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

1	付文，吴勇妹，郑磊磊，等．体检人群焦虑、抑郁生理相关因素的Logistic回归分析[J]．中华健康管理学杂志，2013，7(4)：262-266.
2	王静．关于体检人群焦虑、抑郁情绪的生理相关因素分析[J]．中国实用医药，2015，10(4)：241-242.
3	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)：85-87.
4	Herrman H, Patrick DL, Diehr P, et al.Longitudinal investigation of depression outcomes in primary care in six countries: the LIDO study. Functional status, health service use and treatment of people with depressive symptoms[J].Psychol Med, 2002, 32 (5):889-902.
5	Barkow K, Heun R, Ustün TB, et al.Identification of somatic and anxiety symptoms which contribute to the detection of depression in primary health care[J].Eur Psychiatry, 2004, 19(5):250-257.
6	Brawman-Mintzer O, Lydiard RB.Biological basis of generalized anxiety disorder[J].J Clin Psychiatry, 1997, 58(Suppl 3):16-25.
7	杨海龙，曹秋云，赵鹏，等．综合医院心理门诊患者躯体化症状的临床分析[J]．精神医学杂志，2010，23(2)：103-105.
8	Johnson RC, Slade P. Obstetric complications and anxiety during pregnancy:is there a relationship？[J].J Psychosom Obstet Gynaecol, 2003, 24(1):1-14.
9	Neggers Y, Goldenberg R, Cliver S, et al.The relationship between psychosocial profile, health practices, and pregnancy outcomes[J].Acta Obstet Gynecol Scand, 2006, 85(3):277-285.
10	Hansen D, Lou HC, Olsen J. Serious life events and congenital malformations: a national study with complete follow-up[J].Lancet, 2000, 356(9233):875-880.
11	芦小娟，温砾，醋红娟，等．选择性剖宫产的影响因素及对孕妇、新生儿的影响[J]．中华现代临床医学杂志，2005，3(15)：1500-1501.
12	Carey JC, Rayburn WF. Nuchal cord encirclements and risk of stillbirth[J]. Int J Gynaecol Obstet, 2000, 69(2):173-174.
13	匡军秀，魏敏，白骏．产妇心理与分娩方式及分娩过程的关系[J]．中华围产医学杂志，2003，6(1)：3-5.
14	秦峰，曾昭清，张立新，等．"孕产妇心身健康门诊"研究[J]．中国卫生标准管理，2015，6(21)：13-15.
15	秦峰，曾昭清，张立新，等．"孕产妇心身健康门诊"研究-基于产科临床路径研究[J]．中国卫生标准管理，2015，6(32)：20-22.
16	李立明．流行病学．5版[M]．北京：人民卫生出版社，2003：112.
17	胡华，吴爱琴．焦虑症的特质焦虑水平与心率变异性相关研究[J]．临床精神医学杂志，2007，17(2)：389-391.
18	孙瑞龙，吴宁，杨世豪，等．心率变异性检测临床应用的建议[J]．中华心血管病杂志，1998，26(4)：252-255.
19	阎克乐，张文彩，张月娟，等．心率变异性在心身疾病和情绪障碍研究中的应用[J]．心理科学进展，2006，14(2)：261-265.
20	Segerstrom SC, Nes LS. Heart rate variability reflects self-regulatory strength, effort, and fatigue[J]. Psychol Sci, 2007, 18(3):275-281.
21	秦峰，张立新，孙静，等．应用PPM治疗孕期焦虑的临床研究[J]．中国卫生标准管理，2015，6(18)：73-75.
22	秦峰，张立新，孙静，等．应用PPM治疗孕期抑郁的临床研究[J]．中国卫生标准管理，2015，6(28)：30-32.

[1]	Tiantian Chen, Xiaodong Wang, Haiyan Yu. Pregnancy outcome of twin pregnancy with Gitelman syndrome: a case report and literature review[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 559-568.
[2]	Xiaoqing Ju, Yunjie Jin, Xiaoyan Wang. Influencing factors of uterine rupture during vaginal delivery in patients with scarred uterus after cesarean section[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 575-581.
[3]	Beibei Wang, Qixiu Dong, Hongyan Xi, Qingyun Yu, Lijun Zhang, Guang Shi. Analysis of influencing factors of medical abortion failure of pregnant women in early pregnancy and construction of related prediction model and its predictive value for medical abortion success[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 588-594.
[4]	Xu Chen, Yuru Zhan, Chunhua Wang. Clinical value of ABO blood group combined with thyroid function in prediction of gestational diabetes mellitus[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 604-610.
[5]	Mengling Zhou, Zhiwei Xue, Shu Zhou. Changes in size of uterine myoma during pregnancy and its association with adverse pregnancy outcomes[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(05): 611-615.
[6]	Chenxi Ran, Rufei Shen, Mingyu Liao, Qian Liao, Ling Zhou, Yuling Zhang, Min Long. Treatment and management of pituitary tumor during pregnancy[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(04): 487-491.
[7]	Ying Chen, Yanli Chen. Causes of heart rate variability and perinatal outcomes in elderly pregnant women[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(03): 295-301.
[8]	Danyan Feng, Xiaohui Cao, Yuxia Shi. Effect of serum adiponectin and placental leucine aminopeptidase levels on pregnancy outcome in pregnant women with gestational diabetes mellitus[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(03): 302-308.
[9]	Defeng Kuang, Zhiguo Li, Shaofang Hua, Fengxia Xue. Levels and significance of fatty acid-binding protein 4 in serum and placental tissues and related lipid protein expression of high-fat-induced pregnant rats[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(03): 338-344.
[10]	Qi Wang, Xin Chen, Jie Min, Lu Fang, Zhiqi Liu, Wei Sun, Dexin Yu. Application of modified "Bag Squeeze" method in flexible cystoscopy and analysis of factors influencing pain and anxiety[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(03): 237-241.
[11]	Wei Dai, Guilin Jiang, Zhaoping Che, Jiao Zhang, Xingxing Wang, Haitao Zhao. Application effect of seamless surgical nursing in perioperative period of laparoscopic surgery for inguinal hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(06): 778-781.
[12]	Li Jiang, Xiaohui Wang, Weiyi Li, Shuangyun Gou, Min Ding, Li Yang. Influence of innovative intelligent health education and follow-up management on anxiety of patients with pulmonary nodules: a randomized control trial[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2023, 16(04): 485-489.
[13]	Qiang Fu, Liyuan Qin, Quanbo Li. Analysis of serum miR-15a level and significance in patients with neuropathic pain[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2023, 13(05): 293-298.
[14]	Hui Pan, Ming Wang, Zhong Yang, Xiangdong Du. Low-frequency repetitive transcranial magnetic stimulation for adjuvant treatment of depression with different characteristics: a controlled study[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(05): 562-568.
[15]	Xueyun Liu, Ying Fan, Aijun Yao, Shengmiao Zhang, Yani Lv, Bingqing Zhang, Xiaoyu Zhang, Heng. Liu. Effects of individualized whole-course nursing intervention based on WeChat mini program on pregnancy weight and delivery outcome[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(04): 455-460.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export