应用多学科合作诊疗系统治疗孕妇常见躯体功能障碍症状临床研究

doi:10.3877/cma.j.issn.1673-5250.2018.01.008

中华妇幼临床医学杂志(电子版) ›› 2018, Vol. 14 ›› Issue (01) : 51 -56. doi: 10.3877/cma.j.issn.1673-5250.2018.01.008

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论著

应用多学科合作诊疗系统治疗孕妇常见躯体功能障碍症状临床研究

秦峰¹^,^†(

), 肖利军², 李丽娟³, 张立新⁴, 刘婷⁴, 孙静⁴, 黄维维⁵, 潘秋萍⁵, 胡娟⁵, 曾妍芳⁶, 丁颖⁶, 邹雨霞⁶, 王盈力⁷, 杨林芝⁷, 陈静⁷, 郭存玲⁸, 韩艳菲⁸, 苏红梅⁸, 李洋⁹, 李小莉⁹, 赵斌⁹, 王月华¹⁰, 覃玉霞¹⁰, 何晓燕¹¹, 王静¹¹, 吴万粉¹¹, 欧小敏¹², 李丹¹², 李霖¹²

^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. 100098　北京，中国疾病预防控制中心妇幼保健中心
^4. 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
^5. 311300　杭州市临安区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
^6. 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
^7. 264000　山东，烟台市烟台山医院孕产妇心身健康门诊研究基地
^8. 454150　河南，焦作市妇幼保健院孕产妇心身健康门诊研究基地
^9. 610200　成都市双流区妇幼保健院孕产妇心身健康门诊研究基地
^10. 533700　广西百色，德保县妇幼保健院孕产妇心身健康门诊研究基地
^11. 225002　江苏，扬州市妇幼保健院孕产妇心身健康门诊研究基地
^12. 545027　广西，柳州市潭中人民医院孕产妇心身健康门诊研究基地

收稿日期:2018-01-09 修回日期:2018-01-19 出版日期:2018-02-01
通信作者: 秦峰

Clinical study of multidisciplinary cooperative diagnosis and treatment system in treating common somatic dysfunction symptoms of pregnant women

Feng Qin¹^,^†(), Lijun Xiao², Lijuan Li³, Lixin Zhang⁴, Ting Liu⁴, Jing Sun⁴, Weiwei Huang⁵, Qiuping Pan⁵, Juan Hu⁵, Yanfang Zeng⁶, Ying Ding⁶, Yuxia Zou⁶, Yingli Wang⁷, Linzhi Yang⁷, Jing Chen⁷, Cunling Guo⁸, Yanfei Han⁸, Hongmei Su⁸, Yang Li⁹, Xiaoli Li⁹, Bin Zhao⁹, Yuehua Wang¹⁰, Yuxia Tan¹⁰, Xiaoyan He¹¹, Jing Wang¹¹, Wanfen Wu¹¹, Xiaomin Ou¹², Dan Li¹², Lin Li¹²

^1. 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. Maternal and Child Health Center, Chinese Center for Disease Control and Prevention, Beijing 100098, China
^4. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Dagang Maternal and Child Care Center, Binhai New Area, Tianjin 300270, China
^5. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Lin′an Maternal and Child Health Care and Family Planning Service Center, Hangzhou 311300, Zhejiang Province, China
^6. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Yuexiu District Maternal and Child Care Center, Guangzhou 510055, Guangdong Province, China
^7. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Yantaishan Hospital, Yantai, Yantai 264000, Shandong Province, China
^8. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Jiaozuo Maternal and Child Health Care Hospital, Jiaozuo 454150, Henan Province, China
^9. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Shuangliu Maternal and Child Health Care Hospital, Chengdu 610200, Sichuan Province, China
^10. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Debao County Maternal and Child Health Care Hospital, Baise 533700, Guangxi Zhuang Autonomous Region, China
^11. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Yangzhou Maternal and Child Care Service Center, Yangzhou 225002, Jiangsu Province, China
^12. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Tanzhong People′s Hospital of Liuzhou, Liuzhou 545027, Guangxi Zhuang Autonomous Region, China

Received:2018-01-09 Revised:2018-01-19 Published:2018-02-01
Corresponding author: Feng Qin
About author:
Corresponding author: Qin Feng, Email: bgs_010@126.com

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引用本文：

秦峰, 肖利军, 李丽娟, 张立新, 刘婷, 孙静, 黄维维, 潘秋萍, 胡娟, 曾妍芳, 丁颖, 邹雨霞, 王盈力, 杨林芝, 陈静, 郭存玲, 韩艳菲, 苏红梅, 李洋, 李小莉, 赵斌, 王月华, 覃玉霞, 何晓燕, 王静, 吴万粉, 欧小敏, 李丹, 李霖. 应用多学科合作诊疗系统治疗孕妇常见躯体功能障碍症状临床研究[J/OL]. 中华妇幼临床医学杂志(电子版), 2018, 14(01): 51-56.

Feng Qin, Lijun Xiao, Lijuan Li, Lixin Zhang, Ting Liu, Jing Sun, Weiwei Huang, Qiuping Pan, Juan Hu, Yanfang Zeng, Ying Ding, Yuxia Zou, Yingli Wang, Linzhi Yang, Jing Chen, Cunling Guo, Yanfei Han, Hongmei Su, Yang Li, Xiaoli Li, Bin Zhao, Yuehua Wang, Yuxia Tan, Xiaoyan He, Jing Wang, Wanfen Wu, Xiaomin Ou, Dan Li, Lin Li. Clinical study of multidisciplinary cooperative diagnosis and treatment system in treating common somatic dysfunction symptoms of pregnant women[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2018, 14(01): 51-56.

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)临床诊疗系统，对于治疗孕妇常见躯体功能障碍症状的临床效果。

方法

选择2017年11月至12月，在天津市滨海新区大港妇女儿童保健中心等9家医疗机构的孕产妇心身健康门诊研究基地，进行产前检查时，发现有恶心、呕吐、胃胀、便秘、尿频及心悸6项常见躯体功能障碍症状的93例孕妇为研究对象。采取抽签方式，将受试者随机分为观察组(n＝45)及对照组(n＝48)。观察组受试者在孕期健康教育基础上，应用PPM诊疗系统进行治疗，对照组受试者则仅进行孕期健康教育。采用成组t检验，对2组孕妇治疗前《汉密顿焦虑量表(HAMA)》评分值进行比较。采用χ²检验，对2组孕妇的年龄、学历、职业、产妇类型、孕龄及治疗3周后自主神经系统(ANS)功能状态构成比进行比较。采用Mann-Whitney U秩和检验，对2组孕妇治疗3周后的6项常见躯体功能障碍症状治疗疗效进行比较。本研究遵循的程序符合病例收集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，征得受试者知情同意，并与之签署临床研究知情同意书。

结果

①治疗前，2组孕妇ANS功能状态均为紊乱状态。2组孕妇的年龄、学历、职业、产妇类型及孕龄构成比比较，以及治疗前HAMA评分值比较，差异均无统计学意义(P>0.05)。②观察组孕妇恶心症状的治疗显效率、有效率及无效率分别为80.8%(21/26)、19.2%(5/26)及0，对照组孕妇分别为12.5%(3/24)、41.7%(10/24)及45.8%(11/24)；观察组孕妇呕吐症状的治疗显效率、有效率及无效率分别为89.5%(17/19)、10.5%(2/19)及0，对照组孕妇分别为17.6%(3/17)、64.8%(11/17)及17.6%(3/17)；观察组孕妇胃胀症状的治疗显效率、有效率及无效率分别为100.0%(13/13)、0及0，对照组孕妇分别为14.3%(1/7)、28.6%(2/7)及57.1%(4/7)；观察组孕妇便秘症状的治疗显效率、有效率及无效率分别为100.0%(7/7)、0及0，对照组孕妇分别为0、0及100.0%(12/12)；观察组孕妇尿频症状的治疗显效率、有效率及无效率分别为87.5%(14/16)、12.5%(2/16)及0，对照组孕妇分别为23.1%(3/13)、0及76.9%(10/13)；观察组孕妇心悸症状的治疗显效率、有效率及无效率分别为100.0%(7/7)、0及0，对照组孕妇分别为0、0及100.0%(1/1)。观察组孕妇恶心、呕吐、胃胀、便秘、尿频、心悸6项常见躯体功能障碍症状治疗显效率均较对照组高，并且差异均有统计学意义(Z＝－4.222、－4.351、－4.255、－4.243、－3.719、－2.646，均为P<0.05)。经治疗后，观察组孕妇上述6项常见躯体功能障碍症状均较对照组孕妇显著改善。③观察组孕妇治疗后的ANS功能状态，4.4%(2/45)为紊乱状态，95.6%(43/45)为平衡状态，对照组孕妇100.0%(48/48)为紊乱状态。治疗后，2组孕妇ANS功能状态构成比比较，差异有统计学意义(χ²＝85.312，P<0.001)。

结论

应用多学科合作模式的PPM临床诊疗系统，治疗孕妇常见躯体功能障碍症状，疗效显著。

关键词: 多学科合作, 心理生理性障碍, 躯体型障碍, 孕妇

Objective

To explore the clinical effects of clinical diagnosis and treatment system of physiological regulation, psychological adjustment, music conditioning (PPM) under multidisciplinary cooperative model in treating common somatic dysfunction symptoms of pregnant women.

Methods

A total of 93 pregnant women with 6 common somatic dysfunction symptoms including nausea, vomit, gastric distention, constipation, frequent micturition and palpitation were chosen as research subjects. All of these pregnant women received prenatal examination in the Study Base of Psychosomatic Health Outpatient for Pregnant Women of 9 medical institutes such as Dagang Maternal and Child Care Center in Binhai New Area, Tianjin, etc., from November to December 2017. The subjects were randomly divided into observation group (n=45) and control group (n=48) by lotting method. On the basis of prenatal health education, PPM diagnosis and treatment system was adopted for treatment of subjects in observation group, while subjects in control group only took prenatal health education. Independent-samples t test was taken to compare the Hamilton Anxiety Scale (HAMA) score before treatment between two groups. Chi-square test was taken to compare the constituent ratios of age, educational background, occupation, parturient type, gestational age and functional status of autonomic nerves system (ANS) of the pregnant women after 3 weeks of treatment between two groups. Mann-Whitney U rank sum test was taken to compare clinical effects of 6 common somatic dysfunction symptoms after 3 weeks of treatment between two groups. Procedures adopted in this research which was approved by the ethical committee were in line with ethical standards made by Institutional Review Board of the aforementioned 9 medical institutes. After obtaining informed consent of the subjects, informed clinical research consent was signed with each of them.

Results

① Before treatment, ANS functional status of pregnant women in two groups were all in disorder. There were no significant differences between two groups of pregnant women in constituent ratios of age, educational background, occupation, parturient type and gestational age, and HAMA score before treatment (P>0.05). ② Marked effective rate, effective rate and ineffective rate of nausea therapeutic results of the pregnant women in observation group were 80.8% (21/26), 19.2% (5/26) and 0, respectively, and those in control group were 12.5% (3/24), 41.7% (10/24) and 45.8% (11/24), respectively. Marked effective rate, effective rate and ineffective rate of vomit therapeutic results of the pregnant women in observation group were 89.5% (17/19), 10.5% (2/19) and 0, respectively, and those in control group were 17.6% (3/17), 64.8%(11/17) and 17.6% (3/17), respectively. Marked effective rate, effective rate and ineffective rate of gastric distention therapeutic results of the pregnant women in observation group were 100.0% (13/13), 0 and 0, respectively, and those in control group were 14.3% (1/7), 28.6% (2/7) and 57.1% (4/7), respectively. Marked effective rate, effective rate and ineffective rate of constipation therapeutic results of the pregnant women in observation group were 100.0% (7/7), 0 and 0, respectively, and those in control group was 0, 0 and 100.0% (12/12), respectively. Marked effective rate, effective rate and ineffective rate of frequent micturition therapeutic results of the pregnant women in observation group were 87.5% (14/16), 12.5% (2/16) and 0, respectively, and those in control group was 23.1% (3/13), 0 and 76.9% (10/13), respectively. Marked effective rate, effective rate and ineffective rate of palpitation therapeutic results of the pregnant women in observation group were 100.0% (7/7), 0 and 0, respectively, and those in control group was 0, 0 and 100.0% (1/1), respectively. The marked effective rates of 6 common somatic dysfunctions of the pregnant women in observation group, namely nausea, vomit, gastric distention, constipation, frequent micturition and palpitation, all were statistically higher than those in control group, and all the differences were statistically significant (Z=-4.222, -4.351, -4.255, -4.243, -3.719, -2.646; P<0.05). After 3 weeks of treatment, the 6 common somatic dysfunctions in observation group were greatly improved when compared to those of control group. ③ Regarding ANS functional status of the pregnant women after treatment, 4.4%(2/45) was in disorder state and 95.6%(43/45) was in equilibrium state of observation group, while 100.0%(48/48) was still in disorder state of control group. There was significant difference between two groups of pregnant women in constituent ratio of ANS functional status after treatment (χ²=85.312, P<0.001).

Conclusion

The PPM clinical diagnosis and treatment system under multidisciplinary cooperation model can effectively treat common somatic dysfunction symptoms of pregnant women.

Key words: Multidisciplinary cooperation, Psychophysiologic disorders, Somatoform disorders, Pregnant women

表1 2组孕妇一般临床资料构成比及治疗前《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(%)]
组别	例数	20～35岁	>35岁	高中及以下	大学及以上	在职	家庭主妇
观察组	45	41(91.1)	4(9.9)	17(37.8)	28(62.2)	19(42.2)	26(57.8)
对照组	48	39(82.0)	9(18.0)	27(56.0)	21(44.0)	25(52.0)	23(48.0)
检验值	?	χ²＝1.878		χ²＝3.179		χ²＝0.906
P值	?	0.171		0.075		0.341
组别	例数	产妇类型[例数(%)]		孕龄[例数(%)]			治疗前HAMA评分值(分，±s)
组别	例数	初产妇	经产妇	≤12周	12～28周	≥28周	治疗前HAMA评分值(分，±s)
观察组	45	28(62.2)	17(37.8)	10(22.2)	33(73.3)	2(4.5)	4.8±1.3
对照组	48	22(46.0)	26(54.0)	13(27.1)	35(72.9)	0(0)	4.4±1.2
检验值	?	χ²＝2.510		χ²＝0.295			t ＝1.599
P值	?	0.113		0.587			0.117

表1 2组孕妇一般临床资料构成比及治疗前《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(%)]
组别	例数	20～35岁	>35岁	高中及以下	大学及以上	在职	家庭主妇
观察组	45	41(91.1)	4(9.9)	17(37.8)	28(62.2)	19(42.2)	26(57.8)
对照组	48	39(82.0)	9(18.0)	27(56.0)	21(44.0)	25(52.0)	23(48.0)
检验值	?	χ²＝1.878		χ²＝3.179		χ²＝0.906
P值	?	0.171		0.075		0.341
组别	例数	产妇类型[例数(%)]		孕龄[例数(%)]			治疗前HAMA评分值(分，±s)
组别	例数	初产妇	经产妇	≤12周	12～28周	≥28周	治疗前HAMA评分值(分，±s)
观察组	45	28(62.2)	17(37.8)	10(22.2)	33(73.3)	2(4.5)	4.8±1.3
对照组	48	22(46.0)	26(54.0)	13(27.1)	35(72.9)	0(0)	4.4±1.2
检验值	?	χ²＝2.510		χ²＝0.295			t ＝1.599
P值	?	0.113		0.587			0.117

表2 2组孕妇6项常见躯体功能障碍症状治疗疗效比较[例数(%)]

组别	恶心				呕吐
组别	例数	显效	有效	无效	例数	显效	有效	无效
观察组	26	21(80.8)	5(19.2)	0(0)	19	17(89.5)	2(10.5)	0(0)
对照组	24	3(12.5)	10(41.7)	11(45.8)	17	3(17.6)	11(64.8)	3(17.6)
Z值	－4.222				－4.351
P值	<0.001				<0.001
组别	胃胀				便秘
组别	例数	显效	有效	无效	例数	显效	有效	无效
观察组	13	13(100.0)	0(0)	0(0)	7	7(100.0)	0(0)	0(0)
对照组	7	1(14.3)	2(28.6)	4(57.1)	12	0(0)	0(0)	12(100.0)
Z值	－4.255				－4.243
P值	<0.001				<0.001
组别	尿频				心悸
组别	例数	显效	有效	无效	例数	显效	有效	无效
观察组	16	14(87.5)	2(12.5)	0(0)	7	7(100.0)	0(0)	0(0)
对照组	13	3(23.1)	0(0)	10(76.9)	1	0(0)	0(0)	1(100.0)
Z值	－3.719				－2.646
P值	<0.001				0.008

表2 2组孕妇6项常见躯体功能障碍症状治疗疗效比较[例数(%)]

组别	恶心				呕吐
组别	例数	显效	有效	无效	例数	显效	有效	无效
观察组	26	21(80.8)	5(19.2)	0(0)	19	17(89.5)	2(10.5)	0(0)
对照组	24	3(12.5)	10(41.7)	11(45.8)	17	3(17.6)	11(64.8)	3(17.6)
Z值	－4.222				－4.351
P值	<0.001				<0.001
组别	胃胀				便秘
组别	例数	显效	有效	无效	例数	显效	有效	无效
观察组	13	13(100.0)	0(0)	0(0)	7	7(100.0)	0(0)	0(0)
对照组	7	1(14.3)	2(28.6)	4(57.1)	12	0(0)	0(0)	12(100.0)
Z值	－4.255				－4.243
P值	<0.001				<0.001
组别	尿频				心悸
组别	例数	显效	有效	无效	例数	显效	有效	无效
观察组	16	14(87.5)	2(12.5)	0(0)	7	7(100.0)	0(0)	0(0)
对照组	13	3(23.1)	0(0)	10(76.9)	1	0(0)	0(0)	1(100.0)
Z值	－3.719				－2.646
P值	<0.001				0.008

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Clinical study of multidisciplinary cooperative diagnosis and treatment system in treating common somatic dysfunction symptoms of pregnant women

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Clinical study of multidisciplinary cooperative diagnosis and treatment system in treating common somatic dysfunction symptoms of pregnant women