孫素改,李春雷,左喜愛(ài)

(張家口市第二醫(yī)院，河北 張家口 075000)

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心理護(hù)理對(duì)產(chǎn)后抑郁癥的預(yù)防

孫素改,李春雷,左喜愛(ài)

(張家口市第二醫(yī)院，河北 張家口 075000)

摘要：目的觀察心理護(hù)理對(duì)產(chǎn)后抑郁癥發(fā)生的預(yù)防效果。方法選取定期產(chǎn)檢并分娩的孕婦84例，隨機(jī)分為治療組和對(duì)照組，各42例，對(duì)照組給予孕婦常規(guī)產(chǎn)前知識(shí)講座、定期心理培訓(xùn)；治療組在對(duì)照組的常規(guī)處置基礎(chǔ)上，對(duì)親密家庭人員和孕婦行心理干預(yù)及預(yù)防產(chǎn)后抑郁癥相關(guān)知識(shí)講座，2組產(chǎn)婦均在產(chǎn)后15 d采用愛(ài)丁堡產(chǎn)后抑郁自評(píng)量表(EPDS)、生活質(zhì)量評(píng)定量表(QOL)進(jìn)行評(píng)分，并對(duì)比2組產(chǎn)后抑郁癥發(fā)生率。結(jié)果治療組EPDS評(píng)分明顯低于對(duì)照組(P<0.05),QOL評(píng)分明顯高于對(duì)照組(P<0.05)，治療組抑郁癥發(fā)生率明顯低于對(duì)照組(P<0.05)。結(jié)論親密家庭人員和孕婦同時(shí)進(jìn)行心理干預(yù)培訓(xùn)及預(yù)防產(chǎn)后抑郁癥相關(guān)知識(shí)講座能明顯降低孕婦產(chǎn)后抑郁率，對(duì)預(yù)防產(chǎn)后抑郁癥發(fā)生作用顯著。

關(guān)鍵詞：親密家庭人員；心理干預(yù)；產(chǎn)后抑郁癥

產(chǎn)后抑郁癥是一組非精神的抑郁綜合征,大多發(fā)病在產(chǎn)后2周內(nèi)，產(chǎn)婦表現(xiàn)為失眠乏力、情緒激動(dòng)、悲傷、抑郁等，不僅影響產(chǎn)婦的身心健康，還對(duì)嬰兒的身心健康也有一定的影響[1-3]，發(fā)病率為3.8%～16.7%，且有逐年上升的趨勢(shì)[4-6]。本研究不僅對(duì)孕婦進(jìn)行心理干預(yù)治療，同時(shí)對(duì)產(chǎn)婦親密家庭人員進(jìn)行心理培訓(xùn)，并講解預(yù)防產(chǎn)后抑郁癥相關(guān)知識(shí)，取得良好效果。報(bào)道如下。

1資料與方法

1.1一般資料選取2013年1月—12月我院定期產(chǎn)檢并分娩的符合納入標(biāo)準(zhǔn)的孕婦84例，隨機(jī)分為治療組及對(duì)照組，各42例。治療組年齡22～35歲；1胎24例，2胎18例；對(duì)照組年齡21～35歲；1胎29例，2胎13例。入選產(chǎn)婦產(chǎn)前均無(wú)心理障礙，頭腦清晰，無(wú)心理及精神方面疾病，自愿參加調(diào)查，并能獨(dú)立完成問(wèn)卷。

1.2治療方法2組產(chǎn)婦產(chǎn)前均定期實(shí)施常規(guī)產(chǎn)前知識(shí)講座 、定期孕婦心理培訓(xùn)。治療組在此基礎(chǔ)上對(duì)家庭親密人員共同進(jìn)行心理培訓(xùn)及預(yù)防產(chǎn)后抑郁癥相關(guān)知識(shí)講座，包括：1)入院前孕婦分娩知識(shí)宣教，讓孕婦及親密家庭人員明白抑郁是產(chǎn)后最常見(jiàn)的心理問(wèn)題，容易引起產(chǎn)婦抑郁的問(wèn)題如母親角色轉(zhuǎn)換，嬰兒哺乳問(wèn)題等，由專(zhuān)業(yè)人員對(duì)孕婦及親密家庭人員進(jìn)行心理護(hù)理培訓(xùn)。2)讓親密家庭人員積極和孕、產(chǎn)婦交流溝通， 激發(fā)孕、產(chǎn)婦對(duì)周?chē)挛?、生活的興趣，減輕產(chǎn)婦產(chǎn)后出現(xiàn)情緒不穩(wěn)，擔(dān)心、焦慮等，從而避免發(fā)展成抑郁癥，并講解產(chǎn)后抑郁癥相關(guān)知識(shí)。3)親密家庭人員為產(chǎn)婦提供親密、舒適的家庭休養(yǎng)環(huán)境，滿(mǎn)足產(chǎn)婦的生活需要，更多關(guān)心和體貼產(chǎn)婦，隨時(shí)進(jìn)行心理、生活的幫助，如鼓勵(lì)產(chǎn)婦堅(jiān)持母乳喂養(yǎng)嬰兒的信心，幫助產(chǎn)婦康復(fù)鍛煉，使產(chǎn)婦放松身心，產(chǎn)生愉悅的情緒 。有研究表明，親密家庭人員的情感支持對(duì)產(chǎn)婦心理可起到正向性作用，能最大程度滿(mǎn)足產(chǎn)婦心理需求[7]。

1.3調(diào)查方法2組產(chǎn)婦均于產(chǎn)后15 d進(jìn)行問(wèn)卷調(diào)查，問(wèn)卷發(fā)放及評(píng)分固定由3名經(jīng)驗(yàn)豐富的主管護(hù)師進(jìn)行處理，采用愛(ài)丁堡產(chǎn)后抑郁自評(píng)量表(EPDS)進(jìn)行抑郁程度評(píng)分，EPDS 共 10項(xiàng)，10項(xiàng)相加滿(mǎn)分為30 分。陰性：總分≤12分；陽(yáng)性：總分>13分，評(píng)分陽(yáng)性產(chǎn)婦即可確認(rèn)為產(chǎn)后抑郁癥。采用生活質(zhì)量評(píng)定量表(QOL)進(jìn)行生存質(zhì)量評(píng)分，QOL共6個(gè)領(lǐng)域，24個(gè)方面以及1個(gè)一般健康狀況和生存質(zhì)量的評(píng)分，得分越高生存質(zhì)量越好。評(píng)價(jià)問(wèn)卷由3名經(jīng)驗(yàn)豐富的主管護(hù)師當(dāng)場(chǎng)發(fā)放，由產(chǎn)婦親自填寫(xiě)完成后回收，并由主管護(hù)師確認(rèn)問(wèn)卷真實(shí)有效。2組共發(fā)放問(wèn)卷84份，全部有效回收。

2結(jié)果

2.12組分娩前后EPDS、QOL評(píng)分比較見(jiàn)表1。

組 別KEPDS產(chǎn)前產(chǎn)后15dQOL產(chǎn)前產(chǎn)后15d治療組9.4±2.35.8±3.4#18.96±7.8663.24±3.25#對(duì)照組9.3±5.17.9±2.7 19.02±1.6753.46±4.62

注：與對(duì)照組比較，#P<0.05

2.22組抑郁癥發(fā)生率比較治療組抑郁自評(píng)量表陽(yáng)性者3例(7.1%)，對(duì)照組陽(yáng)性者7例(16.7%)，2者比較，差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。

3小結(jié)

產(chǎn)后抑郁癥的發(fā)病是多方面因素相互作用的結(jié)果，主要有生物學(xué)因素、心理因素和社會(huì)因素等3個(gè)方面[8-10]。孕婦的心理情緒與親密家庭人員各方面的支持密不可分，本研究通過(guò)專(zhuān)業(yè)的心理知識(shí)培訓(xùn)及預(yù)防產(chǎn)后抑郁癥相關(guān)知識(shí)講座，親密家庭人員更了解孕產(chǎn)婦生理、心理的變化以及抑郁癥發(fā)生的危險(xiǎn)因素。發(fā)揮親密家庭人員的主觀能動(dòng)性，應(yīng)用學(xué)習(xí)的專(zhuān)業(yè)心理知識(shí)去護(hù)理孕、產(chǎn)婦，從多方面了解孕、產(chǎn)婦的心理情緒，對(duì)其擔(dān)心、焦慮的問(wèn)題隨時(shí)給予解答，幫助孕、產(chǎn)婦克服各種不良情緒的產(chǎn)生，避免各種心理障礙誘發(fā)產(chǎn)后抑郁癥的發(fā)生[11-13]。

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Psychological nursing in preventing postpartum depression

SUN Sugai,LI Chunlei,ZUO Xiai

(The Second Hospital of Zhangjiakou City in Hebei Province,Zhangjiakou 075000,Hebei Province,China)

Abstract：ObjectiveTo observe the effect of professional psychological intervention to the pregnant women and their intimate family members in preventing the occurrence of postpartum depression.MethodsA total of 84 pregnant women who came for regular antenatal examination and delivery were included in the study and randomized into the observation group and the control group with 42 cases in each group.The pregnant women in the control group were given routine prenatal knowledge lecture and regular psychological training.On this basis,the pregnant women in the observation group were given psychological intervention to the pregnant women and their intimate family members and related knowledge lecture about how to prevent the postpartum depression.EPDS and QOL were used for scoring for the pregnant women in the two groups 15 d after delivery.The occurrence rate of postpartum depression in the two groups was compared.ResultsEPDS score in the observation group was significantly lower than that in the control group (P<0.05),while QOL score was significantly higher than that in the control group (P<0.05).he occurrence rate of depression in the observation group was significantly lower than that in the control group (P<0.05).ConclusionPsychological intervention to the pregnant women and their intimate family members and related knowledge lecture about how to prevent the postpartum depression can significantly reduce the postpartum depression rate with a significant effect to prevent the postpartum depression.

Keywords：intimate family members;psychological intervention;postpartum depression

(收稿日期:2015-10-20)

文章編號(hào)：2095-6258(2016)01-0156-03

中圖分類(lèi)號(hào)：R248.3

文獻(xiàn)標(biāo)志碼：A

作者簡(jiǎn)介：孫素改(1971-)，女，大學(xué)本科，主管護(hù)師，主要從事婦產(chǎn)科臨床研究。

基金項(xiàng)目：河北省科技研究與發(fā)展指導(dǎo)項(xiàng)目(1021957D)。

DOI:10.13463/j.cnki.cczyy.2016.01.054