内科

目的整合定量与定性研究数据，分析接受人工肝支持系统（ALSS）治疗的肝衰竭患者的经济毒性现状、影响因素及负性体验。方法采用解释性序贯混合研究设计，先进行定量研究，再进行定性研究。（1）定量研究：选取2024年9月～12月在广西某三级甲等医院住院的240例接受ALSS治疗的肝衰竭患者作为研究对象，采用一般资料调查表、患者报告结局的经济毒性综合评分量表（COST-PROM）进行调查，并采用多重线性回归模型分析该群体经济毒性的影响因素。（2）定性研究：选取定量研究中存在中重度经济毒性（COST-PROM总分<17分）的15例患者进行半结构式访谈，采用Colaizzi七步分析法整理并分析访谈资料，以探究该群体因经济毒性而产生的负性体验。结果（1）240例接受ALSS治疗的肝衰竭患者的COST-PROM总分为（25.39±3.07）分，整体处于轻度经济毒性水平；多重线性回归分析结果显示，工作状态、文化程度、肝衰竭类型、是否等待肝移植、家庭月收入是接受ALSS治疗的肝衰竭患者经济毒性的独立影响因素（均P<0.05）。（2）定性研究共提炼出4个主题：①经济压力的持续性与家庭影响：患者普遍面临治疗费用高昂、医保报销额度有限的持续性压力，部分家庭因此关系紧张、生活质量下降；②多重复杂情绪的影响：患者普遍存在焦虑、抑郁、内疚等情绪，易产生拖累家庭的自我否定感，部分患者甚至萌生放弃治疗的想法；③社会关系信任缺失：部分患者因患病遭受社会孤立，对筹款平台失去信任，同时因依赖他人照顾而产生心理负担；④对医疗体系的矛盾认知：患者既依赖ALSS治疗延续生命，又对报销政策不清晰、医疗资源分布不均衡感到困惑。结论接受ALSS治疗的肝衰竭患者整体处于轻度经济毒性水平，工作状态、文化程度、肝衰竭类型、是否等待肝移植、家庭月收入是其影响因素；其中，存在中重度经济毒性患者的负性体验主要体现在经济家庭压力、心理情绪困扰、社交信任缺失、医疗体系认知矛盾方面。

Objective To integrate quantitative and qualitative research data to analyze the current status of financial toxicity, influencing factors, and negative experiences in liver failure patients treated with artificial liver support system (ALSS). Methods An explanatory sequential mixed‑methods research design was adopted, with the quantitative research conducted first, followed by the qualitative research. (1) Quantitative research: A total of 240 liver failure inpatients treated with ALSS at a class A tertiary hospital in Guangxi from September to December 2024 were enrolled as research subjects. Data were collected using a general information questionnaire and the Comprehensive Score for Financial Toxicity based on the patient‑reported outcome measures (COST‑PROM). Multiple linear regression model was used to identify influencing factors of financial toxicity in this population. (2) Qualitative research: Fifteen patients with moderate‑to‑severe financial toxicity (COST‑PROM total score<17 points) identified from the quantitative research were selected for semi‑structured interviews. The interview data were organized and analyzed using Colaizzi's seven‑step analysis method to explore the negative experiences arising from financial toxicity in this population. Results (1) The COST‑PROM total score of the 240 ALSS‑treated liver failure patients was (25.39 ± 3.07) points, indicating an overall mild level of financial toxicity. Multiple linear regression analysis showed that working status, educational level, type of liver failure, being on the waiting list for liver transplantation, and monthly family income were independent influencing factors of financial toxicity in ALSS‑treated liver failure patients (all P<0.05). (2) Qualitative analysis extracted 4 themes. ① Persistence of financial stress and family impact: Patients endured continuous pressure stemming from expensive medical expenses and inadequate insurance reimbursement, leading to family tension and deteriorated quality of life in some households. ② Impact of multiple complex emotions: Patients experienced anxiety, depression, and guilt, accompanied by self‑denial due to feeling like a burden to their families; some patients even contemplated giving up treatment. ③ Lack of trust in social relationships: Some patients suffered social isolation due to illness, lost trust in fundraising platforms, and experienced psychological burden from relying on others for care. ④ Contradictory perceptions of the healthcare system: Patients not only relied on ALSS treatment for life extension, but also felt confused about unclear reimbursement policies and uneven distribution of medical resources. Conclusion Liver failure patients receiving ALSS treatment experience a mild level of financial toxicity in general, with working status, educational level, type of liver failure, liver transplantation waiting status, and monthly family income being its influencing factors. Among those with moderate‑to‑severe financial toxicity, the negative experiences are mainly manifested in financial‑family stress, psychological‑emotional distress, lack of social trust, and cognitive contradictions regarding the healthcare system.

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