初产妇介入性产前诊断的焦虑心理状况与针对性干预

Anxiety in women receiving early invasive prenatal diagnosis

目的调查初产妇介入性产前诊断的心理焦虑状况，并提出相关针对性干预对策。方法采用前瞻眭研究方法，选择2010年6月至2014年12月在本院妇产科参加产前筛查的320例初产妇作为研究对象，所有产妇均给予羊膜腔穿刺术进行诊断，调查与记录诊断手术前、诊断后手术第3天、取得胎儿诊断结果时产妇的焦虑状况、心率与血压情况，并且在诊断手术前进行产妇担忧情况的调查。所有产妇在诊断期间均给予积极的针对性干预。结果所有产妇均顺利完成羊膜腔穿刺术，无严重并发症发生，确诊唐氏综合征阳性42例，阴性278例，阳性率为13．1％。320例产妇在诊断手术前、诊断后手术第3天、取得胎儿诊断结果时的焦虑评分依次为（55．3±4．1）分、（42．1±6．1）分和（40．2±4．2）分，心率依次为（80．2±65）次／分、（74．1±5．3）次／分、（73．0±4．0）次／分，收缩压依次为（133．0±14．3）mmHg、（122．0±12．4）mmHg、（117．1±13．1）mmHg，舒张压分别为（82．1±8．6）mmHg、（74．1±7．3）mmHg、（71．3±7．1）mmHg，不同时间点对比，差异均有统计学意义。经过调查，诊断手术前产妇对于自身损伤、胎儿损伤、胎儿健康与隐私泄露的忧虑比例分别为50．0％、72．8％、96．9％和5．9％。结论初产妇介入性产前诊断的心理焦虑状况比较常见，并伴随有心率与血压的波动，对于胎儿损伤与健康有更多担忧，要积极加强针对性护理干预。

Objective To investigate anxiety status among women receiving early invasive prenatal diagnosis. Methods From June 2010 to December 2014, 320 nulliparous women participating in invasive prenatal diagnosis in our hospital were selected as the study subjects. All mothers were given amniocentesis, and were assessed on anxiety, heart rate, and blood pressure during, three days after the diagnostic surgery, and at the time of getting the results. Results All women were successfully completed amniocentesis and there were no serious complications. In all, 42 women were diagnosed with having a Down syndrome affected fetus, with a rate of 13.1%. During and three days after the procedure and at the time of receiving the results, anxiety score was （55.3± 4. 1 ） points, （42. 1 ± 6. 1 ） points, and （40.2±4.2） points, respectively; heart rate was （80.2 ± 6.5） beats / min, （74.1 ± 5.3） beats / min, and （73.0±4. 0） beats / min, respectively; systolic blood pressure was （ 13.3 ± 14. 3） mmHg, （ 1.22 ±12.4） mmHg, and （117. 1 ± 13. 1 ） mmHg, respectively; and diastolic blood pressure was （82. 1 ± 8.6） mmHg, （74. 1 ±7. 3 ） mmHg, and （71.3 ±7.1 ） mmHg, respectively. The differences in all the parameters between different time points were statistically significant （ Ps 〈 0. 05 ）. Before the procedure, the proportion of women with anxiety on maternal injury, fetal injury, fetal health, and loss of privacy was 50.0% , 72.8%, 96.9%, and 5.9%, respectively. Conclusion Maternal anxiety before early invasive prenatal diagnosis was common. Most women had concerns on fetal injury and health. Targeted intervention should be in place before the procedure.