初产妇剖宫产后大出血PTSD发生现状及影响因素分析

Analysis of the occurrence status and influencing factors of PTSD in primiparas with massive hemorrhage after cesarean section

目的探讨初产妇剖宫产后大出血创伤后应激障碍(PTSD)发生现状及影响因素。方法选取2019年1月至2021年12月广东省惠州市中心人民医院进行剖宫产后大出血的82例初产妇为研究对象,另选取同期本院进行剖宫产后无出血的产妇30例为对照组,采用创伤后应激障碍量表(PCL⁃C)评估两组的PTSD评分;另采用一般资料调查表、焦虑自评量表(SAS)及抑郁自评量表(SDS)对剖宫产后大出血产妇进行调查评估,以PCL⁃C总分≥38分为PTSD症状阳性划界标准,进一步应用单因素及二元Logistic回归分析初产妇剖宫产后大出血发生PTSD的影响因素。结果经剖宫产后大出血发生PTSD有15例(18.29%);产后大出血组、PTSD阳性组的PTSD总分及各维度评分均高于产后无大出血组、PTSD阴性组,差异有统计学意义(t=11.210、7.713、9.526、15.135、6.727、3.637、3.539、14.048,P<0.05)。单因素分析表明创伤史、睡眠质量、住院期医护支持、新生儿并发症、SAS和SDS评分均是初产妇剖宫产后大出血发生PTSD的影响因素(x^(2)=16.452、4.679、9.856、18.988、4.874、6.504,P<0.05);二元Logistic回归分析表明创伤史、睡眠质量、住院期医护支持、新生儿并发症、SAS和SDS评分均是初产妇剖宫产后大出血发生PTSD的独立危险因素(P<0.05)。结论创伤史、睡眠质量、住院期医护支持、新生儿并发症均、焦虑、抑郁均是初产妇剖宫产后大出血发生PTSD的独立危险因素,临床上应结合相关影响因素,早期采取预防策略和措施,降低PTSD的发生率,保障母婴健康。

Objective To investigate the status and influencing factors of post⁃traumatic stress disorder(PTSD)in primiparas after cesarean section.Methods From January 2019 to December 2021,82 primiparas with massive hemorrhage after cesarean section in Huizhou Central People's Hospital,Guangdong Province were selected as the research object.In addition,30 women without bleeding after cesarean section in our hospital during the same period were selected as the control group.Post⁃traumatic stress Disorder Scale(PCL⁃C)was used to evaluate the PTSD scores of the two groups.In addition,the general data questionnaire,self⁃rating anxiety scale(SAS)and self⁃rating depression scale(SDS)were used to investigate and evaluate the postpartum hemorrhage after cesarean section.The PCL⁃C score≥38 was divided into positive criteria for PTSD symptoms.Single factor and binary Logistic regression were used to analyze the influencing factors of PTSD in primiparas after cesarean section.Results 15 cases(18.29%)had PTSD after cesarean section.The total PTSD score and all dimensions scores of the postpartum hemorrhage group and the PTSD positive group were higher than those of the postpartum hemorrhage group and PTSD negative group,and the difference was statistically significant in the PTSD positive group(t=11.210、7.713、9.526、15.135、6.727、3.637、3.539、14.048,P<0.05).Univariate analysis showed that trauma history,sleep quality,hospital support,neonatal complications,SAS and SDS scores were all influencing factors of PTSD in primiparas after cesarean section.(x^(2)=16.452,4.679,9.856,18.988,4.874,6.504,P<0.05).Binary Logistic regression analysis showed that trauma history,sleep quality,hospital support,neonatal complications,SAS and SDS scores were all independent risk factors for PTSD after cesarean section in primiparas(P<0.05).Conclusion Trauma history,sleep quality,in⁃hospital medical support,neonatal complications,anxiety and depression are all independent risk factors for post⁃cesarean hemorrhage PTSD in primiparas.Clinically,relevant influencing factors should be combined to take early prevention strategies and measures,reduce the incidence of PTSD,and protect the health of mothers and babies.