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

A clinical study on multidisciplinary cooperation diagnosis and treatment system in the treatment of physical dysfunction induced by psychological problems in pregnant women

目的探讨应用多学科合作模式的生理调控、心理调节、音乐调理（PPM）干预措施（基于产科）,治疗孕妇心理问题诱发的躯体功能障碍的临床效果。方法选择2016年3~4月,在天津市滨海新区大港妇女儿童保健中心、广州市越秀区妇幼保健院、烟台市烟台山医院、天津市滨海新区汉沽妇女儿童保健中心及天津市河北区妇女儿童保健中心孕产妇心身健康门诊,进行产前检查的100例孕妇为研究对象,采取抽签方式进行随机抽样,将受试者分为观察组和对照组各50例。观察组在传统健康教育基础上应用PPM干预措施治疗,对照组仅进行传统健康教育。治疗3周后,采用统计学方法比较两组孕妇治疗后主诉躯体功能障碍主要症状变化、自主神经系统（VNS）功能状态变化及汉密顿焦虑量表（HAMA）评分值差异。两组受试者治疗前VNS功能状态均为紊乱,且两组孕妇年龄、学历、职业、产妇类型及孕龄构成比,以及治疗前HAMA评分值比较,差异均无统计学意义（P〉0.05）。本研究遵循的程序符合上述各医疗单位人体试验委员会制定的伦理学标准,得到其伦理委员会批准,征得受试对象知情同意,并与之签署临床研究知情同意书。结果 1观察组孕妇治疗后,多梦、易醒、入睡困难、尿频、恶心、呕吐、便秘、胃胀、胸闷、心悸、口干及肌肉酸痛12项躯体功能障碍主要症状,均较对照组孕妇有显著改善,且差异有统计学意义（P〈0.05）。2两组孕妇治疗后,VNS功能状态构成比比较,差异有统计学意义（χ2=79.704,P=0.000）,观察组孕妇VNS功能状态主要为平衡状态,而对照组孕妇仍主要为紊乱状态。3观察组孕妇治疗后HAMA评分值[（1.9±1.2）分]较对照组[（9.8±2.5）分]显著降低,且差异有统计学意义（t=-19.490,P=0.000）。结论应用多学科合作模式的PPM干预措施（基于产科）治疗孕妇由心理问题诱发的躯体功能障碍,疗效显著;同时对焦虑、抑郁亦起到治疗作用。

Objective To investigate the clinical effect of a multidisciplinary cooperation mode of physiological regulation,psychological adjustment and music conditioning（PPM）intervention measures（based on obstetrics department）in the treatment of psychological problems induced physical dysfunction among pregnant women.Methods A total of 100 pregnant women who received prenatal examination in the Maternal Physical and Mental Health Clinic of Dagang Maternal and Child Health Care Center in Binhai New Area,Tianjin,Maternal and Child Health Care Hospital in Yuexiu District,Guangzhou,Yantai Mountain Hospital in Yantai,Hangu Maternal and Child Health Care Center in Binhai New Area,Tianjin,and Maternal and Child Health Care Center in Hebei District,Tianjin,from March to April 2016 were selected as study objects.They were randomly divided into observation group（n=50）and control group（n=50）employing the ballot method.The observation group was treated with PPM intervention measures in addition to traditional health education,while the control group was only treated with traditional health education.Statistical methods were applied to compare the changes in main symptoms of the chief complain of physical dysfunction,the functional state of the autonomic nervous system（VNS）and Hamilton anxiety scale（HAMA）scores between two groups after treatment for 3weeks.Subjects in both groups showed disordered functional state of the VNS before treatment,and there were no significant differences between two groups in constituent ratios of age,educational background,occupation,maternal types and gestational age,also HAMA scores before treatment（P0.05）.Procedures in this study were in line with the ethical standards established by the Institutional Review Board of each medical unit above mentioned and approved by each committee,additionally, all subjects signed informed consent in clinical research.Results 1 After treatment,twelve kinds of main symptoms of physical dysfunction including dreaminess,festless sleep, difficulty falling asleep,frequent micturition, nausea, vomiting,astriction,gastrectasia,chest tightness,palpitation,dry mouth and muscular soreness of pregnant women in observation group were improved compared with those of control group,and the differences were statistically significant（P〈0.05）.2 There were significant differences between pregnant women of two groups in constituent ratio of VNS functional state after treatment,and the difference was statistically significant（χ2=79.704,P=0.000）,with equilibrium state mainly of pregnant women in observation group while disordered state mainly in control group.3HAMA score of pregnant women in observation group after treatment[（1.9±1.2）points]was lower than that of control group[（9.8±2.5）points],and the difference was statistically significant（t=- 19.490,P = 0.000）.Conclusions Application of PPM intervention measures in a multidisciplinary cooperation mode（based on obstetrics department）in the treatment of physical dysfunction induced by psychological problems in pregnant women presents significant efficacy,moreover,PPM has therapeutic effect on anxiety and depression.