切换至 "中华医学电子期刊资源库"
高级检索
中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2017, Vol. 13 ›› Issue (05) : 563 -568. doi: 10.3877/cma.j.issn.1673-5250.2017.05.011

所属专题： 文献；

论著

多学科合作诊疗系统与不同单一干预措施分别治疗孕产期心身障碍的临床效果分析
秦峰1,†(), 肖利军2, 张立新3, 王书霞3, 孙静3, 陈俊梅3, 刘婷3, 徐林英3, 薛伟3, 郜正美4, 陈双燕4, 吴孟芳4, 黄维维4, 胡娟4, 蓝海英5, 曾妍芳5, 丁颖5, 邹雨霞5, 王盈力6, 吕翠6, 邬萍7, 张雅静7, 何晓燕8, 王静8, 吴万粉8, 顾雪兰8   
  1. 1. 100142　北京，全国孕产妇心身健康门诊总课题组
    2. 100700　北京，陆军总医院附属八一儿童医院科研室
    3. 300270　天津市滨海新区大港妇女儿童保健中心孕产妇心身健康门诊研究基地
    4. 311300　浙江，临安市妇幼保健计划生育服务中心孕产妇心身健康门诊研究基地
    5. 510055　广州市越秀区妇幼保健院孕产妇心身健康门诊研究基地
    6. 264000　山东，烟台市烟台山医院孕产妇心身健康门诊研究基地
    7. 300150　天津市河北区妇女儿童保健和计划生育服务中心孕产妇心身健康门诊研究基地
    8. 225002　江苏，扬州市妇幼保健院孕产妇心身健康门诊研究基地
  • 收稿日期:2017-07-18 修回日期:2017-08-25 出版日期:2017-10-01
  • 通信作者: 秦峰

Analysis of clinical effects on treating psychosomatic disorder in pregnancy by multidisciplinary cooperation medical system and different single intervention measures

Feng Qin1,†(), Lijun Xiao2, Lixin Zhang3, Shuxia Wang3, Jing Sun3, Junmei Chen3, Ting Liu3, Linying Xu3, Wei Xue3, Zhengmei Gao4, Shuangyan Chen4, Mengfang Wu4, Weiwei Huang4, Juan Hu4, Haiying Lan5, Yanfang Zeng5, Ying Ding5, Yuxia Zou5, Yingli Wang6, Cui Lyu6, Ping Wu7, Yajing Zhang7, Xiaoyan He8, Jing Wang8, Wanfen Wu8, Xuelan Gu8   

  1. 1. The General Research Group of National Maternal Physical and Mental Health Clinic, Beijing 100142, China
    2. Scientific Research Office, Bayi Children′s Hospital, General Hospital of Beijing Military Region, Beijing 100700, China
    3. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Dagang Maternal and Child Care Center, Binhai New Area, Tianjin 300270, China
    4. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Lin′an Maternal and Child Health Care and Family Planning Service Center, Lin′an 311300, Zhejiang Province, China
    5. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Yuexiu District Maternal and Child Care Center, Guangzhou 510055, Guangdong Province, China
    6. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Yantai Mountain Hospital, Yantai, Yantai 264000, Shandong Province, China
    7. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Hebei District Maternal and Child Care and Family Planning Service Center, Tianjin 300150, China
    8. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Yangzhou Maternal and Child Care Service Center, Yangzhou 225002, Jiangsu Province, China
  • Received:2017-07-18 Revised:2017-08-25 Published:2017-10-01
  • Corresponding author: Feng Qin
  • About author:
    Corresponding author: Qin Feng, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

秦峰, 肖利军, 张立新, 王书霞, 孙静, 陈俊梅, 刘婷, 徐林英, 薛伟, 郜正美, 陈双燕, 吴孟芳, 黄维维, 胡娟, 蓝海英, 曾妍芳, 丁颖, 邹雨霞, 王盈力, 吕翠, 邬萍, 张雅静, 何晓燕, 王静, 吴万粉, 顾雪兰. 多学科合作诊疗系统与不同单一干预措施分别治疗孕产期心身障碍的临床效果分析[J]. 中华妇幼临床医学杂志(电子版), 2017, 13(05): 563-568.

Feng Qin, Lijun Xiao, Lixin Zhang, Shuxia Wang, Jing Sun, Junmei Chen, Ting Liu, Linying Xu, Wei Xue, Zhengmei Gao, Shuangyan Chen, Mengfang Wu, Weiwei Huang, Juan Hu, Haiying Lan, Yanfang Zeng, Ying Ding, Yuxia Zou, Yingli Wang, Cui Lyu, Ping Wu, Yajing Zhang, Xiaoyan He, Jing Wang, Wanfen Wu, Xuelan Gu. Analysis of clinical effects on treating psychosomatic disorder in pregnancy by multidisciplinary cooperation medical system and different single intervention measures[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2017, 13(05): 563-568.

目的

探讨多学科合作模式的生理调控、心理调节、音乐调理(PPM)干预措施，与仅应用PPM中3项措施之一，治疗孕产期心身障碍(PSD)的临床效果。

方法

选择2017年3月至5月，在天津市滨海新区大港妇女儿童保健中心等6家医疗机构的孕产妇心身健康门诊研究基地，进行产前检查被确诊为罹患孕产期PSD的95例孕妇为研究对象。采取抽签方式进行随机抽样，将95例孕妇分为PPM治疗组(n＝25，采取PPM治疗措施)，生理调控干预组(n＝25，仅采用PPM治疗中的生理调控干预措施)，心理调节干预组(n＝22，仅采用PPM治疗中的心理调节干预措施)及音乐调理干预组(n＝23，仅采用PPM治疗中的音乐调理干预措施)，共计4组。4组治疗时间均为3周。治疗结束后，采用统计学方法比较PPM治疗组分别与3个单一干预措施组孕妇治疗后的主诉躯体功能障碍主要症状变化、自主神经系统(ANS)功能状态变化及汉密顿焦虑量表(HAMA)评分值差异。本研究遵循的程序符合上述各医疗机构人体试验委员会制定的伦理学标准，得到其伦理委员会批准，征得受试对象知情同意，并与之签署临床研究知情同意书。

结果

① 4组孕妇治疗前一般临床资料、ANS功能状态及HAMA评分值比较，差异均无统计学意义(P>0.05)。② 4组孕妇完成治疗后，主诉躯体功能障碍主要症状变化比较结果显示，PPM治疗组的治疗效果，较生理调控干预组、心理调节干预组及音乐调理干预组均好，并且差异均有统计学意义(P<0.001)，PPM治疗组孕妇的主诉躯体功能障碍主要症状多数为全部消除，少数为部分消除或缓解。③治疗结束后，PPM治疗组与3个单一干预措施组孕妇的ANS功能状态构成比分别比较，差异均有统计学意义(P<0.001)，PPM治疗组孕妇ANS功能状态全部为平衡状态，而3个单一干预措施组孕妇仍主要为紊乱状态；PPM治疗组孕妇HAMA评分值，均分别较3个单一干预措施组孕妇低，并且差异均有统计学意义(P<0.001)。

结论

采取多学科合作模式的PPM干预措施(基于围生保健和产科)，治疗孕产期PSD疗效显著，对孕妇的焦虑、抑郁亦有治疗作用。对于孕产期PSD孕妇仅采用PPM治疗中3项措施之一的单一干预措施治疗方案的疗效欠佳。

关键词: 心理生理性障碍, 躯体型障碍, 焦虑, 抑郁, 孕妇
Objective

To investigate clinical effects of treating psychosomatic disorder (PSD) in pregnancy by using the physiological regulation, psychological adjustment and music conditioning (PPM) treatment under the multidisciplinary cooperation mode and by using only one of three measures above of PPM treatment.

Methods

A total of 95 pregnant women who were confirmed as PSD in pregnancy when performing the prenatal examinations from March to May 2017 in the research bases in psychosomatic health outpatients for pregnant women of six medical institutions such as Dagang Maternal and Child Care Center, Binhai New Area, Tianjin, etc., were chosen as research subjects. The 95 cases were randomly sampled by lotting, and were assigned to four groups, namely, PPM treatment group (n=25, adopted PPM treatment), physiological regulation intervention group (n=25, adopted physiological regulation measure), psychological adjustment intervention group (n=22, adopted psychological adjustment measure), and music conditioning intervention group (n=23, adopted music conditioning measure). After finishing 3 weeks of treatment for 4 groups, the statistical method was used to compare the differences between PPM treatment group and other three groups with single intervention measure, respectively, in cardinal symptoms of physical dysfunction as the chief complaint, functional status of autonomic nervous system (ANS), and scores of Hamilton Anxiety Scale (HAMA). The procedure followed by this study met the ethical standards set by the Human Trial Board of the above mentioned medical institutions, it was approved by their Ethics Committees and agreed by the study subjects, and the informed consent of clinical research was signed with them.

Results

① There were no significant differences among 4 groups of pregnant women before treatment in general clinical data, functional status of ANS and HAMA scors (P>0.05). ②After treatment for 4 groups of pregnant women, the comparison results of changes of cardinal symptoms of physical dysfunction as the chief complaint showed that: The therapeutic effect of PPM treatment group was better than that of each group with single intervention measure, respectively, and all the differences were statistically significant (P<0.001), and the cardinal symptoms of physical dysfunction as the chief complaint in PPM treatment group was eliminated completely for majority cases, and partially removed or relieved for minority cases. ③Constituent ratio of ANS functional status was compared between PPM treatment group and each group with single intervention measure after treatment, respectively, and all the differences were statistically significant (P<0.001), and ANS functional statuses of pregnant women in PPM treatment group were all the balanced ones, however, pregnant women in other 3 groups with single intervention measure were still mainly the disordered ones. HAMA scores of pregnant women in PPM treatment group was lower than that of each group with single intervention measure after treatment, respectively, and all the differences were statistically significant (P<0.001).

Conclusions

The therapeutic effect was significant in treating PSD in pregnancy by using PPM treatment (based on perinatal health care and obstetrics) under the multidisciplinary cooperation mode, which also had the therapeutic effect on anxiety and depression of pregnant women. Treating PSD in pregnancy only by using single intervention measure of one of three measures of PPM treatment had poor therapeutic effect.

Key words: Psychophysiologic disorders, Somatoform disorders, Anxiety, Depression, Pregnant women
表1 4组孕妇治疗前一般临床资料及《汉密顿焦虑量表》评分值比较
组别 例数 年龄[例数(%)] 学历[例数(%)] 职业[例数(%)]
20～35岁 >35岁 高中及以下 大学及以上 在职 家庭主妇
PPM治疗组 25 21(84.0) 4(16.0) 7(28.0) 18(72.0) 17(68.0) 8(32.0)
生理调控干预组 25 22(88.0) 3(12.0) 6(24.0) 19(76.0) 16(64.0) 9(36.0)
心理调节干预组 22 22(100.0) 0(0) 8(36.5) 14(63.6) 12(54.5) 10(45.5)
音乐调理干预组 23 21(91.3) 2(8.7) 9(39.1) 14(60.9) 15(65.2) 8(34.8)
检验值 ? χ2＝3.144 χ2＝0.590 χ2＝1.070
P值 ? 0.076 0.443 0.301
组别 例数 产妇类型[例数(%)] 孕龄[例数(%)] 治疗前HAMA评分值(分，±s)
初产妇 经产妇 ≤12周 >12周
PPM治疗组 25 17(68.0) 8(32.0) 7(28.0) 18(72.0) 11.1±1.7
生理调控干预组 25 15(60.0) 10(40.0) 4(16.0) 21(84.0) 10.8±1.5
心理调节干预组 22 15(68.2) 7(31.8) 10(45.5) 12(54.5) 10.9±1.8
音乐调理干预组 23 15(65.2) 8(34.8) 6(26.1) 17(73.9) 10.5±1.5
检验值 ? χ2＝0.357 χ2＝0.025 F＝－0.964
P值 ? 0.550 0.876 0.345
表2 治疗后，4组孕妇主诉躯体功能障碍主要症状变化比较[例数(%)]
组别 例数 全部消除 部分消除或缓解 无改变
PPM治疗组 25 18(72.0) 7(28.0) 0(0)
生理调控干预组 25 4(16.0) 17(68.0) 4(16.0)
心理调节干预组 22 1(4.5) 17(77.3) 4(18.2)
音乐调理干预组 23 0(0) 18(78.3) 5(21.7)
表3 治疗后，4组孕妇自主神经系统功能状态及《汉密顿焦虑量表》　评分值比较
组别 例数 ANS功能状态[例数(%)] HAMA评分值(分，±s)
紊乱 平衡
PPM治疗组 25 0(0) 25(100.0) 2.4±1.2
生理调控干预组 25 21(84.0) 4(16.0) 7.4±2.3
心理调节干预组 22 21(95.5) 1(4.5) 8.7±2.0
音乐调理干预组 23 23(100.0) 0(0) 8.3±1.8
[1]
秦峰，肖利军，张立新. 孕产期心身障碍临床研究进展[J/CD]. 中华妇幼临床医学杂志(电子版), 2017, 13(1): 105-107.
[2]
杨婷，合浩，冒才英，等. 孕妇产前抑郁焦虑的危险因素[J]. 中国心理卫生杂志，2015, 29(4): 246-250.
[3]
杨蜀云，苏虹，阮冶，等. 围生期抑郁、焦虑的现况调查[J]. 神经疾病与精神卫生，2015, 15(1): 50-52.
[4]
陈焱，汤月芬，漆琨，等. 孕期和产后焦虑、抑郁的随访及社会心理因素分析[J]. 上海医学，2006, 29(2): 85-88.
[5]
Qiao Y, Wang J, Li J, et al. Effects of depressive and anxiety symptoms during pregnancy on pregnant, obstetric and neonatal outcomes: a follow-up study[J]. J Obstet Gynaecol, 2012, 32(3): 237-240.
[6]
Eskici L, Akca ASD, Atasoy N, et al. The effects of depression and anxiety disorders in pregnant women on obstetric outcomes and newborn[J]. Anatol J Clin Invest, 2012, 6(1): 210-216.
[7]
Wilkie GL, Deligiannidis KM. Effects of perinatal depression and anxiety on labor and delivery outcomes[J]. Obstet Gynecol, 2014, 1(3): 82S-83S.
[8]
秦峰，丁辉，肖利军，等. 多学科合作诊疗系统治疗孕妇心理问题诱发的躯体功能障碍临床研究[J/CD]. 中华妇幼临床医学杂志(电子版), 2016, 12(3): 280-285.
[9]
张立新，孙静，陈俊梅，等. 多学科合作诊疗系统治疗孕妇心理问题诱发的躯体功能障碍临床回顾性研究[J]. 中国妇幼健康研究，2017, 28(5): 514-516.
[10]
秦峰，徐宝良，张立新，等. "孕产妇心身健康门诊"研究进展[J]. 中国卫生标准管理，2017, 8(4): 17-20.
[11]
李立明，主编. 流行病学.5版[M]. 北京：人民卫生出版社，2003: 112.
[12]
蔡湘捷，刘慎德，沈树康，等. 音乐信号对人体心理生理影响的研究[J]. 声学技术，1992, 11(1): 42-46.
[13]
霍杰斯，刘沛. 音乐生理反应研究文献综述[J]. 中国音乐，1993，13(2): 40-41.
[14]
龚斌. 音乐对运动员生理影响初探[J]. 湖南工业大学学报(社会科学版), 2000, 5(3): 64-66.
[15]
余铀，高永祥，叶海青. 校园音乐对大学生心理生理指标的影响[J]. 中国卫生工程学，2003, 2(1): 30-31.
[16]
周为民. 音乐治疗的生理学研究[J]. 中国音乐学，2007，23(1): 117-121.
[17]
解鸿雁，王健英，魏育林. 不同音乐作用下人的自主神经生理反应的研究[J]．天津音乐学院学报，2011，27(4): 108-113.
[18]
顾秋鸿. 浅谈音乐治疗中音乐体验的心理和生理机制[J]. 理论界，2014，30(2): 146-148.
[19]
刘根平，龙建新，李学武，等. 不同类型音乐对体院运动员自主生理反应的影响研究[J]. 青少年体育，2016，5(10): 95-97.
[20]
Mccraty R, Barrios-Choplin B, Rozman D, et al. The impact of a new emotional self-management program on stress, emotions, heart rate variability, DHEA and cortisol[J]. Integr Physiol Behav Sci, 1998, 33(2): 151-170.
[21]
Censi F, Calcagnini G, Lino S, et al.Transient phase locking patterns among respiration, heart rate and blood pressure during cardiorespiratory synchronisation in humans[J]. Med Biol Eng Comput, 2000, 38(4): 416-426.
[22]
Maraes VRFS. Frequência cardíaca e sua variabilidade: análises e aplicaçoes[J]. Revista Andaluza De Medicina Del Deporte, 2015, 3(1): 33-42.
[23]
Tiller WA, Mccraty R, Atkinson M．Cardiac coherence: a new, noninvasive measure of autonomic nervous system order[J]. Altern Ther Health Med, 1996, 2(1): 52-65.
[24]
刘晓虹. 中美临床心理护理模式的比较与思考[J]. 解放军护理杂志，2002, 19(6): 5-6.
[25]
褚玲玲，谢刚敏. 心理护理的概念及成分研究进展[J/CD]. 中华肺部疾病杂志(电子版), 2010, 3(1): 67-70.
[1] 陈甜甜, 王晓东, 余海燕. 双胎妊娠合并Gitelman综合征孕妇的妊娠结局及文献复习[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 559-568.
[2] 居晓庆, 金蕴洁, 王晓燕. 剖宫产术后瘢痕子宫患者再次妊娠阴道分娩发生子宫破裂的影响因素分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 575-581.
[3] 王蓓蓓, 董启秀, 郗红燕, 于庆云, 张丽君, 式光. 早孕期孕妇药物流产失败的影响因素分析与构建相关预测模型及其对药物流产成功的预测价值[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 588-594.
[4] 陈絮, 詹玉茹, 王纯华. 孕妇ABO血型联合甲状腺功能检测对预测妊娠期糖尿病的临床价值[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 604-610.
[5] 周梦玲, 薛志伟, 周淑. 妊娠合并子宫肌瘤的孕期变化及其与不良妊娠结局的关系[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 611-615.
[6] 冉晨曦, 沈如飞, 廖明钰, 廖倩, 周玲, 张玉玲, 隆敏. 垂体瘤孕妇的诊治与围分娩期管理[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(04): 487-491.
[7] 陈樱, 陈艳莉. 高龄孕妇心率变异性原因及围产结局分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 295-301.
[8] 冯丹艳, 曹晓辉, 史玉霞. 血清脂联素与胎盘亮氨酸氨肽酶对妊娠期糖尿病患者妊娠结局的影响[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 302-308.
[9] 戴玮, 江桂林, 车兆平, 张姣, 王星星, 赵海涛. 无缝手术护理在腹股沟疝腹腔镜手术围手术期的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 778-781.
[10] 张荷连, 刘禹, 李丹妮, 彭茹, 杨彩蝶, 窦恒, 吴红梅. 心理障碍对重度哮喘患者的疾病控制及生活工作质量的影响[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 589-591.
[11] 蒋丽, 王晓慧, 李维益, 苟双芸, 丁敏, 杨丽. 创新智能健康教育与随访管理对肺结节患者焦虑的影响随机对照研究[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 485-489.
[12] 赵晓红, 修翠萍, 张瑜, 吴珂. 大康复理念在COPD稳定期肺康复治疗的临床应用[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 424-426.
[13] 付强, 秦丽媛, 李全波. 神经病理性疼痛患者血清miR-15a水平及意义分析[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(05): 293-298.
[14] 潘惠, 王明, 杨忠, 杜向东. 低频重复经颅磁刺激辅助治疗伴不同特征抑郁症的对照研究[J]. 中华临床医师杂志(电子版), 2023, 17(05): 562-568.
[15] 刘雪云, 范颖, 姚爱军, 张胜苗, 吕亚妮, 张冰清, 张晓宇, 刘恒. 基于微信小程序的个体化、全程护理干预对孕妇孕期体重及分娩结局的影响[J]. 中华临床医师杂志(电子版), 2023, 17(04): 455-460.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号