高危妊娠产妇产后创伤后应激障碍现状调查及危险因素分析  

Investigation and risk factors analysis of post-traumatic stress disorder in high risk pregnant women

作　　者：李锋娜 曾庆芬 韩颖[1] 董晗琼 Li Fengna;Zeng Qingfen;Han Ying;Dong Hanqiong(Department of Obstetrics and Gynecology,the Tenth People's Hospital Affiliated to Tongji University,Shanghai 200040,P.R.China)

机构地区：[1]同济大学附属第十人民医院妇产科,上海200040

出　　处：《中国计划生育和妇产科》2024年第1期84-88,92,共6页Chinese Journal of Family Planning & Gynecotokology

基　　金：上海市第十人民医院2021年专科护理人才项目(项目编号:SYZKHLRC-B11)。

摘　　要：目的调查高危妊娠产妇产后创伤后应激障碍(post-traumatic stress disorder,PTSD)发生现状,探究影响产后发生PTSD的危险因素。方法选取2020年6月至2021年12月期间于同济大学附属第十人民医院待产的高危妊娠女性120例。采用自行设计调查问卷调查研究对象一般资料,根据产后创伤后应激障碍量表(PCL-C)评估PTSD发生情况,分析PTSD发生现状及其可能的危险因素。结果120例高危妊娠产妇产后PTSD阳性率为11.67%(14/120),主要表现为反复体验症状和警觉性增高症状。PTSD阳性产妇心理弹性量表(CD-RISC)总分及各维度得分低于PTSD阴性,爱丁堡产后抑郁量表(EPDS)得分高于PTSD阴性,差异有统计学意义(P<0.05)。Pearson相关性显示,产妇PCL-C得分与CD-RISC得分呈负相关(r=-0.457,P<0.05),与EPDS得分呈正相关(r=0.538,P<0.05)。Logistic回归分析显示,睡眠质量、分娩方式、精神创伤史、产后抑郁、妊娠期并发症、婴儿健康状况、产妇目前健康状况及心理弹性是高危妊娠产妇产后发生PTSD的独立危险因素(P<0.05)。结论高危妊娠产妇产后PTSD主要表现为反复体验症状和警觉性增高症状群,易激惹或易发怒、入睡困难或睡眠很浅、兴趣明显减退是最易出现的症状问题;PTSD发生与产妇心理弹性和产后抑郁程度明显相关,临床工作者应提高对睡眠质量差、分娩方式为紧急剖宫产、有精神创伤史、产后抑郁、妊娠期并发症、心理弹性低及婴儿健康状况较差的产妇的重视,早期干预。Objective To investigate the occurrence status of postpartum post-traumatic stress disorder(PTSD)in high risk pregnant women and explore the risk factors affecting the occurrence of postpartum PTSD.Methods A total of 120 high-risk pregnant women who were expecting to give birth in the Tenth People's Hospital Affiliated to Tongji University from June 2020 to December 2021 were selected.A self-designed questionnaire was used to investigate the general data of the subjects,and the occurrence of PTSD was assessed according to the postpartum PTSD checlist-civilian version Disorder Scale(PCL-C),and the occurrence status and possible risk factors of PTSD were investigated and analyzed.Results The positive rate of postpartum PTSD in 120 high-risk pregnant women was 11.67%(14/120),mainly manifested as repeated experience symptoms and increased alertness symptoms.The total score of Connor-Davidson resilience scale(CD-RISC)and the scores of all dimensions were lower than those of negative PTSD,while the score of Edinburgh Postpartum Depression Scale(EPDS)was higher than that of negative PTSD,the difference was statistically significant(P<0.05).Pearson correlation showed that maternal PCL-C score was negatively correlated with CD-RISC score(r=-0.457,P<0.05),and positively correlated with EPDS score(r=0.538,P<0.05).Logistic regression analysis showed that sleep quality,delivery mode,mental trauma history,postpartum depression,pregnancy complications,maternal and infant health status and mental resilience were independent risk factors for postpartum PTSD in high-risk women(P<0.05).Conclusion The occurrence of postpartum PTSD in high-risk pregnancy women is mainly manifested as repeated experience symptoms and increased alertness symptoms.The most common symptom problems are irritability or anger,difficulty in falling asleep or very shallow sleep,and obvious loss of interest.The occurrence of PTSD is significantly related to maternal mental resilience and the degree of postpartum depression.Clinical workers should pay more atte

关 键 词：高危妊娠 创伤后应激障碍 心理弹性 产后抑郁 影响因素 

分 类 号：R714[医药卫生—妇产科学] R395.1[医药卫生—临床医学]