认知行为疗法对肥胖型多囊卵巢综合征不孕妇女心理状态和辅助生殖结局的影响  

Effect of cognitive-behavioral therapy on psychological status and assisted reproductive outcomes in infertile women with obese polycystic ovary syndrome

作　　者：林慧[1] 蔡柳洪[1] 邢卫杰[1] 朱洁茹[1] 欧建平[1] Lin Hui;Cai Liuhong;Xing Weifie;Zhu Jieru;Ou Jianping(Center for Reproductive Medicine,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China)

机构地区：[1]中山大学附属第三医院生殖医学中心,广州510630

出　　处：《中华生殖与避孕杂志》2018年第10期860-863,共4页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨认知行为疗法对肥胖型多囊卵巢综合征(PCOS)不孕妇女心理状态和辅助生殖结局的影响。方法本研究为前瞻性队列研究,将2015年9月—2018年6月期间在我中心进行辅助生殖技术(ART)治疗的84例肥胖型PCOS不孕妇女分为对照组(n=35):接受常规护理和知识宣教;治疗组(n=49):在常规护理和知识宣教基础上,接受认知行为疗法。认知行为疗法包括认知、情感、行为3个层面内容,采用小组课程与微信群沟通相结合模式对入组成员进行指导。了解两组患者在进入ART周期前和胚胎移植后的心理状态和辅助生殖妊娠相关结局。结果治疗组患者治疗后的焦虑状态评分(28.5±7.6)和抑郁状态评分(13.8±7.0)显著低于对照组(43.2±8.6,P=0.008;17.2±6.3,P=0.021)。治疗组的生育生活质量的治疗环境评分(79.7±18.0)和治疗耐受性评分(85.6±21.1)显著高于对照组(64.2±20.2,P=0.015;64.9±22.3,P=0.023)。两组患者的取卵数、流产率、异位妊娠率差异无统计学意义(P>0.05)。治疗组的胚胎种植率和临床妊娠率略高于对照组,但差异无统计学意义(P>0.05)。结论认知行为疗法可以有效改善肥胖型PCOS不孕女性的焦虑、抑郁状态和提高生育生活质量,一定程度上有助于改善这类不孕女性ART治疗效果。Objective To investigate the effect of cognitive-behavioral therapy on psychological status and assisted reproductive outcomes among infertile women with obese polycystic ovary syndrome （PCOS）. Methods This was a prospective cohort study. Eighty-four obese PCOS women undergoing assisted reproductive technology （ART） treatment from September 2015 to June 2018 were divided into two groups： control group （n=35） received routine nursing care and healthy education, while treatment group （n=49） accepted cognitive-behavioral therapy which included recognition, emotional and behavioral interventions. The cognitive-behavioral therapy was performed through small group workshop and intercommunication via wechat. The psychological status before and after ART cycles and ART outcomes were compared between the two groups. Results The anxiety score （28.5 ±7.6） and depression score （13.8±7.0） were significantly lower among patients in treatment group than in control group （43.2± 8.6, P=0.008; 17.2±6.3, P=0.021） . The score of treatment environment （79.7± 18.0）and treatment tolerance of fertility-related quality of life （85.6±21.1） were significantly higher in the treatment group than in control group （64.2±20.2, P=0.015; 64.9 ± 22.3, P=0.023）. No significant differences were identified considering the number of retrieved oocytes, miscarriage rate and ectopic pregnancy rate between the two groups （P〉0.05）. The implantation rate and clinical pregnancy rate were slightly higher in treatment groupthan control group, but failed to reach significant differences （P〉0.05）. Conclusion Cognitive-behavioral therapy could effectively decrease the anxiety and depression status, improve treatment-related fertility quality of life, and might improve ART outcomes of obese PCOS infertile women.

关 键 词：肥胖 多囊卵巢综合征(PCOS) 不孕症 辅助生殖技术(ART) 认知行为疗法 

分 类 号：R473.71[医药卫生—护理学]