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 from the perspective of health ecology，and to provide reference for formulating targeted intervention strategies. Methods From November 2024 to June 2025，342 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. Results 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）. Multiple linear regression analysis showed that the number of comorbidities（β=0.155，95%CI=0.552~1.563），number of hospital admissions（β=0.097，95%CI=0.409~2.882），regular exercise（β=0.114，95%CI=0.551~2.789），average monthly medication cost（β=0.179，95%CI=1.623~4.300），psychological flexibility（β=0.183，95%CI=0.065~0.238），health literacy（β=-0.249，95%CI=-0.992~-0.517），and social support（β=-0.212，95%CI=-0.188~-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 interaction of 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 model

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和高应激状态，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 便利选取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患者作为调查对象，收集患者的一般资料，并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。结果 共发放问卷360份，回收有效问卷342份，有效回收率为95%。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。多元线性回归分析结果显示，合并症数量（β=0.155，95%CI=0.552~1.563）、入院次数（β=0.097，95%CI=0.409~2.882）、是否规律锻炼（β=0.114，95%CI=0.551~2.789）、月均服药费用（β=0.179，95%CI=1.623~4.300）、心理灵活性（β=0.183，95%CI=0.065~0.238）、健康素养（β=-0.249，95%CI=-0.992~-0.517）、社会支持（β=-0.212，95%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交互影响，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, 健康生态学模型