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Article(id=1322169073664905417, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322168583854080893, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.08.010, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1753027200000, receivedDateStr=2025-07-21, revisedDate=1774627200000, revisedDateStr=2026-03-28, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159271875, onlineDateStr=2026-10-28, pubDate=1777046400000, pubDateStr=2026-04-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159271875, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159271875, creator=13701087609, updateTime=1793159271875, updator=13701087609, issue=Issue{id=1322168583854080893, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='8', pageStart='1241', pageEnd='1424', issueExtLink='null', onlineDate='null', pubDate='1777046400000', pubDateStr='2026-04-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793159155095, creator='13701087609', updateTime=1793159155095, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1317, endPage=1322, ext={EN=ArticleExt(id=1322169073966895306, articleId=1322169073664905417, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Qualitative study on the disease adaptation dilemma of lung transplant patients, columnId=1220689488284668633, journalTitle=Chinese Nursing Research, columnName=Comprehensive Study, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the dynamic changes of disease adaptation dilemma in patients undergoing lung transplantation at different stages,and to provide basis for formulating precise rehabilitation intervention strategies.

Methods

Using purposive sampling,a total of 15 lung transplant patients who were hospitalized in a tertiary grade A hospital in Henan province from June 2024 to March 2025 were selected as the research subjects.According to the timing theory,semi-structured interviews were conducted with the patients.The data were analyzed using the Colaizzi's 7-step analysis method.

Results

Based on the timing theory,five stages of development for lung transplant patients were formed.Five themes were extracted:the diagnosis stage(the dual dilemma of cognitive disruption and life decision-making),the hospital stabilization stage(the adaptation dilemma of life transition and physical and mental upheaval),the discharge preparation stage(the dilemma of rapid recovery desire and lack of discharge preparation ability),the adjustment stage(the dilemma of establishing a new normal and reconstructing life),and the adaptation stage(accumulation of negative emotions and persistent existence of adaptation dilemmas).

Conclusions

The disease adaptation dilemma of lung transplant patients at different stages were dynamically changing.Medical staff should provide lung transplant rehabilitation management in a phased, planned, and continuous manner based on the adaptation difficulties at each stage,so as to facilitate the rapid recovery of lung transplant patients.

, authors=Saisai LIU, Shuang HE, Hui YANG, Ruiyun CHEN, Yaxin QIAO, Jingru CHEN, authorsList=Saisai LIU, Shuang HE, Hui YANG, Ruiyun CHEN, Yaxin QIAO, Jingru CHEN, authorCompany=null, correspAuthors=Saisai LIU, authorNote=null, correspAuthorsNote=
LIU Saisai， E-mail：
, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322169074382131403, articleId=1322169073664905417, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=肺移植病人疾病适应困境的质性研究, columnId=1220689488938980091, journalTitle=护理研究, columnName=综合研究, runingTitle=null, highlight=null, articleAbstract=
目的

探讨肺移植病人不同阶段疾病适应困境的动态变化，为制定精准康复干预策略提供依据。

方法

采用目的抽样法，选取2024年6月—2025年3月在河南省某三级甲等医院住院的15例肺移植病人作为研究对象。根据时机理论，对病人进行半结构化访谈，采用Colaizzi 7步分析法整理分析资料。

结果

结合时机理论形成肺移植发展的5个阶段，提炼出5个主题：诊断期（认知颠覆与生命抉择的双重困境）、住院稳定期（生命过渡与身心剧变的适应困境）、出院准备期（快速康复意愿与出院准备能力不足的困境）、调整期（新常态建立与生活重构的困境）、适应期（消极情绪累积，适应困境持续存在）。

结论

肺移植病人不同阶段的适应困境呈动态变化。医护人员应根据不同阶段的适应困境，阶段性、计划性、持续性地提供肺移植康复管理，促进肺移植病人快速康复。

, authors=刘赛赛, 何爽, 杨慧, 陈瑞云, 乔亚欣, 陈静儒, authorsList=刘赛赛, 何爽, 杨慧, 陈瑞云, 乔亚欣, 陈静儒, authorCompany=null, correspAuthors=刘赛赛, authorNote=null, correspAuthorsNote=
LIU Saisai， E-mail：
刘赛赛，主管护师，硕士研究生，E-mail：
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journalId=1220038315760373764, articleId=1322169073664905417, language=CN, orderNo=5, keyword=护理)], refs=[Reference(id=1322530534195049277, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322169073664905417, doi=null, pmid=null, pmcid=null, year=2023, volume=15, issue=10, pageStart=5856, pageEnd=5862, url=null, language=null, rfNumber=1, rfOrder=0, authorNames=SUZUKI H, YOSHINO I, journalName=Journal of Thoracic Disease, refType=null, unstructuredReference=SUZUKI H,YOSHINO I.A narrative review on the management of patients awaiting lung transplantation in Japan[J].Journal of Thoracic Disease,2023,15(10):5856-5862., articleTitle=A narrative review on the management of patients awaiting lung transplantation in Japan, refAbstract=null), Reference(id=1322530534266352446, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322169073664905417, doi=null, pmid=null, pmcid=null, year=2023, volume=42, issue=5, pageStart=e1, pageEnd=e141, url=null, language=null, rfNumber=2, rfOrder=1, authorNames=VELLECA A, SHULLO M A, DHITAL K, journalName=The Journal of Heart and Lung Transplantation, refType=null, unstructuredReference=VELLECA A,SHULLO M A,DHITAL K,et al.The International Society for Heart and Lung Transplantation(ISHLT) guidelines for the care of heart transplant recipients[J].The Journal of Heart and Lung Transplantation,2023,42(5):e1-e141., articleTitle=The International Society for Heart and Lung Transplantation(ISHLT) guidelines for the care of heart transplant recipients, refAbstract=null), Reference(id=1322530534341849919, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322169073664905417, doi=null, pmid=null, pmcid=null, year=2023, volume=null, issue=null, pageStart=44, pageEnd=51, url=null, language=null, rfNumber=3, rfOrder=2, authorNames=中国器官移植发展基金会, journalName=中国器官移植发展报告(2021), refType=null, unstructuredReference=中国器官移植发展基金会.中国器官移植发展报告(2021)[M].北京:人民卫生出版社,2023:44-51., articleTitle=null, 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refAbstract=null), Reference(id=1322530535121990473, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322169073664905417, doi=null, pmid=null, pmcid=null, year=2023, volume=38, issue=2, pageStart=108, pageEnd=112, url=null, language=null, rfNumber=13, rfOrder=12, authorNames=王熔, 赵庆, 蔡英华, journalName=护理学杂志, refType=null, unstructuredReference=王熔,赵庆,蔡英华,等.肺移植病人术后症状群研究的范围综述[J].护理学杂志,2023,38(2):108-112., articleTitle=肺移植病人术后症状群研究的范围综述, refAbstract=null), Reference(id=1322530535193293642, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322169073664905417, doi=null, pmid=null, pmcid=null, year=2025, volume=28, issue=1, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=14, rfOrder=13, authorNames=PARASKEVA M, GULLINE H, WEST S, journalName=Health Expectations, refType=null, unstructuredReference=PARASKEVA M,GULLINE H,WEST S,et al.'You can't muck around with transplant':young people's experiences of clinical care following lung transplant[J].Health Expectations,2025,28(1):e70156., articleTitle='You can't muck around with transplant':young people's experiences of clinical care following lung transplant, refAbstract=null), Reference(id=1322530535256208203, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322169073664905417, doi=null, pmid=null, pmcid=null, year=2025, volume=60, issue=2, pageStart=142, pageEnd=148, url=null, language=null, rfNumber=15, rfOrder=14, authorNames=谭雯渲, 张容, 张立力, journalName=中华护理杂志, refType=null, unstructuredReference=谭雯渲,张容,张立力,等.心脏移植病人支持性照护需求的纵向质性研究[J].中华护理杂志,2025,60(2):142-148., articleTitle=心脏移植病人支持性照护需求的纵向质性研究, refAbstract=null), Reference(id=1322530535327511372, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322169073664905417, doi=null, pmid=null, pmcid=null, year=2024, volume=41, issue=2, pageStart=39, pageEnd=42, url=null, language=null, rfNumber=16, rfOrder=15, authorNames=张莹湘, 蔡英华, 周海琴, journalName=军事护理, refType=null, unstructuredReference=张莹湘,蔡英华,周海琴,等.肺移植患者居家肺康复自我管理行为决策体验的质性研究[J].军事护理,2024,41(2):39-42., articleTitle=肺移植患者居家肺康复自我管理行为决策体验的质性研究, refAbstract=null), Reference(id=1322530535411397453, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322169073664905417, doi=null, pmid=null, pmcid=null, year=2024, volume=24, issue=1, pageStart=65, pageEnd=null, url=null, language=null, rfNumber=17, rfOrder=16, authorNames=YANG H, LIU S S, CHEN J R, journalName=BMC Pulmonary Medicine, refType=null, unstructuredReference=YANG H,LIU S S,CHEN J R,et al.Perceptions of barriers to and facilitators of exercise rehabilitation in adults with lung transplantation:a qualitative study in China[J].BMC Pulmonary Medicine,2024,24(1):65., articleTitle=Perceptions of barriers to and facilitators of exercise rehabilitation in adults with lung transplantation:a qualitative study in China, refAbstract=null), Reference(id=1322530535486894926, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322169073664905417, doi=null, pmid=null, pmcid=null, year=2020, volume=30, issue=3, pageStart=281, pageEnd=285, url=null, language=null, rfNumber=18, rfOrder=17, authorNames=FITZ S, DIEGEL-VACEK L, MAHONEY E, journalName=Progress in Transplantation, refType=null, unstructuredReference=FITZ S,DIEGEL-VACEK L,MAHONEY E.A performance improvement initiative for implementing an evidence-based discharge bundle for lung transplant recipients[J].Progress in Transplantation,2020,30(3):281-285., articleTitle=A performance improvement initiative for implementing an evidence-based discharge bundle for lung transplant recipients, refAbstract=null), Reference(id=1322530535579169615, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322169073664905417, doi=null, pmid=null, pmcid=null, year=2021, volume=36, issue=10, pageStart=38, pageEnd=41, url=null, language=null, rfNumber=19, rfOrder=18, authorNames=王瑞婷, 胡树菁, 刘红霞, journalName=护理学杂志, refType=null, unstructuredReference=王瑞婷,胡树菁,刘红霞,等.肺移植家庭照顾者负担体验和需求的质性研究[J].护理学杂志,2021,36(10):38-41., articleTitle=肺移植家庭照顾者负担体验和需求的质性研究, refAbstract=null), Reference(id=1322530535650472784, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322169073664905417, doi=null, pmid=null, pmcid=null, year=2023, volume=58, issue=18, pageStart=2181, pageEnd=2188, url=null, language=null, rfNumber=20, rfOrder=19, authorNames=高春华, 林燕, 俞超, journalName=中华护理杂志, refType=null, unstructuredReference=高春华,林燕,俞超,等.专科护士主导的出院准备服务在肺移植病人中的应用研究[J].中华护理杂志,2023,58(18):2181-2188., articleTitle=专科护士主导的出院准备服务在肺移植病人中的应用研究, refAbstract=null), Reference(id=1322530535746941777, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322169073664905417, doi=null, pmid=null, pmcid=null, year=2018, volume=16, issue=4, pageStart=831, pageEnd=837, url=null, language=null, rfNumber=21, rfOrder=20, authorNames=REBAFKA A, BENNETT C, JONES J, journalName=JBI Database of Systematic Reviews and Implementation Reports, refType=null, unstructuredReference=REBAFKA A,BENNETT C,JONES J,et al.Lung transplant recipients' experiences of and attitudes towards self-management:a qualitative systematic review protocol[J].JBI Database of Systematic Reviews and Implementation Reports,2018,16(4):831-837., articleTitle=Lung transplant recipients' experiences of and attitudes towards self-management:a qualitative systematic review protocol, refAbstract=null), Reference(id=1322530535839216466, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322169073664905417, doi=null, pmid=null, pmcid=null, year=2019, volume=13, issue=2, pageStart=99, pageEnd=108, url=null, language=null, rfNumber=22, rfOrder=21, authorNames=中华医学会器官移植学分会, journalName=中华移植杂志, refType=null, unstructuredReference=中华医学会器官移植学分会.中国肺移植术后并发症诊疗和随访技术规范(2019版)[J].中华移植杂志(电子版),2019,13(2):99-108., articleTitle=中国肺移植术后并发症诊疗和随访技术规范(2019版), refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322530530361455376, 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language=EN, label=Table 1, caption=

General information of the research subjects(n=15)

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编号性别年龄（岁）文化程度医疗费用支付方式婚姻状况职业居住地合并症
P1男56小学新型农村合作医疗已婚无业农村高血压
P2女68高中城镇医保已婚退休城市无
P3男49初中新型农村合作医疗已婚个体经营农村无
P4女63专科城镇医保离异退休城市无
P5男67专科公费医疗已婚退休城市高血压
P6男46硕士研究生职工医保已婚教师城市冠心病
P7女39本科公费医疗已婚公务员城市无
P8男46高中城镇医保已婚个体经营城市无
P9女51初中新型农村合作医疗已婚无业农村冠心病
P10女42高中新型农村合作医疗已婚无业农村无
P11男52本科职工医保已婚教师城市无
P12男75高中城镇医保丧偶退休城市高血压、糖尿病
P13男55初中新型农村合作医疗已婚无业农村无
P14男46高中职工医保已婚工人城市无
P15男69本科公费医疗已婚退休城市冠心病、糖尿病
), ArticleFig(id=1322530534010499900, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322169073664905417, language=CN, label=表1, caption=

研究对象的一般资料（n=15）

, figureFileSmall=null, figureFileBig=null, tableContent=
编号性别年龄（岁）文化程度医疗费用支付方式婚姻状况职业居住地合并症
P1男56小学新型农村合作医疗已婚无业农村高血压
P2女68高中城镇医保已婚退休城市无
P3男49初中新型农村合作医疗已婚个体经营农村无
P4女63专科城镇医保离异退休城市无
P5男67专科公费医疗已婚退休城市高血压
P6男46硕士研究生职工医保已婚教师城市冠心病
P7女39本科公费医疗已婚公务员城市无
P8男46高中城镇医保已婚个体经营城市无
P9女51初中新型农村合作医疗已婚无业农村冠心病
P10女42高中新型农村合作医疗已婚无业农村无
P11男52本科职工医保已婚教师城市无
P12男75高中城镇医保丧偶退休城市高血压、糖尿病
P13男55初中新型农村合作医疗已婚无业农村无
P14男46高中职工医保已婚工人城市无
P15男69本科公费医疗已婚退休城市冠心病、糖尿病
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肺移植病人疾病适应困境的质性研究
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刘赛赛 , 何爽 , 杨慧 , 陈瑞云 , 乔亚欣 , 陈静儒
护理研究 | 综合研究 2026,40(8): 1317-1322
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护理研究 |综合研究 2026 , 40 (8) : 1317 -1322
肺移植病人疾病适应困境的质性研究
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刘赛赛 , 何爽, 杨慧, 陈瑞云, 乔亚欣, 陈静儒
作者信息
  • 1河南省人民医院 河南省护理医学重点实验室 郑州大学人民医院，河南 450003
通讯作者:
LIU Saisai， E-mail：
刘赛赛，主管护师，硕士研究生，E-mail：
Qualitative study on the disease adaptation dilemma of lung transplant patients
Saisai LIU , Shuang HE, Hui YANG, Ruiyun CHEN, Yaxin QIAO, Jingru CHEN
Affiliations
  • 1Henan Provincial People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou University People's Hospital, Henan 450003 China
    • Corresponding Author:
    LIU Saisai， E-mail：
出版时间: 2026-04-25 doi: 10.12102/j.issn.1009-6493.2026.08.010
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摘要
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目的

探讨肺移植病人不同阶段疾病适应困境的动态变化，为制定精准康复干预策略提供依据。

方法

采用目的抽样法，选取2024年6月—2025年3月在河南省某三级甲等医院住院的15例肺移植病人作为研究对象。根据时机理论，对病人进行半结构化访谈，采用Colaizzi 7步分析法整理分析资料。

结果

结合时机理论形成肺移植发展的5个阶段，提炼出5个主题：诊断期（认知颠覆与生命抉择的双重困境）、住院稳定期（生命过渡与身心剧变的适应困境）、出院准备期（快速康复意愿与出院准备能力不足的困境）、调整期（新常态建立与生活重构的困境）、适应期（消极情绪累积，适应困境持续存在）。

结论

肺移植病人不同阶段的适应困境呈动态变化。医护人员应根据不同阶段的适应困境，阶段性、计划性、持续性地提供肺移植康复管理，促进肺移植病人快速康复。

肺移植  /  时机理论  /  疾病适应困境  /  质性研究  /  护理
Objective

To explore the dynamic changes of disease adaptation dilemma in patients undergoing lung transplantation at different stages,and to provide basis for formulating precise rehabilitation intervention strategies.

Methods

Using purposive sampling,a total of 15 lung transplant patients who were hospitalized in a tertiary grade A hospital in Henan province from June 2024 to March 2025 were selected as the research subjects.According to the timing theory,semi-structured interviews were conducted with the patients.The data were analyzed using the Colaizzi's 7-step analysis method.

Results

Based on the timing theory,five stages of development for lung transplant patients were formed.Five themes were extracted:the diagnosis stage(the dual dilemma of cognitive disruption and life decision-making),the hospital stabilization stage(the adaptation dilemma of life transition and physical and mental upheaval),the discharge preparation stage(the dilemma of rapid recovery desire and lack of discharge preparation ability),the adjustment stage(the dilemma of establishing a new normal and reconstructing life),and the adaptation stage(accumulation of negative emotions and persistent existence of adaptation dilemmas).

Conclusions

The disease adaptation dilemma of lung transplant patients at different stages were dynamically changing.Medical staff should provide lung transplant rehabilitation management in a phased, planned, and continuous manner based on the adaptation difficulties at each stage,so as to facilitate the rapid recovery of lung transplant patients.

lung transplantation  /  timing theory  /  disease adaptation dilemma  /  qualitative research  /  nursing
刘赛赛, 何爽, 杨慧, 陈瑞云, 乔亚欣, 陈静儒. 肺移植病人疾病适应困境的质性研究. 护理研究, 2026 , 40 (8) : 1317 -1322 . DOI: 10.12102/j.issn.1009-6493.2026.08.010
Saisai LIU, Shuang HE, Hui YANG, Ruiyun CHEN, Yaxin QIAO, Jingru CHEN. Qualitative study on the disease adaptation dilemma of lung transplant patients[J]. Chinese Nursing Research, 2026 , 40 (8) : 1317 -1322 . DOI: 10.12102/j.issn.1009-6493.2026.08.010
正文
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肺移植（lung transplantation,LTx）是目前治疗终末期肺疾病的有效手段[1]。国际心肺移植协会（ISHLT）数据显示，2022年全球共完成约5 000例肺移植手术，较2021年增长约5%[2]。中国肺移植手术呈逐年上升趋势，位居世界前列[3]。尽管手术能够延长病人生存结局，但仍面临诸多问题。漫长的就医体验使肺移植病人深受负性情绪、症状困扰、免疫抑制药物副作用等困扰，进而导致身体活动减少、衰弱等不良结局[4]，给国家经济、社会及器官分配供需带来沉重负担。疾病适应是指个体对新的或改变的健康状况的调整[5]。移植手术、并发症等引起的生理、心理及社会方面的适应，对促进肺移植病人术后恢复、改善不良结局至关重要[6]。相关研究表明，较高水平的疾病适应有助于病人积极参与自我管理、正向应对心理压力，促进病人早日回归社会[7]。然而，现有的质性研究及Meta整合重点分析肺移植病人在特定背景下的真实体验，但病人的适应体验会随着时间的推移而变化。鉴于此，本研究以时机理论为指导，深入挖掘肺移植病人在不同阶段的疾病适应困境，以期为医护人员制定全程康复管理方案提供依据。
1　对象与方法
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1.1　对象
采用目的抽样法，选择2024年6月—2025年3月在河南省某三级甲等医院胸外科住院肺移植病人为研究对象。纳入标准：术前诊断明确具有肺移植指征，行肺移植术；年龄≥18岁。排除标准：存在精神疾病或认知障碍等。脱落标准：并发其他严重威胁生命的疾病。所有病人均签署知情同意书，自愿参与本研究。访谈人数以资料达到饱和为标准，最终纳入15例肺移植病人，研究对象的一般资料见表1。本研究已通过郑州大学伦理委员会审批（编号：ZZUIRB2024-86）。
1.2　方法
1.2.1　确定访谈时机和访谈提纲
Cameron等[8]提出的时机理论包括疾病诊断期、稳定期、准备期、调整期和适应期5个不同阶段。本研究基于该理论，结合研究目的进行文献回顾和团队讨论，初步拟定访谈提纲。通过咨询2名胸外科副主任医师、2名肺移植专科护理专家（工作≥10年）、1名呼吸治疗师对访谈提纲进修订，然后采用目的抽样法选取5例肺移植病人进行预访谈，并根据受访者的反馈对访谈提纲进行修订，最终形成正式访谈提纲。访谈时机（5个阶段）包括诊断期（患病至手术前）、住院稳定期（开始手术至术后病情稳定）、出院准备期（病情稳定至出院前）、调整期（出院至术后3个月）、适应期（术后3~6个月）。1）诊断期访谈提纲：是什么原因促使您决定做肺移植手术？您是怎样看待肺移植手术的，有哪些认识和了解？患病至今您有什么感受，感受最深的是什么？在这个阶段您遇到哪些困难？如何解决的？2）住院稳定期访谈提纲：您能谈谈手术完之后的感受如何？这个阶段您遇到哪些困难？有哪些需求？3）出院准备期访谈提纲：即将要出院了，您的感受如何？您觉得目前有哪些困难？4）调整期和适应期访谈提纲：居家康复期间，您总体感受如何？有哪些困难？您认为阻碍您康复的原因有哪些？目前您还需要哪些方面的支持与指导？
1.2.2　资料收集方法
根据访谈提纲，采用半结构化访谈进行资料收集。访谈开始前，与病人建立良好的护患关系，向病人详细介绍研究目的和访谈内容，确保所有资料保密，征寻其同意后签署知情同意书。访谈在安静的环境中进行，鼓励受访者充分表达自己的想法、感受及体验，访谈中记录其非语言性内容，当受访者情绪激动时，暂停访谈，进行适当安慰后征询其意愿再决定是否继续访谈。每次访谈时间为20~40 min。为保护受访者隐私，受访者均以编码代替。
1.2.3　资料分析方法
访谈结束后24 h内，由2名研究者将录音转录为文字资料，结合现场记录内容进行校对，并反馈给受访者核对。采用Colaizzi 7步分析法[9]对访谈资料进行分析，当2名研究者意见发生分歧时，由研究组成员共同讨论达成一致观点后确定最终结果。
2　结果
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2.1　诊断期：认知颠覆与生命抉择的双重困境
2.1.1　疾病严重性与移植紧迫性的认知与情感冲击
受访者获悉需肺移植手术时普遍经历认知和情感震荡。部分受访者形容此刻如遭“晴天霹雳”。P14：“我没有想到我竟然换肺才能活，我整个人都蒙了，后面医生说啥我都听不进去”。同时，疾病进展的速度加重认知冲击。P13：“我知道我的肺有大问题，我想着自己还能拖几年，谁知道突然告诉我必须换肺”。这种冲击常常伴随着恐惧、焦虑等负性情绪。P7：“我没想到我的肺竟然成这样了，我才39岁啊！”P6：“我已经辗转跑了好几家医院，总盼着医生说我的肺没问题”。
2.1.2　供体等待期的生存焦虑与不确定性
研究表明，26%的肺移植等待期病人有明显的焦虑情绪，6.2%的病人出现极度焦虑症状[10-11]。随着等待时间的延长，病人的生存焦虑及疾病不确定性日趋严重。P1：“还没有轮到我换肺，我感觉我的身体一天不如一天了，我真的是害怕自己等不到肺源，自己干着急啊！”病人术前的不适症状加重其负性情绪。P5：“我最近感觉越来越喘了，手也控制不住地抖，也不想吃饭了，再这样下去，我不知道自己还能不能等到手术”。值得注意的是，长期的求医过程、间断的抢救经历都消磨着病人治疗的毅力，带来巨大的心理痛苦。P4：“我自从决定要做肺移植手术，已经等了5个多月了，刚开始满怀希望，现在我每隔1个月要来住院，这次又是因为呼吸困难来的，也不知道啥时候是个头”。
2.1.3　移植手术风险、获益与经济压力的复杂权衡
受移植手术风险、生存获益及经济压力的影响，肺移植病人普遍存在决策困境。P8：“不做手术我感觉一点也喘不上来气，做手术我又怕下不了手术台”。信息过载会加重病人决策负担。P11：“我加了好多病友群，每个人说的信息都不一样，什么排斥反应、感染风险，我根本不知道到底咋做才是好的”。高额的手术费用让家庭承受巨大的经济压力，亦会影响病人决策。P13：“我听病友说换肺要好几十万，我们就是普通农民，都是我给这个家带来这么大的灾难”。
2.1.4　家庭系统应对冲击的初始压力
移植决策不仅是病人个人的事，更是对整个家庭系统的巨大冲击，其中照护责任分配是其首要困境。P4：“家里孩子都有工作，我这病也不能一时半会就好，我不想耽误孩子们的生活和工作”。此阶段家庭常处于应激状态，其沟通模式显著改变。P11：“以前很多事情都会和我商量，现在我的病情和治疗方案我都不太了解，只让我好好配合”。
2.2　住院稳定期：生命过渡与身心剧变的适应困境
2.2.1　术后急性疼痛、呼吸困难与早期活动迫切性的矛盾
肺移植手术引起的疼痛导致部分受访者出现灾难化思维，将疼痛视为危险信号，过度警觉并夸大疼痛感知，形成恶性循环，影响术后康复。P10：“我才做完手术第3天，医生说早期活动对恢复好，我下床刚走了几步，伤口那个位置疼得厉害，像撑开一样，吓死我了”。受手术、药物、环境及不良情绪的影响，部分受访者出现呼吸困难症状，针对早期活动选择回避策略。P15：“做完手术后，我感觉能喘上来气了，但我一活动就感觉有点呼吸不上来，就不敢随便活动了，还是再等等身体恢复了再说”。
2.2.2　并发症预警识别与高度警觉状态的心理负担
术后早期是排斥反应、感染、出血等并发症的高发期，但医护人员的频繁监测及并发症相关教育可能引发过度警觉状态。P5：“医生和护士一直和我说，刚做完手术容易出现感染，让我多观察，所以我每天不停地给自己测体温，就怕发烧感染”。P7：“昨天我吐痰的时候看到有血丝，吓得赶紧让医生和护士检查有没有问题，做完手术就怕再出现啥事，经不起折腾了”。
2.2.3　安全焦虑与不确定感的社交回避
因肺移植手术的特殊性及受者身体状况，很多受访者存在社交回避现象。为预防感染，部分受访者选择避免进入人群聚集的公共区域，在一定程度上限制其社交范围。社交回避不仅会影响病人身心恢复，还会引起家庭适应不良。P3：“做完手术后我不敢出病房，更不敢和别人说话，就怕其他人身上有什么致病菌，会让我肺感染”。P11：“以前我很爱和别人交流，自从手术后，我就没出过这个病房，家里人都是戴着口罩，我知道这是为我好，但是我总是觉得很孤独”。
2.3　出院准备期：快速康复意愿与出院准备能力不足的困境
2.3.1　渴望快速康复及回归家庭
术后经过精细化的住院治疗，病人病情基本稳定，部分受访者表示渴望回归家庭。P1：“在医院的这段时间，我很不习惯，就想着赶紧恢复，早日回家”。P8：“医生和护士让我干什么，我基本都听，就想赶紧养好身体”。P11：“经过这次手术，我想了很多，我觉得什么都没有健康重要，我现在别的都不想，就一心一意想着恢复健康，能正常呼吸，出去找人聊聊天”。
2.3.2　自我照护能力不足
肺移植病人在长期患病过程中，缺乏自我管理技能，短期内难以接受“正常人”角色。部分受访者对掌握复杂用药方案（免疫抑制剂等）、识别排斥/感染征兆、康复锻炼等自我管理任务感到信心不足，影响其自我照护能力。P2：“每天医生和护士都会督促我按时吃药，家人每次都会把药给我分好，我自己真的不知道啥时候应该吃什么药，药的种类太多了，我自己肯定搞不定的”。P7：“我现在最怕就是感染，就怕手术白做了，一有点不舒服就怀疑发烧，也不知道怎么区别医生说的排斥反应，感觉自己有点草木皆兵了”。P10：“我本想自己练习骑自行车运动，还没几分钟就感觉腿没劲儿，还是家人给我扶下来的（叹气）”。
2.3.3　照护支持系统的脆弱性
肺移植病人对照顾者的照护能力、精力和长期支持的担忧，以及对获取社区/社会资源支持的途径及成效的疑虑，均会不同程度造成照护支持系统的脆弱性。P4：“我这只有一个孩子照顾我，做完手术要长期恢复，孩子也有自己的工作和家庭，要花费多大的精力才能两边兼顾，感觉自己拖累孩子了”。P11：“我们家附近的社区医院不知道是不是了解肺移植，虽然我有医生和护士的联系方式，也在微信群里，就怕突然有啥事，想着就近医院如果了解的话就更好了”。部分受访者仍希望专业人员能够做好有效沟通和信息传递工作，保障疾病管理连续性和完整性，否则会带来新的困扰。P7：“在家里如果有事情，手机咨询也不知道自己能不能表述明白，就怕没有在医院处理得及时”。P14：“我在医院记录很多出院注意事项，但是我回家后害怕忘记或者有新的问题，我不知道医生或者护士能不能及时解决我的问题”。
2.4　调整期：新常态建立与生活重构的困境
2.4.1　症状管理负担及药物副作用的困扰
受移植手术和药物副作用的影响，肺移植病人遭受多个系统的症状困扰，如肌肉震颤、记忆力下降、代谢紊乱等[12-13]，部分受访者更加依赖照顾者进行疾病管理。P12：“我手抖得自己端不住碗，都是家里人在旁边招呼着，喝汤喝水全用吸管”。P9：“以前家里找不到东西都是问我，现在我啥都记不住了，就连吃药啥的都得有人提醒，不然老忘”。P14：“我现在脸肿得像个馒头，脸色还发黑，头发也大把大把掉，根本不敢出门，就怕碰到熟人”。
2.4.2　延续照护服务需求增加
部分受访者居家管理依从性不高，分析原因均提到亟须居家照护，渴望医护人员能够提供延续服务。P4：“我回家里不知道该做什么了，我觉得家里人指导肯定没有医护人员专业”。同时，大多数受访者表示很愿意和移植团队人员进行沟通。P7：“我很喜欢医护人员给我打电话，这样我有什么问题都能得到回复，我觉得这对于我接下来的康复很重要”。
2.4.3　存在过度保护行为
部分受访者对居家康复产生错误认知，认为“大病静养”的益处远高于康复锻炼，对移植肺存在过度保护行为。P5：“我做完大手术，身体各方面还没有恢复好，最重要的就是休息和吃好，别的不着急”。部分受访者更将活动视为威胁，认为活动会增加移植肺损伤的风险。P9：“我上次稍微活动就觉得呼吸困难。浑身没劲儿，我再也不敢大幅度活动了，就怕影响我的新肺”。
2.5　适应期：消极情绪累积，适应困境持续存在
2.5.1　康复期望与身体现状的落差
肺移植术后的适应过程较为漫长，部分受访者实际治疗效果与预期存在一定差距，从而降低病人康复信心。P13：“我以为做完手术能够恢复如初，可是现在我每隔1周来要医院调整他克莫司浓度，在家稍微活动还是会感到胸闷，我真的不敢大幅度活动了”。通过访谈发现，部分受访者在陈述未坚持活动的原因时均提到近期效果不明显。P2：“我坚持锻炼了1个月，对于我自己来说，我觉得效果不明显，我还是感觉腿没有劲儿”。
2.5.2　面临重新融入社会的难题
随着治疗渐入佳境，病人渴望重新融入社会，但面临定期复查、药物不良反应、经济负担等社会问题，如何重返工作岗位、重建社会联系是部分受访者面临的主要难题。P9：“我现在每隔一段时间就得去医院复查，根本不敢离医院太远，就怕有啥不舒服不能及时解决，唉，好长时间都没回老家了”。P6：“我现在很年轻，家里还有两个孩子，压力很大，我很想尽快工作，减轻家庭的经济压力”。
3　讨论
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3.1　肺移植诊断期病人面临认知颠覆与生命抉择的双重困境，需为其提供信息和心理双向支持
本研究结果发现，在肺移植诊断期病人存在认知及情感冲击、生存焦虑及不确定性、决策两难及家庭系统冲击压力等难题，使其面临认知颠覆与生命抉择的双重困境，这与Paraskeva等[14]研究结果一致。究其原因，一方面与病人术前供体等待期较长有关，另一方面与肺移植手术的认知不足有关。这与谭雯渲等[15]的研究结果一致，即漫长的求医过程和不间断的急救经历均消磨病人意志，使其充满生存焦虑及不确定性等复杂情绪，而为等待期病人提供信息和心理双渠道支持，可有效缓解病人负性情绪，并缓解病人及家属认知及情感冲击，强化家庭系统应对能力。鉴于此，建议医护人员应重点关注等待期病人认知及情绪变化，厘清病人及照顾者主要需求，必要时给予个体化心理辅导，疏导不良情绪，树立“榜样角色”正向激励作用。另外，可开展线上+线下双向肺移植疾病知识宣教工作，联动社区资源，针对性提供肺移植指导，提高病人对肺移植的认知。
3.2　肺移植住院稳定期病人面临生命过渡及身心巨变的适应困境，需为其提供针对性的康复指导
本研究结果发现，在肺移植住院稳定期部分病人因知识缺乏导致疾病不确定性，存在治疗信心不足、适应意识不强等问题，进一步阻碍康复。相关研究发现，知识缺乏是肺移植病人疾病适应的障碍因素[16-17]。因此，医护人员必须重视病人的知识结构，进行动态、连续性评估，以浅显易懂的语言重点讲述肺移植自我管理技能、并发症识别及早期活动的重要性等，并开展病友分享会，为其提供针对性指导，树立正向康复信心，减轻疾病困扰。此外，受手术、免疫抑制剂治疗等影响，病人易引起疼痛、呼吸困难、肌肉无力等一系列问题。有研究表明，肺移植病人术后症状群随时间变化，受多种因素影响[12]。病人对于术后症状的感知必然会影响其应对措施和康复信心，建议医护人员应重视术后症状管理，提高治疗体验。
3.3　肺移植出院准备期病人康复能力欠缺，需帮助其重塑治疗信念
本研究结果发现，在肺移植出院准备期，病人迫切希望恢复，早期回归家庭和社会，但因自我照护能力不足、照护支持系统的脆弱性等原因，影响其治疗信心，与Fitz等[18]研究结果一致。分析原因多与术后需经历长期恢复有关，但病人及照顾者因知识碎片化累积、自我照护技能缺乏、家庭胜任力假象等，导致出院后自我管理不佳，极易产生不良情绪[19]。因此，建议移植术后早期开展出院计划，降低病人再入院率及并发症发生率，重塑病人健康信念。有研究也证实，护士主导的出院准备服务在居家自我管理中起关键作用[20]。提示医护人员应具备预见性护理能力，结合病人及照顾者阶段性特征，制定系统性、可行性出院准备服务方案，评估病人及家属自我管理能力，满足病人居家管理需求。
3.4　肺移植调整期病人受症状管理负担及药物副作用的困扰，需给予其延续性照护支持
经过访谈发现，部分病人受移植手术和药物副作用的影响，存在过度保护行为，病人大多未发挥主观能动性，过于依赖照顾者管理。与医护人员建立长效沟通关系是居家康复管理的关键。因此，在肺移植调整期，医护提供线上、线下咨询服务，搭建个案管理资料库，实时解答病人及照顾者现存困扰，针对现存问题提供个体化的延续护理服务。同时，建议管理者持续推进区域联动策略，构建完整的转诊流程及康复服务体系，全程落实居家康复服务流程，确保延续性照护服务工作顺利开展。
3.5　肺移植适应期病人消极情绪累积、面临重返社会难题，需积极引导并为其提供多元化支持
本研究访谈结果显示，适应期肺移植病人易受躯体症状影响，部分受访者产生消极应对心理，尤其是经济压力大、照顾者数量少、术后恢复差的病人，其康复积极性明显下降。研究显示，肺移植术后1~5年，少数病人认为自己完全康复且生活无限制[21-22]。适应期部分受访者期望能够重返社会和工作，但因移植术后病人面临着体力水平不足、认知功能下降等问题，短期内无法回归工作及社会。因此，提示医护人员应建立有效的社会支持系统，建立随访微信群及随访小程序，定期开展重返社会及工作准备联谊会，协同病友及家属共同参与；另外，呼吁器官移植中心及公益组织开展“回归社会”主题系列活动，帮助病人重建社会关系，回归正常生活。
4　小结
收起
本研究将时机理论应用于肺移植病人，探索其在移植不同阶段的疾病适应困境，发现其适应困境呈动态变化。医护人员应精准评估和早期识别病人在移植不同阶段的疾病适应需求，根据其在不同阶段中的适应困境，提供精准护理服务，个体化、阶段化、全程化提供专业康复指导，引导其积极应对，提升自我管理能力和康复信念，促进病人快速康复。

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2026年第40卷第8期
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doi: 10.12102/j.issn.1009-6493.2026.08.010
  • 接收时间：2025-07-21
  • 首发时间：2026-10-28
  • 出版时间：2026-04-25
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  • 收稿日期：2025-07-21
  • 修回日期：2026-03-28
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    1河南省人民医院 河南省护理医学重点实验室 郑州大学人民医院，河南 450003

通讯作者:

LIU Saisai， E-mail：
刘赛赛，主管护师，硕士研究生，E-mail：
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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