心理干预对人工流产术妇女焦虑反应与唾液分泌型免疫球蛋白A影响的研究

Study on influence of psychological interventions on anxiety reactions and saliva SIgA of women accepting artificial abortion

[目的]为了解人工流产术妇女术前焦虑及其影响因素,探索综合性心理干预对人工流产术妇女焦虑情绪的影响。[方法]选取2004年12月—2005年8月在山西医科大学第一医院门诊妊娠6周～10周要求终止妊娠而无禁忌证的第1次接受人工流产术者100例,按来诊顺序编号,采用随机数字表按随机原则分为干预组50例、对照组50例。干预组术前、术中进行综合心理干预,对照组不进行心理干预。收集病人年龄、文化程度、职业、妊娠天数、妊娠次数等一般资料,并对生理指标(血压、脉搏、疼痛程度、人工流产综合征)、免疫学指标(唾液SIgA),心理指标[焦虑自评量表(SAS)、人格问卷(EPQ)、社会支持评定量表(SSRS)]进行测量。干预前做均衡性检验,心理干预效果的测量方法均来自相关文献。心理干预包括术前宣教、呼吸放松训练、术中心理护理、音乐疗法。[结果]两组研究对象比较均衡;干预组中重度疼痛仅为18%,而对照组为44%,两者比较有统计学意义(P<0.05);人工流产综合征发生率干预组2例(4%),而对照组8例(16%),经χ2检验,有统计学意义(P<0.05);干预前、术前、术中、术后收缩压、舒张压、脉搏变化两组比较无统计学意义(P>0.05);干预组干预后唾液SIgA较干预前明显降低,有统计学意义(P<0.05),而两组间比较无统计学意义;干预前SAS评分与常模比较,有统计学意义(P<0.05),SAS评分值为44.33分±8.70分,明显高于常模37.00分±13.00分;多元因素回归分析表明,对SAS有影响的因素依次为N标准分、妊娠次数、文化程度、社会支持总分,其中妊娠次数与社会支持总分和SAS呈负相关,文化程度、N标准分与SAS呈正相关;干预后SAS标准分两组比较有统计学意义(P<0.05)。[结论]综合性心理干预有助于降低人工流产术妇女的焦虑程度,降低唾液中SIgA含量,降低人工流产综合征的发生率,减轻疼痛,说明综合性心理干预对人工流产术妇女是一种行之有效的干预方法。

Objective：To know about anxiety of women before accepting artificial abortion and its influencing factors,so as to explore the influence of comprehensive psychological intervention on anxiety emotion of women undergoing artificial abortion. Methods：A total of 100 women of pregnancy 6 to 10 weeks requested termination pregnancy and came to outpatient service of the first affiliated hospital of Shanxi medical university from December of 2004 to August of 2005 were selected. All women were the first time accepting artificial abortion and without contraindications. Patients were given a serial number based on their visiting sequences. According to the serial number, all cases were randomly divided into intervention group and control group 50 cases each by adopting random digits table. Patients of intervention group were given comprehensive psychological intervention hefore and during their operation. Patients of control group were not accepted psychological intervention at all. General data including age, education background, occupation, days and times of pregnant of all patients had been collected. And physiological indexes （blood pressure, pulsation, pain degree, artificial abortion syndrome） and immunological indexes of all cases （saliva SIgA） were determined. And psychological indexes of all patients were measured by adopting self - rating anxiety scale（SAS）, Eysenek personality questionnaire（EPQ）, and social support rating scale（SSRS）. Equilibration test among two groups had been carried out before intervention. Evaluation method of psychological intervention effect for patients comes from the related literatures. Psychological interventions included preoperative propaganda, breathing relaxation training, intraoperative psychological nursing and music therapy. Results：Two group of subjects were quite balanced. In psychological intervention group, only 18% of cases had severe pain. Compared to 44% of control group cases, there was statistical significant difference（P〈0.05）. Thc incidence rate of artificial abortion syndrome was 4% in intervention group （2 cases）, and in control group were 8 cases which accounted for 16%. There was statistical significant difference between the two groups by chi square test（P〈0.05）. It demonstrated that psychology intervention may relieve pain for women accepting artificial abortion to a certain extent. However, in terms of systolic pressure, diastolic pressure, and pulsation changes, there were no statistical significant differences between the two group cases before intervention, and before, during, and after operation（all P〈0.05）. After intervention, saliva SIgA of intervention group cases,which was lowered obviously compared to that before intervention. There was statistical significant difference between before and after intervention（P〈0.05）. However, there was no statistical significance between the two groups. In terms of SAS scoring of psychological indexes in intervention group women, there was statistical significance compared with the common model（P〈0.05）. The SAS scoring of intervention group cases was 44.33±8.70 higher than that conventional model 37. 004- 13.00 obviously. The multi - dimensional factor regression analysis showed that the influential factors on SAS were the N standard score, times of pregnant, education background, and social support in turn. Among which, times of pregnant and total scoring of social support of patients were negatively correlated with SAS of them. Both education background and the N standard score of patients were positively correlated with their SAS. After intervention, in terms of the SAS standard scoring, there was statistical significant difference between the two groups. Conclu- sion：Comprehensive psychological intervention could relieve the anxiety of women undergoing artificial abortion. It could lower both the salivary concentration of SIgA and the incidence of artificial abortion syndrome for women undergoing artificial abortion and relieve pain for them. Therefore, comprehensive psychological intervention is an effective and a feasible method for women undergoing artificial abortion.