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)

HTML ( ) PDF ( )

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

[1]	吴爱勤，袁永贵. 中国心身医学实用临床技能培训教程[M]. 北京：中华医学电子音像出版社，2018: 8-12.
[2]	李贤芬，苗云，陈稀. 孕期焦虑与抑郁情绪调查及相关危险因素分析[J]. 齐鲁医学杂志，2010, 25(3): 228-231. DOI: 10.3969/j.issn.1008-0341.2010.03.014.
[3]	杨婷，合浩，冒才英，等. 孕妇产前抑郁焦虑的危险因素[J]. 中国心理卫生杂志，2015, 29(4): 246-250. DOI: 10.3969/j.issn.1000-6729.2015.04.002.
[4]	马雪梅，史慧静. 孕妇焦虑抑郁水平及影响因素的研究进展[J]. 中国妇幼保健，2019, 34(3): 722-724. DOI: 10.7620/zgfybj.j.issn.1001-4411.2019.03.77.
[5]	王竹珍，姜蕾，邱丽蓉，等. 产后抑郁症发生率及相关因素分析[J]. 中国妇幼保健，2009, 24(7): 894-897.
[6]	廖珍，陈光松，欧桂珍. 产后抑郁症的发生率及其相关发病因素的研究[J]. 国际医药卫生导报，2012, 18(10): 1463-1465. DOI: 10.3760/cma.j.issn.1007-1245.2012.10.040.
[7]	张立新，李丽娟，董静，等. 全国多中心31 782例孕妇孕产期心身障碍发病率调查研究[J]. 中国卫生标准管理，2018, 9(19): 1-4. DOI: 10.3969/j.issn.1674-9316.2018.19.001.
[8]	陶瑞雪，刘荃，郝加虎，等. 某市孕妇妊娠呕吐影响因素分析[J]. 安徽大学学报，2013, 48(9): 1139-1141.
[9]	尹燕，高彩云，席丽，等. 早孕反应时绒毛膜促性腺激素水平、甲状腺功能及孕妇心理状态的研究[J]. 中国妇幼卫生杂志，2016, 7(6): 58-60.
[10]	秦峰，徐宝良，张立新，等. "孕产妇心身健康门诊"研究进展[J]. 中国卫生标准管理，2017, 8(4): 17-20. DOI: 10.3969/j.issn.1674-9316.2017.04.010.
[11]	秦峰，李丽娟，肖利军，等. 孕产期心身障碍临床路径(2017版)[J/CD]. 中华妇幼临床医学杂志(电子版), 2017, 13(6): 640-644. DOI: 10.3877/cma.j.issn.1673-5250.2017.06.004.
[12]	秦峰，丁辉，肖利军，等. 多学科合作诊疗系统治疗孕妇心理问题诱发的躯体功能障碍临床研究[J/CD]. 中华妇幼临床医学杂志(电子版), 2016, 12(3): 280-285. DOI: 10.3877/cma.j.issn.1673-5250.2016.03.006.
[13]	秦峰，肖利军，张立新，等. 多学科合作诊疗系统与单一干预措施分别治疗孕产期心身障碍的临床效果分析[J/CD]. 中华妇幼临床医学杂志(电子版), 2017, 13(5): 563-568. DOI: 10.3877/cma.j.issn.1673-5250.2017.05.011.
[14]	秦峰，肖利军，李丽娟，等. 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效果分析[J/CD]. 中华妇幼临床医学杂志(电子版), 2018, 14(1): 51-56. DOI: 10.3877/cma.j.issn.1673-5250.2018.01.008.
[15]	秦峰，肖利军，李丽娟，等. 全国多中心1 046例孕产期心身障碍孕妇临床回顾研究[J]．中国卫生标准理，2018, 9(21): 37-40. DOI: 10.3969/j.issn.1674-9316.2018.21.013.
[16]	蓝海英，曾妍芳，丁颖，等. 应用PPM多学科合作诊疗系统治疗孕产期心身障碍对孕妇焦虑抑郁高危因素影响的调查研究[J]. 中国卫生标准管理，2017, 8(19): 29-31. DOI: 10.3969/j.issn.1674-9316.2017.19.014.
[17]	秦峰，李丽娟，蔡红霞，等. 围生科产褥期防控产后抑郁的多中心临床研究[J]. 中国卫生标准理，2019, 10(23): 18-21. DOI: 10.3969/j.issn.1674-9316.2019.23.008.
[18]	秦峰，李丽娟，张立新，等. "孕产期心身障碍临床路径"研究进展[J]. 中国卫生标准理，2018, 9(23): 33-37. DOI: 10.3969/j.issn.1674-9316.2018.23.014.
[19]	吴爱勤. 心身医学分类诊断评估策略[J]. 实用医院临床杂志，2015, 12(6): 1-6. DOI: 10.3969/j.issn.1672-6170.2015.06.001.
[20]	吴爱勤，袁永贵. 中国心身医学实用临床技能培训教程[M]. 北京：中华医学电子音像出版社，2018: 19-55.
[21]	Spitzer RL, Kroenke K, Williams IB JB, et al. GAD-7量表精确诊断广泛性焦虑障碍.苏丹，译[J]．英国医学杂志中文版，2007, 10(2): 101-102. DOI: 10.3760/cma.j.issn.1007-9742.2007.02.125.
[22]	陈然，王瑜，余建英，等. PHQ-9在综合医院住院患者中信效度研究[J]. 四川精神卫生，2017, 30(2): 149-153. DOI: 10.11886/j.issn.1007-3256.2017.02.013.
[23]	刘晓芳，叶志前. 心率变异性的分析方法和应用[J]. 国际生物医学工程杂志，2001, 24(1): 42-46. DOI: 10.3760/cma.j.issn.1673-4181.2001.01.011.
[24]	Kaya D, Karaca S, Barutcu I, et al. Heart rate variability in patients with essential hyperhidrosis: dynamic influence of sympathetic and parasympathetic maneuvers[J]. Ann Noninvasive Electrocardiol, 2015, 10(1): 1-6. DOI: 10.1111/j.1542-474X.2005.00578.x.
[25]	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. DOI: 10.3969/j.issn.1671-3710.2006.02.019.
[26]	张谦，栾彤，沈洁，等. 焦虑抑郁患者的心率变异性特点[J]. 苏州大学学报(医学版), 2008, 28(5): 804-806.

[1]	Xidong Zhang, Hejie Jia, Rui Feng, Luya Li, Yongzhi Qiao, Ying Zheng. Factors influencing anxiety in family members of emergency patients[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2024, 18(05): 319-324.
[2]	Ling Li, Ya Liu, Peiling Li, Xiumin Zhang, Ping Li. Study on the relationship between postoperative intestinal flora and depression in patients with rectal cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 607-610.
[3]	Jinhong Gao, Yumei Chen, Yun Guo. Application effect analysis of psychological counseling based on King interactive reaching theory in patients undergoing laparoscopic hepatocellular carcinoma resection[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(05): 517-520.
[4]	Chenyang Du, Yong Wang, Xin Duan, Wenjie Ke, Nian Shi, Yingxiang Wu, Wen Luo. Analysis of risk factors for dysphagia after laparoscopic hiatal hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(05): 523-527.
[5]	Xuetao Yuan, Xingjie Wang, He Hei, Hongyi Tian, Junyi Liu, Guangbing Wei, Xuqi Li, Zhengdong Jiang. Experimental study on the behavioral effects of hernia repair with different material Meshes on rats following abdominal wall defect repair surgery[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(02): 154-160.
[6]	Ling Wang, Wenbin Fan, Jiachun Ni, Zengjin Cai. Research progress of functional constipation and anxiety and depression comorbidity[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2024, 13(05): 411-416.
[7]	Yiren Wang, Xiaodan Jiang, Jiaxi Li, Tianyao Zhao, Xuemin Li. The correlation of dry eye symptoms and signs with anxiety and depression[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2024, 14(04): 212-216.
[8]	Xiaojiu Tang, Man Hu, Bijun Xu, Ya Xiao. Study on the correlation between the severity of obesity combined with gastroesophageal reflux disease patients and their anxiety, depression and nutritional status[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(04): 360-364.
[9]	Xing Yang, Mei Liu, Siyuan Liu, Ke Zhang. Analysis of preoperative anxiety and postoperative recovery restlessness in patients with gastrointestinal cancer and their influencing factors[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(02): 159-163.
[10]	Yafei Wang, Ting Deng, Jiangtao Xu, Dandan Geng, Xiaomei Wang. Effect of Huanglian Wendan decoction on chronic atrophic gastritis patients with anxiety and depression[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2024, 14(02): 155-158.
[11]	Jie Bai, Weiyi Wang, Chao Chen, Fan Wang, Xinru Xiao. Occupational burnout among neurosurgery residents and its influencing factors[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(07): 662-670.
[12]	Yunxia Ma, Jinyong Yu, Shufeng Wei, Chenzi Han. Clinical effects of auricular therapy in patients with thyroid nodules of liver qi stagnation type combined with anxiety and depression[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(04): 348-354.
[13]	Li Hua, Weidong Zhong, Gen Hu, Liying Zhang, Guoyi Shao. Study on the psychological state of patients with gastroesophageal reflux disease before and after surgery[J]. Chinese Journal of Gastroesophageal Reflux Disease(Electronic Edition), 2024, 11(03): 126-129.
[14]	Xin Zhang, Zhifen Liu, Yuntong Guo. Research progress on the correlation between obesity and depression[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2024, 10(04): 255-260.
[15]	Lina Wang, Shuxia Lyu, Yanan Li. Correlation analysis of metacognition of health anxiety between disease acceptance and fear disease progression in stroke patients with hemiplegia[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2024, 18(05): 434-440.

Viewed

Full text

Abstract

Please choose a citation manager

Content to export

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

模态框（Modal）标题

Please choose a citation manager

Content to export

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