Clinical pathway for psychosomatic disorders in pregnancy and puerperium (2017)

doi:10.3877/cma.j.issn.1673-5250.2017.06.004

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2017, Vol. 13 ›› Issue (06): 640 -644. doi: 10.3877/cma.j.issn.1673-5250.2017.06.004

Special Issue: ；

Standard ? Proposal ? Guideline

Clinical pathway for psychosomatic disorders in pregnancy and puerperium (2017)

Feng Qin¹^,^†(), Lijuan Li², Lijun Xiao³^,^†(), Lixin Zhang⁴, Zhengmei Gao⁵, Haiying Lan⁶, Yingli Wang⁷, Juanjuan Zhao⁸, Ailing Wang⁹, Daihua Han¹⁰, Yuehua Wang¹¹

^1. General Research Group of National Maternal Physical and Mental Health Clinic, Beijing 100142, China
^2. Maternal and Child Health Center, Chinese Center for Disease Control and Prevention, Beijing 100098, China
^3. Scientific Research Office, Bayi Children′s Hospital, General Hospital of Beijing Military Region, Beijing 100700, 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, Ling′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, Xinjiang Uygur Autonomous Region Maternal and Child Health Care Hospital, Urumchi 830001, Xinjiang Uygur Autonomous Region, China
^9. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Jiaozuo Maternal and Child Health Care Hospital, Jiaozuo 454150, Henan Province, China
^10. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Shuangliu Maternal and Child Health Care Hospital, Chengdu 610200, Sichuan Province, China
^11. Study Base of Psychosomatic Health Outpatient for Pregnant Women, Debao County Maternal and Child Health Care Hospital, Baise 533700, Guangxi Zhuang Autonomous Region, China

Received:2017-11-03 Revised:2017-11-25 Published:2017-12-01
Corresponding author: Feng Qin, Lijun Xiao
About author:
Corresponding authors: Qin Feng, Email: bgs_010@126.com
Xiao Lijun, Email: ycf@vip.126.com

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Psychosomatic disorders (PSD) in pregnancy and puerperium is defined as functional somatization disorders in pregnant and puerperal woman induced by mental health problems, which may cause pregnancy-related diseases, resulting in impaired fetal normal development as well as premature delivery, miscarriage and postpartum complications, and severely affect the delivery mode, labor process and health of newborns. The causes of above mentioned adverse effects are mental health problems of pregnant and puerperal women, which are clinically manifested as PSD in pregnancy and puerperium, including 12 somatic dysfunction symptoms as frequent dreaming, restless sleep, difficulty falling asleep, frequent urination, nausea, vomiting, gastric distention, constipation, chest distress, palpitation, dry mouth and sore muscle. The analysis of clinical data on large number of samples from multiple study bases of psychosomatic health outpatients for pregnant women across China performed by general research group of National Maternal Physical and Mental Health Clinic showed that, the multidisciplinary cooperation mode of physiological regulation, psychological adjustment and music conditioning (PPM) had a clinical effective rate of 92.23% and 99.48% in resolving somatic dysfunction symptoms and high-risk factors of anxiety and depression in pregnant and puerperal women with PSD, respectively, and a recovery rate of 91.50% 2 months after cure in Psychosomatic Health Outpatient for Pregnant Women. This series of studies suggested that PSD in pregnancy and puerperium is controllable and curable. By conducting in depth studies on " maternal psychosomatic health clinic and establishment and application of PSD in pregnancy management system" , the general research group developed the 2017 Clinical Pathway for PSD in Pregnancy and Puerperium based on results of previous related studies, providing clinical standards for further developmental studies.

Key words: Psychophysiologic disorders, Somatoform disorders, Clinical pathways, Pregnant women, Puerpera

表1 《孕产期心身障碍临床路径(2017版)》表单

适用对象：①多梦、易醒、入睡困难、尿频、恶心、呕吐、胃胀、便秘、胸闷、心悸、口干、肌肉酸痛12项躯体功能障碍症状以1项或多项持续或有规律发生≥7 d；②HAMA总分为7～13分；③HRV监测报告显示，反映受试者ANS功能状态的坐标，位于ANS功能状态图的交感或副交感活跃区
孕(产)妇姓名：__________　年龄：______　孕次：______			产次：______　孕龄：______孕周(或)产后：______天		门诊号：______
门诊治疗日期：________年______月______日至________年______月______日					门诊标准疗程：6次
治疗时间	治疗第1次		治疗第2～5次		治疗完成当日
主要诊疗工作	□详细询问病史，完善检查 □初步诊断，确定治疗方案 □向孕产妇及其家属交代病情 □开具诊断报告及检查单 □应用首次PPM＋孕产期健康教育治疗方案治疗 □上级医师指导治疗(必要时) □出具家庭调理方案和心理调节鼓励方案 □完成首次病程记录及病历记录		□随诊检查家庭调理记录单，评估家庭调理疗效和了解孕产妇近期情况 □向孕产妇及其家属介绍诊疗情况 □审查门诊治疗室临床护理报告单，认真分析重点问题 □应用第2～5次PPM＋孕产期健康教育治疗方案治疗 □门诊多学科合作小组疑难病例讨论(必要时) □多学科专家联合，包括远程会诊(必要时) □出具家庭调理方案和心理调节鼓励方案 □完成病程记录		□随诊检查家庭调理记录单，评估家庭调理疗效和了解孕产妇近期情况 □审查门诊治疗室临床护理报告单，认真分析重点问题 □应用第6次PPM＋孕产期健康教育治疗方案治疗 □复诊并开具复诊单 □向孕产妇及其家属介绍康复情况 □出具治疗后10周家庭调理方案 □出具治疗后10周随访方案 □完成病历
重要医嘱	长期医嘱：		长期医嘱：		长期医嘱：
?	□按照医嘱完成PPM家庭调理和填写家庭调理记录单 □按照医嘱执行家庭心理调节鼓励方案 □其他孕产期心身健康注意事项		□按照医嘱完成PPM家庭调理和填写家庭调理记录单 □按照医嘱执行家庭心理调节鼓励方案 □明确每次随诊和治疗时间 □其他孕产期心身健康注意事项		□按照医嘱完成治疗后10周的家庭调理，并填写家庭调理记录单 □认真配合门诊医护人员随访 □门诊复查(必要时) □其他孕产期心身健康注意事项
?	临时医嘱：		临时医嘱：		?
?	□根据首次治疗情况及家庭调理方案下达家庭调理医嘱 □明确下次随诊和治疗时间		□根据每次治疗中的临床重、难点及患者个性化问题，下达门诊治疗室临床应对措施医嘱 □根据每阶段门诊临床问题及家庭调理问题，下达门诊随访室随访医嘱(必要时) □根据每次治疗和家庭调理情况，以及躯体障碍症状变化情况，下达家庭调理医嘱		?
主要护理工作	□介绍门诊环境 □协助完成辅助检查 □首次PPM＋孕产期健康教育临床护理 □观察孕产妇对治疗的临床适应性 □填写临床护理报告手册 □告知随诊和治疗时间及地点		□协助完成随诊 □第2～5次PPM＋孕产期健康教育临床护理 □观察孕产妇对治疗的临床适应性 □严格执行临床医嘱 □填写临床护理报告手册 □告知随诊和治疗时间及地点		□第6次PPM＋孕产期健康教育临床护理 □正确执行临床医嘱 □协助完成复诊 □引导办理治疗结束手续 □治疗结束后的孕产期健康教育
变异记录	□无		□无		□无
?	□有，原因：		□有，原因：		□有，原因：
?	?	1.	?	1.	?	1.
?	?	2.	?	2.	?	2.
护士签名	?		?		?
医师签名	?		?		?

表1 《孕产期心身障碍临床路径(2017版)》表单

适用对象：①多梦、易醒、入睡困难、尿频、恶心、呕吐、胃胀、便秘、胸闷、心悸、口干、肌肉酸痛12项躯体功能障碍症状以1项或多项持续或有规律发生≥7 d；②HAMA总分为7～13分；③HRV监测报告显示，反映受试者ANS功能状态的坐标，位于ANS功能状态图的交感或副交感活跃区
孕(产)妇姓名：__________　年龄：______　孕次：______			产次：______　孕龄：______孕周(或)产后：______天		门诊号：______
门诊治疗日期：________年______月______日至________年______月______日					门诊标准疗程：6次
治疗时间	治疗第1次		治疗第2～5次		治疗完成当日
主要诊疗工作	□详细询问病史，完善检查 □初步诊断，确定治疗方案 □向孕产妇及其家属交代病情 □开具诊断报告及检查单 □应用首次PPM＋孕产期健康教育治疗方案治疗 □上级医师指导治疗(必要时) □出具家庭调理方案和心理调节鼓励方案 □完成首次病程记录及病历记录		□随诊检查家庭调理记录单，评估家庭调理疗效和了解孕产妇近期情况 □向孕产妇及其家属介绍诊疗情况 □审查门诊治疗室临床护理报告单，认真分析重点问题 □应用第2～5次PPM＋孕产期健康教育治疗方案治疗 □门诊多学科合作小组疑难病例讨论(必要时) □多学科专家联合，包括远程会诊(必要时) □出具家庭调理方案和心理调节鼓励方案 □完成病程记录		□随诊检查家庭调理记录单，评估家庭调理疗效和了解孕产妇近期情况 □审查门诊治疗室临床护理报告单，认真分析重点问题 □应用第6次PPM＋孕产期健康教育治疗方案治疗 □复诊并开具复诊单 □向孕产妇及其家属介绍康复情况 □出具治疗后10周家庭调理方案 □出具治疗后10周随访方案 □完成病历
重要医嘱	长期医嘱：		长期医嘱：		长期医嘱：
?	□按照医嘱完成PPM家庭调理和填写家庭调理记录单 □按照医嘱执行家庭心理调节鼓励方案 □其他孕产期心身健康注意事项		□按照医嘱完成PPM家庭调理和填写家庭调理记录单 □按照医嘱执行家庭心理调节鼓励方案 □明确每次随诊和治疗时间 □其他孕产期心身健康注意事项		□按照医嘱完成治疗后10周的家庭调理，并填写家庭调理记录单 □认真配合门诊医护人员随访 □门诊复查(必要时) □其他孕产期心身健康注意事项
?	临时医嘱：		临时医嘱：		?
?	□根据首次治疗情况及家庭调理方案下达家庭调理医嘱 □明确下次随诊和治疗时间		□根据每次治疗中的临床重、难点及患者个性化问题，下达门诊治疗室临床应对措施医嘱 □根据每阶段门诊临床问题及家庭调理问题，下达门诊随访室随访医嘱(必要时) □根据每次治疗和家庭调理情况，以及躯体障碍症状变化情况，下达家庭调理医嘱		?
主要护理工作	□介绍门诊环境 □协助完成辅助检查 □首次PPM＋孕产期健康教育临床护理 □观察孕产妇对治疗的临床适应性 □填写临床护理报告手册 □告知随诊和治疗时间及地点		□协助完成随诊 □第2～5次PPM＋孕产期健康教育临床护理 □观察孕产妇对治疗的临床适应性 □严格执行临床医嘱 □填写临床护理报告手册 □告知随诊和治疗时间及地点		□第6次PPM＋孕产期健康教育临床护理 □正确执行临床医嘱 □协助完成复诊 □引导办理治疗结束手续 □治疗结束后的孕产期健康教育
变异记录	□无		□无		□无
?	□有，原因：		□有，原因：		□有，原因：
?	?	1.	?	1.	?	1.
?	?	2.	?	2.	?	2.
护士签名	?		?		?
医师签名	?		?		?

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Clinical pathway for psychosomatic disorders in pregnancy and puerperium (2017)

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Clinical pathway for psychosomatic disorders in pregnancy and puerperium (2017)