Article(id=1322924466598195390, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924415817757501, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.17.029, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1756137600000, receivedDateStr=2025-08-26, revisedDate=1778774400000, revisedDateStr=2026-05-15, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339371585, onlineDateStr=2026-10-30, pubDate=1788969600000, pubDateStr=2026-09-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339371585, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339371585, creator=13701087609, updateTime=1793339371585, updator=13701087609, issue=Issue{id=1322924415817757501, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='17', pageStart='2961', pageEnd='3152', issueExtLink='null', onlineDate='null', pubDate='1788969600000', pubDateStr='2026-09-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793339359478, creator='13701087609', updateTime=1793343089343, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940060072542250, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924415817757501, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940060072542251, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924415817757501, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=3149, endPage=3152, ext={EN=ArticleExt(id=1322924466816299199, articleId=1322924466598195390, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Application progress on interoception in the management of chronic disease patients, columnId=1220689485315101342, journalTitle=Chinese Nursing Research, columnName=Review Articles, runingTitle=null, highlight=null, articleAbstract=

It integrated theory and application to review the progress of interoception in chronic disease management,so as to provide references for personalized medication and patient self-management.

, authors=Jiahui ZHU1, Xing LIU1, Jiaqi LI1, Yue ZHOU1, Ruining ZHAO1, Xinqian SHI1, Hao GUO1, Linping SHANG1, 2, authorsList=Jiahui ZHU, Xing LIU, Jiaqi LI, Yue ZHOU, Ruining ZHAO, Xinqian SHI, Hao GUO, Linping SHANG, authorCompany=null, correspAuthors=Linping SHANG, authorNote=null, correspAuthorsNote=null, 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=1322924467101511872, articleId=1322924466598195390, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=内感知在慢性病病人管理中的应用进展, columnId=1220689485482873504, journalTitle=护理研究, columnName=科研综述, runingTitle=null, highlight=null, articleAbstract=

整合理论与应用,梳理内感知在慢性病管理中的应用进展,为个体化医疗与病人自我管理提供参考。

, authors=祝嘉慧1, 刘幸1, 李嘉琪1, 周悦1, 赵瑞宁1, 史薪倩1, 郭浩1, 商临萍1, 2, *, *, authorsList=祝嘉慧, 刘幸, 李嘉琪, 周悦, 赵瑞宁, 史薪倩, 郭浩, 商临萍, authorCompany=null, correspAuthors=商临萍, authorNote=

祝嘉慧,硕士研究生在读

, correspAuthorsNote=
商临萍,E-mail:
SHANG Linping, E-mail:
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祝嘉慧,硕士研究生在读

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祝嘉慧,硕士研究生在读

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内感知在慢性病病人管理中的应用进展
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祝嘉慧 1 , 刘幸 1 , 李嘉琪 1 , 周悦 1 , 赵瑞宁 1 , 史薪倩 1 , 郭浩 1 , 商临萍 1, 2, *, *
护理研究 | 科研综述 2026,40(17): 3149-3152
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护理研究 |科研综述 2026 , 40 (17) : 3149 -3152
内感知在慢性病病人管理中的应用进展
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祝嘉慧,硕士研究生在读

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祝嘉慧1, 刘幸1, 李嘉琪1, 周悦1, 赵瑞宁1, 史薪倩1, 郭浩1, 商临萍1, 2, *, *
作者信息
  • 1山西医科大学护理学院,山西 030001
  • 2山西医科大学第一医院
通讯作者:
商临萍,E-mail:
SHANG Linping, E-mail:
作者简介:

祝嘉慧,硕士研究生在读

Application progress on interoception in the management of chronic disease patients
Jiahui ZHU1, Xing LIU1, Jiaqi LI1, Yue ZHOU1, Ruining ZHAO1, Xinqian SHI1, Hao GUO1, Linping SHANG1, 2
Affiliations
  • 1School of Nursing, Shanxi Medical University, Shanxi 030001 China
  • 2First Hospital of Shanxi Medical University
出版时间: 2026-09-10 doi: 10.12102/j.issn.1009-6493.2026.17.029
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整合理论与应用,梳理内感知在慢性病管理中的应用进展,为个体化医疗与病人自我管理提供参考。

内感知  /  慢性病  /  护理  /  综述

It integrated theory and application to review the progress of interoception in chronic disease management,so as to provide references for personalized medication and patient self-management.

interoception  /  chronic disease  /  nursing  /  review
祝嘉慧, 刘幸, 李嘉琪, 周悦, 赵瑞宁, 史薪倩, 郭浩, 商临萍. 内感知在慢性病病人管理中的应用进展. 护理研究, 2026 , 40 (17) : 3149 -3152 . DOI: 10.12102/j.issn.1009-6493.2026.17.029
Jiahui ZHU, Xing LIU, Jiaqi LI, Yue ZHOU, Ruining ZHAO, Xinqian SHI, Hao GUO, Linping SHANG. Application progress on interoception in the management of chronic disease patients[J]. Chinese Nursing Research, 2026 , 40 (17) : 3149 -3152 . DOI: 10.12102/j.issn.1009-6493.2026.17.029
内感知(interoception)是指机体对内部生理状态的综合感知,涉及复杂的神经机制和感觉系统,是神经科学与心理学的交叉研究领域[1]。近年来,这一身心交互机制逐渐成为医学与心理学的研究热点。我国慢性病防治形势复杂,病人需持续关注自身症状、调整生活习惯并应对疾病引发的心理负担,内感知在其中发挥着重要作用[2]。通过提升病人对身体信号的觉察与理解能力,可促进情绪管理、治疗依从性以及生活质量的提升。目前,内感知在心理学、神经科学和医学的各个学科领域都受到了广泛的关注,但在慢性病病人中的研究较少。现通过总结内感知的理论基础及其在慢性病管理中的具体应用,分析其作用机制,并展望其在临床实践中的应用前景。
内感知最初由诺贝尔奖获得者Sherrington等[3]提出,定义为对内脏感觉的感知,之后扩展为涵盖所有与身体状态相关的感知[4]。2015年,Garfinkel等[5]基于Calì 等[6]的研究,提出了内感知三维模型,包含内感知准确性(IAc,指客观检测内部身体信号的精确度)、内感知敏感性(IAs,指个体对内感知信号的认知倾向或专注度)以及内感知意识(IAw,指对自身内感知准确性的元认知意识),为内感知研究提供了系统化框架。迄今为止,内感受已被以多种方式定义,使得跨学科研究多元化。
在慢性病病人群体中,内感知体现为对心跳、呼吸、内脏疼痛等生理信号的感知能力,反映病人对体内稳态和整体生理状况的认知水平[7]。相较于健康人群,慢性病病人的内感知能力通常较弱,影响疾病管理和自我调节效果[8]。
Schandry等[9]开发的心跳感知任务是通过指导参与者专注于可能与心脏活动相关的身体感觉默数他们的心跳实施,量化个体在特定时间间隔内(25、35、45 s)仅凭内在感觉计数心跳次数的准确性。参与者在试验期间不允许测量脉搏或进行任何有助于心跳计数的身体动作,也不知道间隔的持续时间,每个间隔的开始和结束都由柔和的音调呈现。试验结束后,通过将检测到的心跳与实际心跳进行比较,计算感知分数。通过以下公式进行计算:P=1k∑i=1k(1-|mi-ni|mi)。设P为感知准确性得分,k为测试次数,m为实际测得的心率,n为受试者报告的心率。得分越接近1,表明内感受准确性越高;得分越接近0,说明准确感知能力越弱。心跳感知任务已被用于相关研究中[10-11],也被证实是用来测量内感知准确性的一个关键指标。
心跳辨别任务是由Katkin等[12]于1983年开发,通过量化个体对自身心率的主观信念,估计心脏内感受信念的准确性和精确度。参与者首先觉察自身的心脏感觉5 s,期间使用脉搏血氧仪记录心率,计算试验的平均心率,并根据此心率调整反馈音调的频率,参与者需要判断反馈音调序列与自身心率是否同步。心跳辨别任务在基础研究和临床应用中具有广泛的潜力,尤其是在探索内感受信念的形成机制及其对行为的影响方面。
2020年,Murphy等[13]研发了内感受准确性量表,旨在评估个体对多种身体信号(如心跳、呼吸、饥饿、疼痛等)的感知。该量表包括21项条目,采用Likert 5级评分量表对受访者进行评分,分数越高表示其主观内感受准确性越高。2023年,Lin等[14]在Murphy的协助下将其汉化,将两个相近的条目进行合并,最终得到了一个包含20个条目的中文版内感受准确性量表,总分20~100分。后又通过因子分析和项目反应理论分析,开发了12个项目的简短形式(IAS-SF),经验证其信效度良好。内感受准确性量表通过量化内感受准确性,可以提升护理质量与病人健康管理水平。
BPQ由Porges[15]于1993年开发,旨在评估个体对自主神经系统支配的目标器官和结构的功能及反应性的主观体验。该问卷包含122项条目,涵盖身体意识、自主神经系统反应性、认知-情绪-躯体压力反应、身体与认知压力反应类型以及健康史5个维度。然而,问卷篇幅冗长限制了其实际应用,研究团队于2017年推出了简化的身体感知问卷简表(BPQ-SF)[16]。BPQ-SF由46个条目组成,分为身体意识(26个条目)和自主神经系统反应性(20个条目)两个主要部分。自主神经反应性进一步细分为膈上反应性(如心跳加速、呼吸急促)和膈下反应性(如胃部不适、消化系统变化)。BPQ-SF保留了原问卷的核心测量目标,同时提高了施测效率,适用于心理健康、神经科学及临床护理研究等领域。
该问卷是目前国际上测量内感知的普适性评估工具,自2012年开发以来,已被翻译成近30种语言,并在10多个国家进行验证。问卷包含32项条目,涵盖觉察、不分心、不担忧、情绪感知、注意力调节、自我调节、身体倾听、信任8个分量表。该问卷采用Likert 6级评分法,其中不分心和不担忧分问卷反向计分,分数越高反映内感受意识越强[17]。2018年,Mehling等[18]优化了不分心和不担忧维度的内部一致性,保留其原始的8个因素结构,最终形成了包含37个项目的MAIA-2。2022年,中国学者Teng等[19]将MAIA-2汉化,通过因子分析验证了MAIA-2中文版(MAIA-2C)的信效度,确认其可作为评估中国人群内感受意识的可靠工具。
量表主要用于评估个体对身体内部信号(如饥饿、疼痛、疲劳等)的反应性,更强调对身体信号的主动响应而非仅仅感知。该量表由7个条目组成,分为内感受意识的重要性和感知断开连接2个因素。受访者使用Likert 7级评分,评估他们对该陈述的同意程度[20]。BRQ是首个直接测量身体信号信任与响应的工具,有待在临床进一步验证其跨文化适用性及临床价值。
该问卷用于衡量个体对正常身体过程的关注程度,围绕个人对正常或异常身体状况、情感和社会因素评估其对身体反应的敏感性。问卷包含18个条目,分为身体反应预测、睡眠-觉醒周期、疾病启动预测以及身体过程的变化和对反应的关注4个部分。参与者被要求使用1~7对每个项目进行评分,总分越高表示身体意识水平和身体敏感性越好[21]。目前,土耳其版本的BAQ被认为是评估身体意识多维概念的黄金标准[22],而在我国尚未进行本土化的验证与探索。
糖尿病病人的反复低血糖暴露会减弱自主神经症状对低血糖的反应,导致病人对低血糖的认识受损。有证据表明,1型糖尿病病人在低血糖期间的内感受意识发生了改变,可能是对频繁低血糖经历的神经可塑性适应[23]。与健康群体相比,患有1型糖尿病且内感知完整的病人在低血糖反应中,与刺激相关的神经区域的激活显著增强,具备充分内感知的个体可能对低血糖感觉输入中枢的敏感性更强[24]。内感受意识较差的2型糖尿病病人可能更难识别血糖变化带来的身体信号,从而影响胰岛素剂量调整、饮食选择和运动计划的执行[25]。
内感受受损会扰乱自主神经系统调节,导致心血管对潜在压力源的反应失衡,这些因素可表现为心率加快、血压升高和心脏收缩力改变,所有内感受信号的变化可以作为心血管疾病的早期预警信号[26]。
在患有心血管疾病的成年人中,内感受敏感性(如注意、分散注意力和身体倾听)在调节症状与自我护理管理行为之间的关系方面发挥了重要作用。有研究表明,内感受是促进心力衰竭病人自我护理(例如症状感知)的关键因素,其与检测心力衰竭症状的能力相关[27]。
慢性疼痛被认为是涉及内感受功能障碍的众多疾病之一,疼痛的体验本身可以被认为是一种内感受的输入形式。较健康人群而言,慢性疼痛病人表现出较低的内感受准确性和较高的内感受敏感性,这表明慢性疼痛病人可能更多地关注内部信号,但对这些信号性质的洞察力会降低[28]。慢性疼痛病人也表现出适应不良的内感受意识,即对疼痛相关信息的注意力偏差[29],这加剧了对疼痛焦虑的敏感性,并促使个体采取回避行为,以缓解随之而来的情绪困扰。
在呼吸系统中,内感受主要涉及对呼吸过程中呼吸深度、频率、气流顺畅程度的感知。这种感知借助于传入系统,通过整合和解读综合感觉信号,触发如咳嗽、吞咽冲动等感觉体验[30]。当这些信号处理异常时,可能导致呼吸困难,这是一种呼吸系统疾病中常见的主观不适感。研究进一步发现,前岛叶是处理呼吸系统内感受的关键区域,它不仅参与对呼吸困难的感知和情绪反应,还调节与呼吸困难的主观体验[31]。因此,内感受加工在形成呼吸困难的主观体验中起着至关重要的作用。
Tihanyi等[32]的研究表明,内感知能力较强的病人能够更敏锐地感知饮食和运动需求,从而优化自我管理行为,改善糖尿病控制效果。正念冥想、瑜伽等干预措施可以增强糖尿病病人的内感知意识,改善糖尿病和胰岛素抵抗病人的健康饮食习惯和疾病管理能力[33]。具体而言,基于正念的干预能够提升糖尿病病人内感知的准确性,尤其体现在更精确的血糖水平估计方面[34]。因此,通过正念干预提升内感知,不仅有助于优化血糖控制,还可改善病人的情绪状态和整体生活质量。
增强内感知敏感性并减少对不适症状的忽视,可改善心血管疾病病人的自我护理行为。基于正念的干预措施通过提升内感知敏感性,缓解心血管疾病相关的情绪症状和感知压力,从而进一步优化病人的自我护理管理[27]。Keirns等[35]研究证实,正念训练以内感知为中介,能够提高心力衰竭病人的自我护理行为。此外,通过监测心率、血压等内感受信号的变化,可以实现心血管疾病的早期检测与诊断。同时,结合人工智能(AI)技术分析大量的内感受数据,识别疾病相关的模式和特征,可为心血管疾病病人制定个性化的治疗方案提供参考[36]。
包括舞蹈、太极拳、正念认知疗法、触觉疗法等的多种身心疗法被证实可以改善慢性疼痛病人的内感受意识[37]。Parisi等[29]通过实施一项结合正念训练、认知行为疗法和积极心理学原则的综合干预方法,进行为期9个月的随访发现,正念导向的恢复增强显著提高了参与者在注意力调节、身体倾听和自我信任等内感知维度的意识,从而有效减少慢性疼痛病人的阿片类药物滥用行为。同样,以身体为导向的内感知疗法通过靶向内感知过程,帮助病人改善对感觉和情绪体验的自我调节,减轻症状痛苦[38]。
研究表明,通过内感受干预(如呼吸练习、认知行为疗法等)可以有效缓解呼吸系统疾病病人的呼吸困难症状[39]。Lin等[39]通过一项为期8周的正念步行训练研究发现,该干预不仅可改善慢性阻塞性肺疾病(COPD)病人的症状,还提升了他们的内感知意识,促进了自我管理能力的增强。此外,以正念为基础的干预通过改善病人对身体信号的觉察,可进一步减轻情绪压力,并提升生活质量[40]。
内感知作为一种新兴的干预手段,近年来在慢性病管理中的研究与应用显著增加。随着医学领域的交叉融合,内感知的概念逐渐从基础研究走向临床实践,为慢性病病人的健康管理提供了新的视角。然而,其临床适用性仍需进一步验证,尤其是在干预机制、标准化评估工具及长期效果等方面存在诸多挑战。未来的研究应聚焦于构建统一的内感知评估体系,优化干预方案设计,并探索其在不同慢性病人群中的适用性与有效性。通过深入研究内感知的生物-心理-社会机制,临床护理工作者能够更精准地制定个性化干预策略,从而在慢性病管理中发挥更大作用。

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doi: 10.12102/j.issn.1009-6493.2026.17.029
  • 接收时间:2025-08-26
  • 首发时间:2026-10-30
  • 出版时间:2026-09-10
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  • 收稿日期:2025-08-26
  • 修回日期:2026-05-15
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    1山西医科大学护理学院,山西 030001
    2山西医科大学第一医院

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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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