, -0.643, P<0.001). Multiple linear regression analysis showed that the number of comorbidities (B=1.057, 95%CI=0.552-1.563), number of hospital admissions (B=1.646, 95%CI=0.409-2.882), regular exercise (B=1.670, 95%CI=0.551-2.789), average monthly medication cost (B=2.962, 95%CI=1.623-4.300), psychological flexibility (B=0.151, 95%CI=0.065-0.238), health literacy (B=-0.754, 95%CI=-0.992 to -0.517), and social support (B=-0.128, 95%CI=-0.188 to -0.068) were the main influencing factors of intolerance of uncertainty in patients with AECOPD (P<0.05).

Conclusion

The intolerance of uncertainty of AECOPD patients is at a moderately high level, and their intolerance of uncertainty is influenced by the multilevel factors. Comprehensive interventions should be carried out for AECOPD patients according to the patient's condition and from multiple perspectives, such as psychological, family, and social.

Key words: Acute exacerbation of chronic obstructive pulmonary disease, Intolerance of uncertainty, Root cause analysis, Health ecology

中图分类号:

R 563.9

杨芳婷,徐俊风,杨琴,等. 健康生态学视域下慢性阻塞性肺疾病急性加重期患者无法忍受不确定性现状及影响因素研究[J]. 中国全科医学, 2026, 29(11): 1434-1440. DOI: 10.12114/j.issn.1007-9572.2025.0251.
YANG Fangting,XU Junfeng,YANG Qin, et al. Analysis of the Current Situation and Influencing Factors of Intolerance of Uncertainty in AECOPD Patients under the Perspective of Health Ecology[J]. Chinese General Practice, 2026, 29(11): 1434-1440. DOI: 10.12114/j.issn.1007-9572.2025.0251.

图/表 3

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项目	例数	IUS-12总分	F（t）值	P值	项目	例数	IUS-12总分	F（t）值	P值
年龄			1.212	0.299	婚姻状况			-2.394^a	0.017
40~<60岁	76	31.7±7.8			已婚	307	31.9±7.2
60~70岁	128	31.7±6.6			未婚/离异/丧偶	35	34.9±6.1
>70岁	138	32.9±7.5			受教育程度			1.343	0.260
性别			1.122^a	0.263	小学及以下	157	32.8±7.1
男	161	32.7±7.6			初中	74	32.5±6.7
女	181	31.8±6.7			高中	69	30.9±7.3
合并症数量			25.406	<0.001	本科及以上	42	31.5±7.4
0种	50	25.7±4.9			家庭人均月收入			1.858	0.137
1种	92	31.6±6.5			<2 000元	68	32.1±7.9
2种	97	32.8±6.7			2 000~<4 000元	142	32.2±6.7
≥3种	103	35.3±6.8			4 000~<6 000元	109	33.0±7.1
病程			1.988	0.139	≥6 000元	23	29.1±7.0
<5年	153	32.2±6.8			月均服药费用			-11.558^a	<0.001
5~10年	101	31.3±7.1			≤500元	259	30.1±6.0
>10年	88	33.3±7.5			>500元	83	38.9±6.2
入院次数			-6.133^a	<0.001	居住地			0.902^a	0.367
<2次	265	31.0±6.1			城镇	238	32.4±7.2
≥2次	77	36.4±8.6			农村	104	31.7±7.0
是否规律锻炼			-9.668^a	<0.001	医疗保险类型			0.289	0.834
是	128	28.0±6.5			自费	10	31.6±6.3
否	214	34.8±6.2			城镇居民基本医疗保险	158	32.6±7.3
平均夜间睡眠时间			2.146^a	0.033	城镇职工医疗保险	132	31.9±7.2
<6 h	290	32.6±7.0			新型农村合作医疗	42	32.0±6.2
≥6 h	52	30.3±7.4

项目	例数	IUS-12总分	F（t）值	P值	项目	例数	IUS-12总分	F（t）值	P值
年龄			1.212	0.299	婚姻状况			-2.394^a	0.017
40~<60岁	76	31.7±7.8			已婚	307	31.9±7.2
60~70岁	128	31.7±6.6			未婚/离异/丧偶	35	34.9±6.1
>70岁	138	32.9±7.5			受教育程度			1.343	0.260
性别			1.122^a	0.263	小学及以下	157	32.8±7.1
男	161	32.7±7.6			初中	74	32.5±6.7
女	181	31.8±6.7			高中	69	30.9±7.3
合并症数量			25.406	<0.001	本科及以上	42	31.5±7.4
0种	50	25.7±4.9			家庭人均月收入			1.858	0.137
1种	92	31.6±6.5			<2 000元	68	32.1±7.9
2种	97	32.8±6.7			2 000~<4 000元	142	32.2±6.7
≥3种	103	35.3±6.8			4 000~<6 000元	109	33.0±7.1
病程			1.988	0.139	≥6 000元	23	29.1±7.0
<5年	153	32.2±6.8			月均服药费用			-11.558^a	<0.001
5~10年	101	31.3±7.1			≤500元	259	30.1±6.0
>10年	88	33.3±7.5			>500元	83	38.9±6.2
入院次数			-6.133^a	<0.001	居住地			0.902^a	0.367
<2次	265	31.0±6.1			城镇	238	32.4±7.2
≥2次	77	36.4±8.6			农村	104	31.7±7.0
是否规律锻炼			-9.668^a	<0.001	医疗保险类型			0.289	0.834
是	128	28.0±6.5			自费	10	31.6±6.3
否	214	34.8±6.2			城镇居民基本医疗保险	158	32.6±7.3
平均夜间睡眠时间			2.146^a	0.033	城镇职工医疗保险	132	31.9±7.2
<6 h	290	32.6±7.0			新型农村合作医疗	42	32.0±6.2
≥6 h	52	30.3±7.4

健康生态学视域下慢性阻塞性肺疾病急性加重期患者无法忍受不确定性现状及影响因素研究

Analysis of the Current Situation and Influencing Factors of Intolerance of Uncertainty in AECOPD Patients under the Perspective of Health Ecology

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项目	B	95%CI	SE	β	t值	P值
常量	29.558	23.247~35.869	3.208	—	9.214	<0.001
合并症数量	1.057	0.552~1.563	0.257	0.155	4.113	<0.001
入院次数	1.646	0.409~2.882	0.629	0.097	2.618	0.009
是否规律锻炼	1.670	0.551~2.789	0.569	0.114	2.935	0.004
月均服药费用	2.962	1.623~4.300	0.680	0.179	4.353	<0.001
心理灵活性	0.151	0.065~0.238	0.044	0.183	3.428	0.001
健康素养	-0.754	-0.992~-0.517	0.121	-0.249	-6.239	<0.001
社会支持	-0.128	-0.188~-0.068	0.031	-0.212	-4.191	<0.001

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