A clinical study on multidisciplinary cooperation diagnosis and treatment system in the treatment of physical dysfunction induced by psychological problems in pregnant women

doi:10.3877/cma.j.issn.1673-5250.2016.03.006

Objective

To investigate the clinical effect of a multidisciplinary cooperation mode of physiological regulation, psychological adjustment and music conditioning(PPM) intervention measures (based on obstetrics department) in the treatment of psychological problems induced physical dysfunction among pregnant women.

Methods

A total of 100 pregnant women who received prenatal examination in the Maternal Physical and Mental Health Clinic of Dagang Maternal and Child Health Care Center in Binhai New Area, Tianjin, Maternal and Child Health Care Hospital in Yuexiu District, Guangzhou, Yantai Mountain Hospital in Yantai, Hangu Maternal and Child Health Care Center in Binhai New Area, Tianjin, and Maternal and Child Health Care Center in Hebei District, Tianjin, from March to April 2016 were selected as study objects.They were randomly divided into observation group(n=50) and control group(n=50) employing the ballot method.The observation group was treated with PPM intervention measures in addition to traditional health education, while the control group was only treated with traditional health education.Statistical methods were applied to compare the changes in main symptoms of the chief complain of physical dysfunction, the functional state of the autonomic nervous system(VNS) and Hamilton anxiety scale(HAMA) scores between two groups after treatment for 3 weeks. Subjects in both groups showed disordered functional state of the VNS before treatment, and there were no significant differences between two groups in constituent ratios of age, educational background, occupation, maternal types and gestational age, also HAMA scores before treatment(P>0.05). Procedures in this study were in line with the ethical standards established by the Institutional Review Board of each medical unit above mentioned and approved by each committee, additionally, all subjects signed informed consent in clinical research.

Results

①After treatment, twelve kinds of main symptoms of physical dysfunction including dreaminess, festless sleep, difficulty falling asleep, frequent micturition, nausea, vomiting, astriction, gastrectasia, chest tightness, palpitation, dry mouth and muscular soreness of pregnant women in observation group were improved compared with those of control group, and the differences were statistically significant(P<0.05). ②There were significant differences between pregnant women of two groups in constituent ratio of VNS functional state after treatment, and the difference was statistically significant(χ²=79.704, P=0.000), with equilibrium state mainly of pregnant women in observation group while disordered state mainly in control group.③HAMA score of pregnant women in observation group after treatment[(1.9±1.2) points] was lower than that of control group[(9.8±2.5) points], and the difference was statistically significant(t=-19.490, P=0.000).

Conclusions

Application of PPM intervention measures in a multidisciplinary cooperation mode (based on obstetrics department) in the treatment of physical dysfunction induced by psychological problems in pregnant women presents significant efficacy, moreover, PPM has therapeutic effect on anxiety and depression.

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

表1 两组孕妇一般临床资料构成比及治疗前HAMA评分值比较[例数(%)]

组别	例数	年龄(岁)		学历		职业		产妇类型		孕龄(周)			治疗前HAMA评分值(分，±s)
组别	例数	20～35	>35	高中及以下	大学及以上	在职	家庭主妇	初产妇	经产妇	≤12	12～28	≥28	治疗前HAMA评分值(分，±s)
观察组	48	44(91.7)	4(8.3)	11(22.9)	37(77.1)	28(58.3)	20(41.7)	37(77.1)	11(22.9)	13(27.1)	34(70.8)	1(2.1)	10.1±1.6
对照组	47	43(91.5)	4(8.5)	10(21.3)	37(78.7)	32(68.1)	15(31.9)	33(70.2)	14(29.8)	9(19.2)	37(78.7)	1(2.1)	9.7±1.7
检验值		χ²＝0.054		χ²＝0.117		χ²＝2.145		χ²＝1.258		χ²＝1.807			t＝0.978
P值		0.816		0.733		0.143		0.262		0.179			0.330

表1 两组孕妇一般临床资料构成比及治疗前HAMA评分值比较[例数(%)]

组别	例数	年龄(岁)		学历		职业		产妇类型		孕龄(周)			治疗前HAMA评分值(分，±s)
组别	例数	20～35	>35	高中及以下	大学及以上	在职	家庭主妇	初产妇	经产妇	≤12	12～28	≥28	治疗前HAMA评分值(分，±s)
观察组	48	44(91.7)	4(8.3)	11(22.9)	37(77.1)	28(58.3)	20(41.7)	37(77.1)	11(22.9)	13(27.1)	34(70.8)	1(2.1)	10.1±1.6
对照组	47	43(91.5)	4(8.5)	10(21.3)	37(78.7)	32(68.1)	15(31.9)	33(70.2)	14(29.8)	9(19.2)	37(78.7)	1(2.1)	9.7±1.7
检验值		χ²＝0.054		χ²＝0.117		χ²＝2.145		χ²＝1.258		χ²＝1.807			t＝0.978
P值		0.816		0.733		0.143		0.262		0.179			0.330

表2 两组孕妇治疗后主诉躯体功能障碍主要症状变化比较[例数(%)]

组别	多梦				易醒				入睡困难
组别	例数	显效	有效	无效	例数	显效	有效	无效	例数	显效	有效	无效
观察组	21	19(90.5)	2(9.5)	0(0)	17	16(94.1)	0(0)	1(5.9)	9	8(88.9)	1(11.1)	0(0)
对照组	19	0(0)	0(0)	19(100.0)	16	1(6.2)	1(6.2)	14(87.6)	8	2(25.0)	0(0)	6(75.0)
Z值		－6.094			－4.885				－2.789
P值		0.000			0.000				0.004
组别	尿频				恶心				呕吐
组别	例数	显效	有效	无效	例数	显效	有效	无效	例数	显效	有效	无效
观察组	20	19(95.0)	1(5.0)	0(0)	17	14(82.4)	2(11.7)	1(5.9)	10	10(100.0)	0(0)	0(0)
对照组	19	3(15.8)	1(5.3)	15(78.9)	9	1(11.1)	2(22.2)	6(66.7)	9	1(11.1)	2(22.2)	6(66.7)
Z值		－5.079			－4.292				－3.709
P值		0.000?			0.000				0.000
组别	便秘				胃胀				胸闷
组别	例数	显效	有效	无效	例数	显效	有效	无效	例数	显效	有效	无效
观察组	10	8(80.0)	2(20.0)	0(0)	6	6(100.0)	0(0)	0(0)	13	13(100.0)	0(0)	0(0)
对照组	7	1(14.3)	0(0)	6(85.7)	5	0(0)	0(0)	5(100.0)	15	1(6.7)	0(0)	14(93.3)
Z值		－3.147			－3.162				－4.837
P值		0.002			0.002				0.000
组别	心悸				口干				肌肉酸痛
组别	例数	显效	有效	无效	例数	显效	有效	无效	例数	显效	有效	无效
观察组	10	10(100.0)	0(0)	0(0)	9	9(100.0)	0(0)	0(0)	8	8(100.0)	0(0)	0(0)
对照组	12	1(8.3)	0(0)	11(91.7)	9	0(0)	0(0)	9(100.0)	12	1(8.3)	0(0)	11(91.7)
Z值	－4.183				－4.123				－3.935
P值	0.000				0.000				0.000

表2 两组孕妇治疗后主诉躯体功能障碍主要症状变化比较[例数(%)]

组别	多梦				易醒				入睡困难
组别	例数	显效	有效	无效	例数	显效	有效	无效	例数	显效	有效	无效
观察组	21	19(90.5)	2(9.5)	0(0)	17	16(94.1)	0(0)	1(5.9)	9	8(88.9)	1(11.1)	0(0)
对照组	19	0(0)	0(0)	19(100.0)	16	1(6.2)	1(6.2)	14(87.6)	8	2(25.0)	0(0)	6(75.0)
Z值		－6.094			－4.885				－2.789
P值		0.000			0.000				0.004
组别	尿频				恶心				呕吐
组别	例数	显效	有效	无效	例数	显效	有效	无效	例数	显效	有效	无效
观察组	20	19(95.0)	1(5.0)	0(0)	17	14(82.4)	2(11.7)	1(5.9)	10	10(100.0)	0(0)	0(0)
对照组	19	3(15.8)	1(5.3)	15(78.9)	9	1(11.1)	2(22.2)	6(66.7)	9	1(11.1)	2(22.2)	6(66.7)
Z值		－5.079			－4.292				－3.709
P值		0.000?			0.000				0.000
组别	便秘				胃胀				胸闷
组别	例数	显效	有效	无效	例数	显效	有效	无效	例数	显效	有效	无效
观察组	10	8(80.0)	2(20.0)	0(0)	6	6(100.0)	0(0)	0(0)	13	13(100.0)	0(0)	0(0)
对照组	7	1(14.3)	0(0)	6(85.7)	5	0(0)	0(0)	5(100.0)	15	1(6.7)	0(0)	14(93.3)
Z值		－3.147			－3.162				－4.837
P值		0.002			0.002				0.000
组别	心悸				口干				肌肉酸痛
组别	例数	显效	有效	无效	例数	显效	有效	无效	例数	显效	有效	无效
观察组	10	10(100.0)	0(0)	0(0)	9	9(100.0)	0(0)	0(0)	8	8(100.0)	0(0)	0(0)
对照组	12	1(8.3)	0(0)	11(91.7)	9	0(0)	0(0)	9(100.0)	12	1(8.3)	0(0)	11(91.7)
Z值	－4.183				－4.123				－3.935
P值	0.000				0.000				0.000

表3 两组孕妇治疗后VNS功能状态构成比及HAMA评分值比较

组别	例数	VNS功能状态构成比[例数(%)]		HAMA评分值(分，±s)
组别	例数	紊乱	平衡	HAMA评分值(分，±s)
观察组	48	1 (2.1)	47(97.9)	1.9±1.2
对照组	47	45(95.7)	2 (4.3)	9.8±2.5
检验值		χ²＝79.704		t＝－19.490
P值		0.000		0.000

表3 两组孕妇治疗后VNS功能状态构成比及HAMA评分值比较

组别	例数	VNS功能状态构成比[例数(%)]		HAMA评分值(分，±s)
组别	例数	紊乱	平衡	HAMA评分值(分，±s)
观察组	48	1 (2.1)	47(97.9)	1.9±1.2
对照组	47	45(95.7)	2 (4.3)	9.8±2.5
检验值		χ²＝79.704		t＝－19.490
P值		0.000		0.000

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