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随着生活节奏的加快,人们工作压力的增加,近年来我国女性生育年龄逐渐增高,而不孕不育病人数量逐渐递增。目前人类辅助生殖技术是治疗不孕不育的有效方法,其中最常用的为体外授精-胚胎移植(in-vitro fertilization and embryo transfer, IVF-ET), 但在IVF-ET治疗过程中往往需要侵入性操作,且治疗费用昂贵,这往往会加重病人心理负担,引起病人产生心理应激反应,加重病人心理上的痛苦,降低幸福感[1-2]。认知行为干预是目前世界上较流行的一种心理治疗方法,可通过理性思维的方式降低病人心理应激反应,而肌肉放松训练为目前临床上常用的减轻病人负性情绪,提升病人幸福感的常用方式[3-4]。本研究拟观察认知行为干预联合肌肉放松训练对行IVF-ET病人心理应激水平及幸福感的影响,提升行IVF-ET病人治疗质量。
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治疗前,2组病人SDS和SAS评分差异无统计学意义(P>0.05),治疗后,2组病人SDS和SAS评分均明显低于治疗前,且观察组病人SDS和SAS评分明显低于对照组(P < 0.01)(见表 1)。
分组 n SDS SAS 治疗前 治疗后 治疗前 治疗后 观察组 58 56.47±5.30 37.51±6.15** 53.25±5.73 39.26±5.59** 对照组 58 55.82±5.24 43.75±6.39** 53.11±5.54 46.12±6.15** t — 0.66 5.36 0.13 6.29 P — >0.05 < 0.01 >0.05 < 0.01 组内配对t检验:**P < 0.01 表 1 2组病人不同时间点SDS、SAS量表评分比较(x±s;分)
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治疗前2组病人睡眠质量比较差异无统计学意义(P>0.05),治疗后观察组病人睡眠质量明显优于对照组(P < 0.01)。治疗前2组病人皮质醇水平比较差异无统计学意义(P>0.05),治疗后观察组病人皮质醇水平明显低于对照组(P < 0.01)(见表 2)。
分组 n 睡眠质量 心理应激 治疗前 治疗后 治疗前 治疗后 观察组 58 21.15±2.07 20.91±2.53 103.71±33.06 72.69±5.76** 对照组 58 20.84±2.29 27.24±3.17** 102.94±32.89 85.24±5.53** t — 0.76 11.89 0.13 11.97 P — >0.05 < 0.01 >0.05 < 0.01 组内配对t检验:**P < 0.01 表 2 2组病人治疗前后睡眠质量与心理应激比较(x±s;分)
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观察者病人妊娠人数为35例,妊娠率60.34%,对照组为24例,妊娠率41.38%,观察组妊娠率高于对照组(χ2=4.17,P < 0.05)。
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治疗后观察组病人幸福感量表负性评分明显低于对照组,且正性评分以及总分均明显高于对照组病人(P < 0.01)(见表 3)。
分组 n 正性评分 负性评分 总分 观察组 58 18.36±2.52 7.02±2.24 33.29±3.76 对照组 58 16.15±2.13 8.43±2.44 29.69±3.72 t — 5.10 3.24 5.18 P — < 0.01 < 0.01 < 0.01 表 3 2组病人治疗后幸福感评分比较(x±s;分)
认知行为干预联合肌肉放松训练对IVF-ET病人心理应激及幸福感的影响
Effect of the cognitive behavioral intervention combined with muscle relaxation training on psychological stress level and well-being in patients treated with IVF-ET
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摘要:
目的观察认知行为干预联合肌肉放松训练对行体外授精-胚胎移植(in-vitro fertilization and embryo transfer,IVF-ET)病人心理应激水平及幸福感的影响。 方法选择2017年5月至2018年7月行IVF-ET治疗的116例病人为研究对象,按照随机表法将病人分为对照组和观察组2组,各58例;对照组入院后给予常规治疗以及护理,观察组在对照组的基础上给予认知行为干预联合肌肉放松训练。在治疗前和治疗后(完成胚胎移植)使用焦虑自评量表(SAS)、抑郁自评量表(SDS)评价病人焦虑抑郁情绪,使用睡眠状况自评量表(SRSS)评估病人睡眠状况,采集病人静脉血使用化学发光法检测病人皮质醇水平;治疗后使用纽芬兰纪念大学幸福度量表(MUNSH)对病人幸福感进行评估,在治疗后1个月行超声检查,确认病人妊娠情况。 结果治疗前,2组SDS和SAS评分差异无统计学意义(P>0.05),治疗后,2组SDS和SAS评分均明显低于治疗前,且观察组SDS和SAS评分明显低于对照组(P < 0.01)。治疗前2组睡眠质量比较差异无统计学意义(P>0.05),治疗后观察组睡眠质量明显优于对照组(P < 0.01)。治疗前2组皮质醇水平比较差异无统计学意义(P>0.05),治疗后观察组皮质醇水平明显低于对照组(P < 0.01)。观察组妊娠率高于对照组(P < 0.05)。治疗后观察组MUNSH量表负性评分明显低于对照组,且正性评分以及总分均明显高于对照组(P < 0.01)。 结论认知行为干预联合肌肉放松训练可有效减轻IVF-ET病人病人焦虑抑郁情绪,提升病人睡眠质量以及幸福感,有效降低心理应激水平,提高妊娠成功率。 Abstract:ObjectiveTo observe the effects of the cognitive behavioral intervention and muscle relaxation training on psychological stress level and well-being in patients treated with in-vitro fertilization and embryo transfer(IVF-ET). MethodsOne hundred and sixteen patients treated with IVF-ET from May 2017to July 2018 were were divided into the observation group and control group by random number table method(58 cases in each group).The control group was treated and nursed with routine method after admission.The observation group was treated with cognitive behavioral intervention and muscle relaxation training on the basis of the control group.Before and after treatment(completing embryo transfer), the anxiety and depression, and sleep condition in two groups were evaluated using self-rating anxiety scale(SAS) and self-rating depression scale(SDS), and self-rating scale of sleep(SRSS), respectively.The serum levels of cortisol in two groups were detected using chemiluminescent immunoassay.The well-being in two groups after treatment were assessed using Memorial University of Newfoudland Scale of Happiness(MUNSH), and the pregnancy in two groups after 1 month of treatment were identified using ultrasound examination. ResultsBefore treatment, the differences of the scores of SDS and SAS were not statistically significant between two groups(P>0.05).After treatment, the scores of SDS and SAS in two groups were significantly lower than those before intervention, and the SDS and SAS scores in observation group were significantly lower than those in control group(P < 0.01).Before treatment, the difference of the sleep quality score was not statistically significant between two groups(P>0.05).After treatment, the sleep quality in observation group was significantly better than that in control group(P < 0.01).Before treatment, the difference of the cortisol level was not statistically significant between two groups(P>0.05).After treatment, the cortisol level in observation group was significantly lower than that in control group(P < 0.01).The pregnancy rate in observation group was higher than that in control group(P < 0.05).The negative score of the MUNSH scale in observation group was significantly lower than that in control group, and the positive score and total score in obseravtion group were significantly higher than those in control group(P < 0.01). ConclusionsThe cognitive behavioral intervention combined with muscle relaxation training can effectively alleviate anxiety and depression, improve sleep quality and well-being, reduce psychological stress and improve pregnancy success rate in patients treated with IVF-ET. -
表 1 2组病人不同时间点SDS、SAS量表评分比较(x±s;分)
分组 n SDS SAS 治疗前 治疗后 治疗前 治疗后 观察组 58 56.47±5.30 37.51±6.15** 53.25±5.73 39.26±5.59** 对照组 58 55.82±5.24 43.75±6.39** 53.11±5.54 46.12±6.15** t — 0.66 5.36 0.13 6.29 P — >0.05 < 0.01 >0.05 < 0.01 组内配对t检验:**P < 0.01 表 2 2组病人治疗前后睡眠质量与心理应激比较(x±s;分)
分组 n 睡眠质量 心理应激 治疗前 治疗后 治疗前 治疗后 观察组 58 21.15±2.07 20.91±2.53 103.71±33.06 72.69±5.76** 对照组 58 20.84±2.29 27.24±3.17** 102.94±32.89 85.24±5.53** t — 0.76 11.89 0.13 11.97 P — >0.05 < 0.01 >0.05 < 0.01 组内配对t检验:**P < 0.01 表 3 2组病人治疗后幸福感评分比较(x±s;分)
分组 n 正性评分 负性评分 总分 观察组 58 18.36±2.52 7.02±2.24 33.29±3.76 对照组 58 16.15±2.13 8.43±2.44 29.69±3.72 t — 5.10 3.24 5.18 P — < 0.01 < 0.01 < 0.01 -
[1] 薛雪梅, 郝岚, 何凌云.心理疏导在IVF-ET治疗中的应用[J].中国生育健康杂志, 2017, 28(2):178. [2] LI J, LUO H, LONG L.A qualitative investigation of the experience of participation in Mindfulness-based Intervention for IVF-ET (MBII) with Chinese women undergoing first IVF-ET[J].Nursing Open, 2019, 6(2):493. [3] 郑雪梅.渐进式肌肉放松训练对鼻咽癌放疗病人的影响[J].中国医药导报, 2017, 14(5):161. [4] 张爱英, 吕慧, 吴芳芳.认知行为干预对无痛分娩初产妇妊娠压力、自我效能及分娩结局的影响[J].浙江医学, 2017, 39(16):1387. [5] XU H, OUYANG N, LI R, et al.The effects of anxiety and depression on in vitro fertilisation outcomes of infertile Chinese women[J].Psychol Health Med, 2017, 22(1):37. [6] DEMYTTENAERE K, DE FRUYT J.Getting what you ask for:on the selectivity of depression rating scales[J].Psychother Psychosom, 2003, 72(2):61. [7] CRONLEIN T, LANGGUTH B, POPP R, et al.Regensburg Insomnia Scale (RIS):a new short rating scale for the assessment of psychological symptoms and sleep in insomnia; study design:development and validation of a new short self-rating scale in a sample of 218 patients suffering from insomnia and 94 healthy controls[J].Health Qual Life Outcomes, 2013, 11(65):4. [8] LEWIS CA, MCCOLLAM P, JOSEPH S.Convergent validity of the depression-happiness scale with the Memorial University of Newfoundland Scale of Happiness[J].Psychol Rep, 2001, 88(2):471. [9] 中国医师协会生殖医学专业委员会.高龄女性不孕诊治指南[J].中华生殖与避孕杂志, 2017, 37(2):87. [10] 孙方臻, 孙鹿希, 黄秀英.中国优生及辅助生殖的挑战与出路[J].第二军医大学学报, 2017, 38(7):832. [11] 欧阳旭平, 陈丹, 汤华清.不同原因IVF-ET治疗的男性焦虑抑郁情绪与妊娠结局的相关性[J].中华男科学杂志, 2018, 24(4):380. [12] 黄莎, 肖红, 柳鸣.IVF-ET术受孕者孕早期妊娠压力与身体活动的相关性研究[J].现代妇产科进展, 2017, 26(8):619. [13] 吴方贵, 覃金洲, 田菁燕.行为干预对睡眠障碍IVF-ET病人妊娠结局的影响[J].中国妇产科临床杂志, 2019, 20(1):65. [14] 侯宁蕊, 王慧丽, 王燕.渐进性肌肉放松训练对围术期乳腺癌病人焦虑、抑郁和生活质量的影响[J].中华现代护理杂志, 2017, 23(4):489. [15] 张懿, 苏文君, 蒋春雷.应激生理指标皮质醇和α-淀粉酶的研究进展[J].军事医学, 2017, 41(2):146.