不同心理干预方法对妇科人工流产患者缓解疼痛的效果研究

Evaluation of efficacy of the role of different psychological intervention in pain of induced abortion

目的 探讨不同心理干预方法对妇科人流患者缓解疼痛的效果.方法 将2009年7月～2012年12月在浙江诸暨市妇幼保健院妇科门诊行人工流产的患者160例随机分为认知疗法组、音乐疗法组、视听结合组和对照组四组,每组各40例.观察比较4组患者术中配合情况、术前术中心率、血压变化情况及人流时的疼痛程度.采用t检验和x2检验进行数据分析.结果 认知疗法组、音乐疗法组、视听结合组患者的术中主动配合率（92.5％、95.0％、95.0％）均明显高于对照组（55.0％）,差异均有统计学意义（x2=5.38、6.21、5.87,均P＜0.05）.心率、收缩压、舒张压变化幅度在认知疗法组分别为（15.4±1.2）次/min、（11.8±0.6） mmHg、（7.9±0.9） mm Hg（1 mm Hg=0.133 kPa）,音乐疗法组分别为（14.5±1.7）次/min、（11.3±0.8） mmHg、（7.5±0.6） mm Hg,视听结合组分别为（13.8±1.6）次/min、（10.6±0.7） mmHg、（6.4±0.8） mm Hg,三组均明显低于对照组[（24.2±1.8）次/min、（27.4±1.5） mmHg、（18.6±1.4） mm Hg],差异均有统计学意义（均P＜ 0.05）,但三组间相比,差异无统计学意义（P＞0.05）.四组患者人流时的疼痛程度评定比较,认知疗法组、音乐疗法组、视听结合组患者疼痛程度Ⅱ级病例数均显著少于对照组（x2=4.96、5.03、5.16,均P＜0.05）,认知疗法组、音乐疗法组、视听结合组患者疼痛程度0级病例数均显著多于对照组（x2=5.08、5.13、5.11,均P＜0.05）,但三组之间比较,视听结合组患者疼痛程度Ⅱ级病例数均显著少于音乐疗法组、认知疗法组（x2=4.76、4.46,均P＜0.05）,视听结合组患者疼痛程度0级病例数均显著多于音乐疗法组、认知疗法组（x2=4.92、4.62,均P＜0.05）.结论 对行人流术患者实施认知疗法、音乐疗法、视听相结合的干预措施,均能获得疼痛缓解效果,以视听结合的干预效果最佳.

Objective To investigate the efficacy of the role of psychological intervention in pain of induced abortion.Methods 160 patients with induced abortion from July 2009 to December 2012 in outpatient department of gynaecology in Zhuji Maternal and Child Health-Care Center were randomly divided into four groups：cognitive therapy group,music therapy group,audio-visual group and the control group,40 cases in each group.Intraoperative coordination situation changes,preoperative heart rate,blood pressure and the level of pain during induced abortion in 4 groups were observed.The data was analyzed by t test and x2 test.Results The Intraoperative coordination rate in cognitive therapy group,music therapy group,audio-visual combination group （92.5%,95.0%,95.0%） were significantly higher than that of the control group （55.0%）,the differences were statistically significant （x2=5.38,6.21,5.87,all P 〈 0.05）.The variation of heart rate,systolic blood pressure,and diastolic blood pressure in cognitive therapy group were （15.4±1.2） times/min,（11.8±0.6） mm Hg,（7.9±0.9） mm Hg （1 mm Hg=0.133 kPa）,music therapy group were （14.5±1.7） times/min,（11.3± 0.8） mm Hg,（7.5±0.6） mm Hg,audio-visual combination group were （13.8±1.6） times/min,（10.6±0.7） mm Hg,6.4± 0.8） mm Hg,those date in the three were significantly less than those of control group [（24.2±1.8） times/min,（27.4± 1.5） mm Hg,（18.6±1.4） mm Hg],the differences were statistically significant （all P 〈 0.05）,but there were no statistically significant difference among the three groups （P 〉 0.05）.Level of pain assessment of four group when in abortion,the degree of pain in cognitive therapy group,music therapy group,patients with audio-visual combination group were significantly lower than that of the control group,the difference was statistically significant （x2=4.96,5.03,5.16,all P 〈 0.05）.The number of cases with grade Ⅱ pain in cognitive therapy,music therapy group,audio-visual combination group were significantly less than that in the control group （x2=4.96,5.03,5.16,all P 〈 0.05）.The number of cases with grade 0 pain in cognitive therapy group,music therapy group,audio-visual combination group were significantly more than in the control group （x2=5.08,5.13,5.11,all P 〈 0.05）.The number of cases with grade Ⅱ pain in audio-visual combination group was significantly less than that in the music therapy group,cognitive therapy group （x2=4.76,4.46,all P 〈 0.05）.The number of cases with grade 0 pain in audio-visual combination group was significantly more than that in the music therapy,cognitive therapy group （x2=4.92,4.62,all P 〈 0.05）.Conclusion Music therapy,cognitive therapy audio-visual combined intervention measures,can get the pain relief effect for patients with induced abortion,with the combination of audio-visual intervention effect is best.