目的 探讨家庭功能与心理弹性在口腔癌皮瓣移植患者病耻感与社会疏离间的链式中介效应，为患者早日回归社会提供依据。方法 2022年1月至2023年9月，采用便利抽样法选取长沙市某三级甲等医院行口腔癌皮瓣移植修复术后的患者147例为研究对象，采用一般疏离感量表、社会影响量表、家庭关怀度指数问卷、心理弹性量表对其进行调查。结果 口腔癌皮瓣移植患者的社会疏离、病耻感、心理弹性和家庭功能总分分别为（39.40±7.15）分、（57.00±12.03）分、（25.77±6.61）分、（6.96±1.66）分；社会疏离得分与病耻感总分呈正相关（r=0.650）、与家庭功能（r=-0.594）、心理弹性总分（r=-0.624）呈负相关（P＜0.001）。口腔癌皮瓣移植患者病耻感对社会疏离的直接效应为0.22，家庭功能与心理弹性均在口腔癌皮瓣移植患者病耻感与社会疏离感间起部分中介效应，中介效应值为0.05和0.03。二者连续路径起链式中介效应，中介效应值为0.02。结论 口腔癌皮瓣移植患者病耻感和社会疏离均为中等水平，病耻感可直接或通过家庭功能和心理弹性间接作用于社会疏离感，医护人员应采取干预措施提高患者家庭功能和心理弹性水平，减少其社会疏离。

Objective To explore the chain-mediated effects of family functioning and psychological resilience on the relationship between stigma and social alienation in oral cancer patients with flap transplantation.Methods 147 patients with flag graft repair for oral cancer in a tertiary A hospital in Changsha were selected by convenience sampling and surveyed with general alienation scale,social impact scale,family care index questionnaire and psychological resilience scale.Results The total scores of social alienation, stigma, psychological resilience and family functioning of these patients were (39.40±7.15),(57.00±12.0),(25.77±6.61),(6.96±1.66), respectively.The analysis showed a positive correlation between the scores for social alienation and those for stigma(r=0.650), and a negative correlation of the former with those of family functioning(r=-0.594) and psychological elasticity(r=-0.624).The direct effect of stigma on social alienation was 0.22,and both family functioning and psychological resilience had a partial mediating effect between stigma and social alienation in these patients,with mediating effect values of 0.05 and 0.03,respectively.The continuous path between the two had a chain mediating effect value of 0.02.Conclusions Patients with oral cancer flap transplantation experience a moderate level of stigma and social alienation.The stigma either directly influences social alienation or indirectly affects it through the mediating factors of family functioning and psychological resilience.Healthcare professionals should implement targeted intervention to enhance family’s support and psychological resilience,thereby reducing social alienation and improving the overall quality of life of these patients.

R473.73

湖南省科卫联合项目（2020JJ8019）