目的 探讨家庭关怀度和社会心理适应在膀胱癌尿路造口患者病耻感与社会疏离间的中介作用。方法 采取便利抽样法选取2021年9月至2023年7月南京市某三级甲等医院收治的206例膀胱癌尿路造口患者为研究对象，采用一般资料调查表、社会影响量表、家庭关怀度指数问卷、造口社会心理适应量表和一般疏离感量表对其进行调查。结果 膀胱癌尿路造口患者的病耻感、家庭关怀度、社会心理适应和社会疏离总分分别为（65.26±12.70）分、（5.64±2.50）分、（33.34±12.65）分、（37.52±7.24）分；病耻感与社会疏离呈正相关（r=0.603），与家庭关怀度（r=-0.409）、社会心理适应（r=-0.536）呈负相关（均P＜0.05）。家庭关怀度和社会心理适应在膀胱癌尿路造口患者病耻感与社会疏离间起链式中介作用，中介效应值为0＜324，占总效应的44.38%。结论 病耻感不仅能直接影响膀胱癌尿路造口患者的社会疏离水平，也可通过家庭关怀度和社会心理适应间接影响其社会疏离水平；医护人员可通过构建干预支持网络提高患者的家庭关怀度和社会心理适应水平，从而降低其社会疏离水平。

Objective To explore the relationship between family APGAR and psychosocial adjustment between stigma and social alienation in bladder cancer patients with urostomy.Methods A convenience sampling method was adopted to select 206 bladder cancer patients with urostomy for in a tertiary A hospital in Nanjing from September 2021 to July 2023 as the research subjects.The general information questionnaire，social influence scale，family APGAR，stoma psychosocial adjustment scale and general alienation scale were used for investigation.Results The total scores of stigma，family APGAR，psychosocial adjustment and social alienation of these patients were (65.26±12.70)，(5.64±2.50)，(33.34±12.65) and (37.52±7＜24) respectively.The analysis showed a positive correlation between the scores for social alienation and those for stigma(r=0.603)，and a negatively correlated with family APGAR (r=-0.409) and psychosocial adjustment (r=-0.536)(all P＜0.01).Family APGAR and psychosocial adjustment play a chain mediating role in the relationship between stigma and social alienation in bladder cancer patients with urostomy.The mediating effect value was 0.324，accounting for 44.38% of the total effect.Conclusions Stigma can not only directly affect the level of social alienation of bladder cancer patients with urostomy，but also indirectly affect their level of social alienation through family APGAR and psychosocial adjustment.Medical staff can improve patients’ family APGAR and psychosocial adjustment and reduce their level of social alienation by building an intervention support network.

R473.73

国家自然科学基金项目（81974394）；南京大学中国医院改革发展研究院课题项目（NDYGN2023013）；南京鼓楼医院护理重点科研项目（2024-B2138）