心理保健联合孕期放松训练对有流产史再妊娠产妇孕期和妊娠结局的影响

Effect of psychological health care combined with pregnancy relaxation training during pregnancy on pregnancy and pregnancy outcomes in pregnant women with abortion history

目的探讨心理保健联合孕期放松训练对流产史再妊娠产妇孕期和妊娠结局的影响,为该类产妇孕期保健提供参考。方法选取2015年1月-12月在该院住院的再次妊娠产妇320例为研究对象,随机分为观察组(心理保健联合孕期放松训练)和对照组(心理保健),每组各160例。使用产后抑郁量表(EPDS)和睡眠量表(PSQI)评价产妇产后抑郁程度;用焦虑自评量表(SAS)、抑郁自评量表(SDS)、自我效能感量表(GSES)评价保健前和保健6周后产妇心理健康水平;记录两组产妇的分娩方式和妊娠结局。结果观察组产后EPDS和PSQI评分均明显低于对照组(9.16±1.36 vs.13.0±2.16;7.47±1.26 vs.10.82±2.13),差异均有统计学意义(t=3.759、4.162,均P<0.05)。两组产妇保健前SAS、SDS、GSES评分之间差异均无统计学意义(t=1.351、1.079、0.753,均P>0.05);保健6周后观察组产妇SAS、SDS评分均明显低于对照组,GSES评分明显高于对照组,差异均有统计学意义(t=3.160、3.127、4.488,均P<0.05)。保健6周后观察组体质量指数(BMI)、空腹血糖(FBG)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平均明显低于保健前,差异均有统计学意义(t=3.951、3.691、4.056、3.361,均P<0.05);保健6周后观察组BMI、FBG、TG、LDL-C水平均明显低于对照组,差异均有统计学意义(t=4.695、5.981、3.516、2.801,均P<0.05)。观察组产妇孕周及新生儿5 min Apgar评分均明显高于对照组,差异均有统计学意义(t=2.824、2.553,均P<0.05);观察组正常产率明显高于对照组,差异有统计学意义(χ~2=7.595,P<0.01)。结论心理保健联合孕期放松训练可有效改善流产史再妊娠产妇心理健康和血脂、血糖水平,降低产后抑郁、母婴肥胖和剖宫产率,改善母婴结局。

Objective To explore the effect of psychological health care combined with relaxation training during pregnancy on pregnancy and pregnancy outcomes in pregnant women with abortion history,provide reference for gestational health care.Methods From January to December in 2015,a total of 320 cases of subsequent pregnancy with abortion history were selected from the hospital as study objects,then they were randomly divided into observation group（psychological health care combined with relaxation training during pregnancy） and control group（psychological health care）,160 cases in each group.Edinburgh Postnatal Depression Scale（EPDS） and Pittsburgh Sleep Quality Index（PSQI） were used to evaluate the degree of postpartum depression;Self-rating Anxiety Scale（SAS）,Self-rating Depression Scale（SDS）,and General Self-Efficacy Scale（GSES） were used to assess psychological health level of pregnant women before psychological health care and at 6 weeks after psychological health care;delivery modes and pregnancy outcomes in the two groups were recorded.Results EPDS and PSQI scores after delivery in observation group were statistically significantly lower than those in control group（9.16±1.36 vs.13.0±2.16,t = 3.759,P〈0.05;7.47 ± 1.26 vs.10.82 ± 2.13,t = 4.162,P〈0.05）.There was no statistically significant difference in SAS,SDS,and GSES scores before psychological health care between the two groups（t = 1.351,1.079,0.753,P〈0.05）;at 6 weeks after psychological health care,SAS and SDS scores in observation group were statistically significantly lower than those in control group,while GSES score in observation group was statistically significantly higher than that in control group（t = 3.160,3.127,4.488,all P〈0.05）;in observation group,body mass index（BMI）,fasting blood glucose（FBG）,triglyceridemia（TG） and low-density lipoproteincholesterol（LDL-C） levels at 6 weeks after psychological health care were statistically significantly lower than those before psychological health care（t = 3.951,3.691,4.056,3.361,P〈0.05）;at 6 weeks after psychological health care,BMI,FBG,TG,and LDL-C levels in observation group were statistically significantly lower than those in control group（t = 4.695,5.981,3.516,2.801,P〈0.05）.Maternal gestational age and 5-minute Apgar score in observation group were statistically significantly higher than those in control group（t =2.824,2.553,P〈0.05）.Normal delivery rate in observation group was statistically significantly higher than that in control group（χ~2=7.595,P〈0.01）.Conclusion Psychological health care combined with relaxation training during pregnancy can effectively improve psychological health,blood lipids,and blood glucose levels of pregnant women with abortion history,reduce postpartum depression rate,maternal obesity and cesarean section rates,improve maternal and neonatal outcomes.