复发性流产患者诊治流程图规范化的临床研究

Clinical Study of the Standardized Procedures for the Diagnosis and Treatment of Recurrent Spontaneous Abortion

目的探讨粤西地区复发性流产(RSA)患者接受RSA流程图诊治的效果,实施流程规范化。方法选取2010—2016年在广东医科大学附属医院生殖医学中心进行诊治确诊为RSA患者180例。按照患者流产次数和治疗意愿将其进行分组。A组为发生自然流产1次,接受RSA流程图诊治;B组为发生自然流产2次,接受RSA流程图诊治;C组为发生自然流产≥3次,接受RSA流程图诊治;D组为发生自然流产1次,不接受RSA流程图诊治;E组为发生自然流产2次,不接受RSA流程图诊治;F组为发生自然流产≥3次,不接受RSA流程图诊治。每组各30例。对患者进行为期1年的随访。记录6组患者再次妊娠成功率、对RSA疾病认知度、满意度和抑郁症发生率。结果 A、D组再次妊娠成功率分别为73.3%(22/30)、63.3%(19/30),两组比较,差异无统计学意义(χ~2=0.69,P>0.05);B组再次妊娠成功率为66.7%(20/30),高于E组的36.7%(11/30)(χ~2=5.41,P<0.05);C组再次妊娠成功率为53.3%(16/30),高于F组的23.3%(7/30)(χ~2=5.71,P<0.05)。A、D组疾病认知度分别为26.7%(8/30)、20.0%(6/30),两组比较,差异无统计学意义(χ~2=0.37,P>0.05);B组疾病认知度为63.3%(19/30),高于E组的33.3%(10/30)(χ~2=5.41,P<0.05);C组疾病认知度为83.3%(25/30),高于F组的53.3%(16/30)(χ2=6.24,P<0.05)。A、D组满意度分别为70.0%(21/30)、60.0%(18/30),两组比较,差异无统计学意义(χ~2=0.66,P>0.05);B组满意度为73.3%(22/30),高于E组的43.3%(13/30)(χ~2=5.55,P<0.05);C组满意度为63.3%(19/30),高于F组的33.3%(10/30)(χ~2=5.41,P<0.05)。A、D组抑郁症发生率分别为16.7%(5/30)、20.0%(6/30),两组比较,差异无统计学意义(χ~2=0.11,P>0.05);B、E组抑郁症发生率分别为23.3%(7/30)、30.0%(9/30),两组比较,差异无统计学意义(χ~2=0.34,P>0.05);C组抑郁症发生率为26.7%(8/30),低于F组的56.7%(17/30)(χ~2=5.55,P<0.05)。结论 RSA患者诊治流程图的规范化及推广,有利于提高患者的满意度和对疾病的认知度,降低抑郁症发生率,改善妊娠结局。

Objective To explore the effect of standardized procedures for the diagnosis and treatment of recurrent spontaneous abortion(RSA)in western Guangdong province,in order to promote the popularization of the procedures.Methods One hundred and eighty patients,who were diagnosed with RSA and treated in Reproductive Medicine Center,Affiliated Hospital of Guangdong Medical University from 2010 to 2016 were enrolled and equally divided into 6 groups based on their own willing:patients who had one,two,three or more RSAs and were willing to receive the diagnosis and treatment of RSA in accordance with the standardized procedures were assigned to groups A,B,C respectively,and those who had one,two,three or more RSAs but were not willing to accept the diagnosis and treatment of RSA in accordance with the standardized procedures were assigned to groups D,E,F,respectively.All of them were followed up for one year.The rate of successful pregnancy after treatment,RSA perception,satisfaction with the treatment and incidence of depression occurred in all the groups during the follow-up period were recorded.Results The rate of successful pregnancy after treatment did not differ significantly between groups A and D〔73.3%(22/30)vs 63.3%(19/30)〕(χ2=0.69,P>0.05).The rate of successful pregnancy after treatment was higher in group B than in group E〔66.7%(20/30)vs 36.7%(11/30)〕(χ2=5.41,P<0.05).Group C demonstrated higher rate of successful pregnancy after treatment than group F〔53.3%(16/30)vs 23.3%(7/30)〕(χ2=5.71,P<0.05).Groups A and D showed similar percentage of patients with RSA perception〔26.7%(8/30)vs 20.0%(6/30)〕(χ2=0.37,P>0.05).Group B had higher percentage of patients with RSA perception compared with group E〔63.3%(19/30)vs 33.3%(10/30)〕(χ2=5.41,P<0.05).Higher percentage of patients with RSA perception was found in group C instead of group F〔83.3%(25/30)vs 53.3%(16/30)〕(χ2=6.24,P<0.05).No significant difference in the level of satisfaction with treatment was found between groups A and D〔70.0%(21/30)vs 60.0%(18/30)〕(χ2=0.66,P>0.05).Higher level of satisfaction with treatment was identified in group B rather than group E〔73.3%(22/30)vs 43.3%(13/30)〕(χ2=5.55,P<0.05).Compared with group F,group C had higher level of satisfaction with treatment〔63.3%(19/30)vs 33.3%(10/30)〕(χ2=5.41,P<0.05).Groups A and D were found with similar incidence of depression〔16.7%(5/30)vs 20.0%(6/30)〕(χ2=0.11,P>0.05).No obvious difference in the incidence of depression was observed between groups B and E〔23.3%(7/30)vs 30.0%(9/30)〕(χ2=0.34,P>0.05).Group C presented lower incidence of depression compared with group F〔26.7%(8/30)vs 56.7%(17/30)〕(χ2=5.55,P<0.05).Conclusion The standardization and popularization of the diagnosis and treatment for RSA will help to improve the level of satisfaction with treatment,raise the level of perception of the disease,reduce the incidence of depression and gain a better pregnancy outcome in these patients.