摘要
目的探讨接受体外受精-胚胎移植技术治疗的患者胚胎移植日焦虑情绪对妊娠结局的影响。方法采用随机抽样方法,将2016年10月至2017年10月在杭州市妇产科医院生殖医学中心进行体外受精-胚胎移植技术(IVF-ET)治疗的131名女性患者作为研究对象,胚胎移植日采用焦虑自评量表评估患者焦虑状况。根据焦虑程度对其进行分类,比较无焦虑、轻度焦虑、中度焦虑患者之间妊娠结局情况。结果 131名患者中有焦虑情绪者64人(48.9%);无焦虑组与焦虑组患者比较,其生化妊娠率、临床妊娠率和胚胎种植率差异均有统计学意义(均P<0.05);无焦虑组与轻度焦虑组患者比较,其生化妊娠率、临床妊娠率差异均有统计学意义(均P<0.05);无焦虑组与中度焦虑组患者比较,其临床妊娠率差异均有统计学意义(P<0.05)。结论患者在胚胎移植日普遍存在不同程度的焦虑情绪,轻度焦虑对近期妊娠结局即存在影响,医护人员必须在胚胎移植日加强患者心理干预,引导患者积极应对,改善不孕症患者妊娠结局。
Objective To explore the effect of anxiety on the embryo transferring(ET) day on the pregnancy outcome of in vitro fertilization-embryo transfer(IVF-ET) for infertile females. Methods A total of 131 infertile females undergoing IVF-ET in the Reproductive Medicine Center of Hangzhou Obstetrics and Gynecology Hospital from October 2016 to October 2017 were assessed by self-rating anxiety scale(SAS) on ET day. The pregnancy outcomes were compared between the three groups of no anxiety, mild anxiety and moderate anxiety. Results 64 females(48.9%) had anxiety. Among them, there were 55(42.0%) cases of mild anxiety, 9(6.9%) cases of moderate anxiety and 0 case of severe anxiety. The biochemical pregnancy rate, clinical pregnancy rate and implantation rate in anxiety group were lower than that in no anxiety group(all P<0.05). Mild anxiety group showed lower biochemical pregnancy rate and clinical pregnancy rate compared with no anxiety group(all P<0.05). Moderate anxiety group showed lower clinical pregnancy rate compared with no anxiety group(P<0.05). Conclusions There are different levels of anxiety on ET day among IVF-ET females and even mild anxiety may affect the near-term pregnancy outcomes. Therefore, psychological intervention should be strengthened on the ET day to improve the pregnancy outcomes.
引文
[1] World Health Organization.Global burden of infertility[EB/OL].http://www.who.int/reproductivehealth/topics/infertility/en/.
[2] 郭启云,颜丹,刘颖,等.体外受精胚胎移植患者焦虑、抑郁情绪与生育生命质量的相关性分析[J].中国实用护理杂志,2017,33(27):2081-2081.
[3] 张琼,陈丹,蒋玲,等.接受体外受精-胚胎移植治疗女患者个人社会心理因素对治疗结局的影响[J].护理学报,2016,23(20):1-4.
[4] 周晓景,谭丽.女性焦虑障碍对供精体外受精-胚胎移植妊娠结局的影响[J].中国继续医学教育,2016,8(18):71-72.
[5] 王向东,主编.心理卫生评定量表手册(增订版)[M].北京:中国心理卫生杂志社,1999:235-237.
[6] 李小红.体外受精-胚胎移植病人心理相关性研究[D].成都:四川大学,2007.
[7] 张琼,陈丹,蒋俐萍,等.行体外受精-胚胎移植女性患者焦虑抑郁现状及影响因素分析[J].护理学报,2017,24(14):43-47.
[8] 何玉洁,王瑛,土增荣,等.体外受精-胚胎移植过程中焦虑抑郁、子宫收缩频率和妊娠结局的相关性[J].山西医科大学学报,2016,47(12):1108-1111.
[9] Schweiger U,Wischmann T,Strowizki T.Mental disorders and female infertility[J].Der Nervenarzt,2012,83(11):1442-1447.
[10] 牟善芳,孙振高,陈莉军,等.心理干预对体外受精-胚胎移植患者心理状态及结局的影响[J].护理学杂志,2008,23(10):9-11.
[11] 唐惠艳,邱忠君,王成刚.以夫妻为中心的心理干预在体外受精-胚胎移植患者中的应用效果[J].中国实用护理杂志,2016,32(5):350-354.
[12] 吴汉霞,刘玉芹.健康教育在体外受精-胚胎移植患者取卵前后的应用[J].解放军护理杂志,2007,24(1):85-86.
[13] 苏霞,丛云凤.心理干预对体外受精-胚胎移植临床妊娠率影响的Meta分析[J].中国实用护理杂志,2013,29(1):66-68.
[14] 蔡艳娜,董悦芝.不孕女性生活事件、压力反应、应对方式与生育压力的关系及应对方式的中介效应[J].中国全科医学,2017,20(6):715-719.
[15] 闵丽华,张潇潇,吕群.体外受精-胚胎移植患者不同阶段知识需求调查[J].护理学杂志,2009,24(6):14-15.
[16] 蒋玲,陈丹,张琼,等.阶段性健康教育联合肌肉松弛训练对体外受精-胚胎移植患者的影响[J].中华护理杂志,2017,52(2):166-170.
[17] Domínguez F,Garrido-Gómez T,López JA,et al.Proteomic analysis of the human receptive versus non-receptive endometrium using differential in-gel electrophoresis and MALDI-MS unveils stathmin 1 and annexin A2 as differentially regulated[J].Hum Reprod,2009,24(10):2607-2617.
[18] Bersinger NA,Wunder DM,Birkh?user MH,et al.Gene expression in cultured endometrium from women with different outcomes following IVF[J].Mol Hum Reprod,2008,14(8):475-484.