Clinical pathway for pregnancy and puerperium psychosomatic disorders (2020 revised version)

doi:10.3877/cma.j.issn.1673-5250.2020.05.006

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2020, Vol. 16 ›› Issue (05): 535 -542. doi: 10.3877/cma.j.issn.1673-5250.2020.05.006

Special Issue: ；

Clinical pathway for pregnancy and puerperium psychosomatic disorders (2020 revised version)

Feng Qin¹^,^†(), Jun Zheng², Lijuan Li³, Lixin Zhang⁴, Jianjuan Li⁵, Kun Chen⁶, Chunmei Lu⁷, Haiying Lan⁸, Qiang Pang⁹, Shuangyan Chen¹⁰, Yao Chen¹¹, Fengxian Li¹², Chunhong Li¹³, Liqiu Zhu¹⁴, Fengying Yang¹⁵

^1. General Research Group of National Psychosomatic Health Clinic for Pregnancy and Puerperium, Beijing 100142, China
^2. Department of Neonatology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin 300052, China
^3. Maternal and Child Health Center, Chinese Center for Disease Control and Prevention, Beijing 100098, China
^4. Research Base of Psychosomatic Health Clinic for Pregnancy and Puerperium of Dagang, Women and Children Health Care and Family Planning Service Center in Binhai New Area, Tianjin 300270, China
^5. Research Base of Psychosomatic Health Clinic for Pregnancy and Puerperium, Beichen District Women and Children Health Care and Family Planning Service Center, Tianjin 300400, China
^6. Research Base of Psychosomatic Health Clinic for Pregnancy and Puerperium, Shapingba District Women and Children Health Care and Family Planning Service Center, Chongqing 400030, China
^7. Research Base of Psychosomatic Health Clinic for Pregnancy and Puerperium, Pidu District Women and Children Health Care Hospital, Chengdu 611745, Sichuan Province, China
^8. Research Base of Psychosomatic Health Clinic for Pregnancy and Puerperium, Yuexiu District Women and Children Health Care Hospital, Guangzhou 510055, Guangdong Province, China
^9. Research Base of Psychosomatic Health Clinic for Pregnancy and Puerperium, Debao Maternal and Child Health Care Hospital, Baise 533700, Guangxi Zhuang Autonomous Region, China
^10. Research Base of Psychosomatic Health Clinic for Pregnancy and Puerperium, Lin′an District Women and Children Health Care and Family Planning Service Center, Hangzhou 311300, Zhejiang Province, China
^11. Research Base of Psychosomatic Health Clinic for Pregnancy and Puerperium, Hangzhou Fuyang Women and Children Hospital, Hangzhou 311400, Zhejiang Province, China
^12. Research Base of Psychosomatic Health Clinic for Pregnancy and Puerperium, Meihekou Women and Children Health Care Hospital, Meihekou 135000, Jilin Province, China
^13. Research Base of Psychosomatic Health Clinic for Pregnancy and Puerperium, Anda Women and Children Health Care and Family Planning Service Center, Anda 151400, Heilongjiang Province, China
^14. Research Base of Psychosomatic Health Clinic for Pregnancy and Puerperium, Dongning Women and Children Health Care Hospital, Dongning 157200, Heilongjiang Province, China
^15. Research Base of Psychosomatic Health Clinic for Pregnancy and Puerperium, Bayannur Hospital, Bayannur 015000, Inner Mongolia Autonomous Region, China

Received:2020-05-24 Revised:2020-09-14 Published:2020-10-01
Corresponding author: Feng Qin
Supported by:
Physical and Psychological Health Foundation of China Health Promotion Foundation(CHSX20190601)

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Under the bio-psycho-social medicine model, pregnancy and puerperium psychosomatic disorder (PPPSD) means physical dysfunction caused by either physiological, psychological and social factors or physiological and pathological risk factors, or jointly caused by the aforesaid factors. PPPSD can exert a significant impact on obstetric medical quality and do huge damage to the health of pregnant women, fetuses and newborns. The General Research Group of National Psychosomatic Health Clinic for Pregnancy and Puerperium (hereinafter referred to as " General Research Group" ) is devoted to researches of etiology, pathogenesis, diagnosis, treatment, prognosis, rehabilitation and other factors related to PPPSD, establishment of clinical diagnosis and treatment systems and relevant criteria and standards of PPPSD and establishment of clinical pregnancy physical and psychological health service patterns. Moreover, it is devoted to the establishment of outpatient research bases at perinatal care centers or obstetrics department in general hospitals at different levels, maternity and child care hospitals (centers), and community health service centers in different ethnic, economic and cultural regions of China, in order to carry out clinical studies of PPPSD. PPPSD clinical pathway was initially developed by the General Research Group in 2015 and then revised in 2016, 2017 and 2018. With progress in theoretical studies, General Research Group revises the Clinical Pathway for Pregnancy and Puerperium Psychosomatic Disorder(2018 Revised Version) based on large-sample size analysis from numerous clinical research centers nationwide, and Clinical Pathway for Pregnancy and Puerperium Psychosomatic Disorder(2020 Revised Version) for perinatal period and obstetrics department is developed to standardize clinical diagnosis and treatment of PPPSD.

Key words: Psychophysiologic disorders, Somatoform disorders, Mental disorders, Anxiety, Depression, Critical pathways, Pregnancy and puerperium

表1 《孕产期心身障碍临床路径(2020修订版)》表单

适用对象：入睡困难、易醒、恶心、呕吐、胃胀、便秘、尿频、胸闷、口干、肌肉酸痛10项主述躯体功能障碍症状中，≥1项持续或有规律发生，或本次妊娠前已发生，而由于妊娠后加重≥7 d的PPPSD孕产妇
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，完善其PPPSD相关检查	□随诊检查家庭调理记录单，评估家庭调理疗效和了解PPPSD孕产妇近期情况	□随诊检查家庭调理记录单，评估家庭调理疗效和了解PPPSD孕产妇近期情况
	□对其PPPSD进行初步诊断，并确定治疗方案	□向PPPSD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
	□向孕产妇及其家属交待病情	□审查门诊治疗室临床护理报告单，认真分析重点问题	□采用PPM系统，进行第6次PPM＋孕产期健康教育治疗
	□开具诊断报告及检查单	□采用PPM系统，进行第2～5次PPM＋孕产期健康教育治疗	□复诊并开具检查单和复诊单
	□采用PPM系统，进行首次PPM＋孕产期健康教育治疗	□门诊多学科合作小组疑难病例讨论(必要时)	□向孕产妇及其家属介绍康复情况
	□上级医师指导治疗(必要时)	□多学科专家联合(包括远程)会诊(必要时)	□出具治疗后10周家庭调理方案
	□出具家庭调理方案和心理调节鼓励方案	□出具家庭调理方案和心理调节鼓励方案	□出具治疗后10周随访方案
	□建立PPPSD孕产妇的病历档案，并完成首次病程记录	□完成病程记录	□完结病历，并建立档案
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，并填写家庭调理记录单	□按照医嘱完成PPM家庭调理，并填写家庭调理记录单	□根据每阶段门诊临床问题及家庭调理问题，下达电话或入户随访医嘱(必要时)
	□按照医嘱执行家庭心理调节鼓励方案	□按照医嘱执行家庭心理调节鼓励方案	□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
	□其他孕产期心身健康注意事项	□明确每次随诊和治疗时间	□认真配合门诊医护人员随访
	临时医嘱：	□其他孕产期心身健康注意事项	□门诊复查(必要时)
	□根据首次治疗情况及家庭调理方案下达家庭调理医嘱	临时医嘱：	□其他孕产期心身健康注意事项
	□明确下次随诊和治疗时间	□根据每次治疗中的临床重点、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(必要时)
		□根据每次治疗和家庭调理情况，以及患者躯体功能障碍症状变化情况，下达家庭调理应对措施医嘱(必要时)
主要护理工作	□介绍门诊环境	□协助完成随诊	□第6次PPM＋孕产期健康教育临床护理
	□协助完成辅助检查	□第2～5次PPM＋孕产期健康教育临床护理	□协助完成辅助检查
	□首次PPM＋孕产期健康教育临床护理	□严格执行主诊医师下达的临床应对医嘱	□协助完成复诊
	□观察孕产妇对治疗的临床适应性和疗效	□观察孕产妇对治疗的临床适应性和疗效	□引导孕产妇办理治疗结束手续
	□填写临床护理报告手册，并及时上报主诊医师	□填写临床护理报告手册，并及时上报主诊医师	□治疗结束后的孕产期健康教育
	□告知孕产妇随诊和治疗时间及地点	□告知孕产妇随诊和治疗时间及地点
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(2020修订版)》表单

适用对象：入睡困难、易醒、恶心、呕吐、胃胀、便秘、尿频、胸闷、口干、肌肉酸痛10项主述躯体功能障碍症状中，≥1项持续或有规律发生，或本次妊娠前已发生，而由于妊娠后加重≥7 d的PPPSD孕产妇
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，完善其PPPSD相关检查	□随诊检查家庭调理记录单，评估家庭调理疗效和了解PPPSD孕产妇近期情况	□随诊检查家庭调理记录单，评估家庭调理疗效和了解PPPSD孕产妇近期情况
	□对其PPPSD进行初步诊断，并确定治疗方案	□向PPPSD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
	□向孕产妇及其家属交待病情	□审查门诊治疗室临床护理报告单，认真分析重点问题	□采用PPM系统，进行第6次PPM＋孕产期健康教育治疗
	□开具诊断报告及检查单	□采用PPM系统，进行第2～5次PPM＋孕产期健康教育治疗	□复诊并开具检查单和复诊单
	□采用PPM系统，进行首次PPM＋孕产期健康教育治疗	□门诊多学科合作小组疑难病例讨论(必要时)	□向孕产妇及其家属介绍康复情况
	□上级医师指导治疗(必要时)	□多学科专家联合(包括远程)会诊(必要时)	□出具治疗后10周家庭调理方案
	□出具家庭调理方案和心理调节鼓励方案	□出具家庭调理方案和心理调节鼓励方案	□出具治疗后10周随访方案
	□建立PPPSD孕产妇的病历档案，并完成首次病程记录	□完成病程记录	□完结病历，并建立档案
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，并填写家庭调理记录单	□按照医嘱完成PPM家庭调理，并填写家庭调理记录单	□根据每阶段门诊临床问题及家庭调理问题，下达电话或入户随访医嘱(必要时)
	□按照医嘱执行家庭心理调节鼓励方案	□按照医嘱执行家庭心理调节鼓励方案	□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
	□其他孕产期心身健康注意事项	□明确每次随诊和治疗时间	□认真配合门诊医护人员随访
	临时医嘱：	□其他孕产期心身健康注意事项	□门诊复查(必要时)
	□根据首次治疗情况及家庭调理方案下达家庭调理医嘱	临时医嘱：	□其他孕产期心身健康注意事项
	□明确下次随诊和治疗时间	□根据每次治疗中的临床重点、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(必要时)
		□根据每次治疗和家庭调理情况，以及患者躯体功能障碍症状变化情况，下达家庭调理应对措施医嘱(必要时)
主要护理工作	□介绍门诊环境	□协助完成随诊	□第6次PPM＋孕产期健康教育临床护理
	□协助完成辅助检查	□第2～5次PPM＋孕产期健康教育临床护理	□协助完成辅助检查
	□首次PPM＋孕产期健康教育临床护理	□严格执行主诊医师下达的临床应对医嘱	□协助完成复诊
	□观察孕产妇对治疗的临床适应性和疗效	□观察孕产妇对治疗的临床适应性和疗效	□引导孕产妇办理治疗结束手续
	□填写临床护理报告手册，并及时上报主诊医师	□填写临床护理报告手册，并及时上报主诊医师	□治疗结束后的孕产期健康教育
	□告知孕产妇随诊和治疗时间及地点	□告知孕产妇随诊和治疗时间及地点
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 pregnancy and puerperium psychosomatic disorders (2020 revised version)

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Clinical pathway for pregnancy and puerperium psychosomatic disorders (2020 revised version)