体外受精-胚胎移植治疗过程中的心理应激研究

A Study of Psychological Stress in Women Undergoing IVF-ET Treatment

目的在心理应激框架下,研究IVF治疗过程中患者诸心理因素的变化情况,并探索这些心理因素对IVF治疗结果的影响作用。方法纳入接受IVF治疗的患者324例为被试,分别于周期第2日、取卵前当日晨、移植前当日晨和孕检前4个时点进行PSS、STAI、SDS和MCMQ问卷测量。分析其压力感知、情绪状况、应对方式变化情况及与IVF治疗结果的关系。结果患者基线水平的状态-特质焦虑分数与常模相比均无显著性差异。PSS分数和抑郁分数分别为25.26±4.944和44.41±9.812,均显著高于常模(P<0.05)。患者的医学应对方式3个分量表得分均高于常模(P>0.01)。IVF治疗过程中的不同时点间状态焦虑(F=21.688,P<0.01)及抑郁水平(F=4.938,P<0.01)差异显著,两者总体均呈上升趋势。将心理因素及患者一般情况数据对IVF治疗结果进行Logistic回归,"回避"及"屈服"及"年龄"进入方程。其标准回归系数OR分别为1.124、0.903和0.944,其中"回避"为保护性因素,而"屈服"及年龄为危险因素,3因素的P<0.05。结论刚进入周期的IVF患者已存在一定的抑郁情绪,且其焦虑和抑郁水平在治疗过程中还会逐步升高。采取"回避"应对方式的患者似乎更有可能成功妊娠。研究结果说明对IVF患者进行心理干预有其必要性,并提示了一种可能的干预方向。

Objective Under the psychological stress framework, to investigate the changes of psychological stress before and during the IVF treatment, and the effects of psychological factors on IVF outcome. Methods We assessed factors of psychological stress before and during the IVF treatment with PSS,STAI,SDS and MCMQ. Results 324 women completed the questionnaires. The baseline SDS and PSS scores of 25.26 ±4. 944 and 44.41 ± 9. 812 ,respectively were significantly higher than norm scores（ P 〈 0.05 ）. The procedure SAI （F = 21. 688 ,P 〈 0.01 ）and SDS score（ F = 4. 938 ,P 〈 0.01 ） had significantly differences, and both factors had an elevated trends among the four time points. Adjusting for general biomedical data of patients, neither baseline nor procedural state anxiety affected the ongoing pregnancy rates. The avoidance strategy was positively and significantly associated with pregnancy, but age and the resignation strategy were the relative risk factors for IVF outcome, with odds ratios of 1. 124 （95% CI 1. 033 - 1. 222） , 0. 944 （95% CI 0. 895 -0. 996） and 0. 903 （95% CI 0. 827 - 0. 987 ） , respectively. Conclusion Before IVF treatment, patients had relatively higher depression level. The state anxiety and depression level increased during the course of the cycle, in which pregnancy test was the most stressful stages. The resignation coping may be a risk factor for pregnancy rates. The avoidance strategy may be beneficial during IVF treatment and is an recommend interventions aimed at promoting distraction strategies.