接纳承诺疗法在胎儿异常引产妇女中的应用

陶蕾; 张凤英; 周利华; 陈家云; 匡玲; 杨文玲

doi:10.16766/j.cnki.issn.1674-4152.003256

接纳承诺疗法在胎儿异常引产妇女中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003256

1.
安徽医科大学第一附属医院妇产科/产房，安徽合肥 230032
2.
安徽医科大学护理学院，安徽合肥 230012

基金项目:

安徽医科大学第一附属医院2020年度新技术新项目院医[2021]8号

安徽高校自然科学研究项目 KJ2021A0254

安徽省教育厅高等学校省级质量工程项目 2020jyxm0926

详细信息

通讯作者:
陶蕾，E-mail：taolei1226@163.com

中图分类号: R719.3R395.6
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出版历程
- 收稿日期: 2023-04-17
- 网络出版日期: 2024-01-13

Applied research of acceptance and commitment therapy in women with termination of pregnancy for fetal abnormality

1.
Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, China

摘要

摘要: 目的探讨接纳承诺疗法在胎儿异常引产妇女中的应用效果, 旨在为胎儿异常引产妇女的心理干预提供参考。方法以就诊于安徽省某三甲医院的139例胎儿异常引产妇女为研究对象, 按照患者引产时间顺序分为对照组和试验组, 2020年10月-2021年3月69例患者为对照组, 2021年4月-2021年7月70例患者为试验组。对照组实施常规心理护理, 试验组应用接纳承诺疗法进行心理干预。使用广泛性焦虑量表、爱丁堡产后抑郁量表和家庭亲密度和适应性量表, 于入产房2 h内(干预前)、引产后第42天(干预后)对患者进行效果评价。结果干预前, 2组患者广泛性焦虑量表得分、产后抑郁发生率、家庭亲密度和适应性得分差异无统计学意义(均P>0.05), 具有可比性。干预后, 试验组广泛性焦虑量表得分[2.00(1.00, 6.00)分]低于对照组[4.00(2.00, 7.00)分], 差异有统计学意义(P < 0.05);试验组产后抑郁发生率(严重抑郁0人、抑郁8人、无抑郁62人)低于对照组(严重抑郁3人、抑郁15人、无抑郁51人), 差异有统计学意义(P < 0.05);试验组家庭亲密度得分[(71.84±5.96)分]和家庭适应性得分[(61.87±5.31)分]均高于对照组[(66.41±8.88)分、(56.83±5.12)分], 差异有统计学意义(均P < 0.05)。结论接纳承诺疗法能够有效减轻胎儿异常引产妇女焦虑水平, 降低产后抑郁发生率, 提升患者家庭亲密度和适应性。
- 接纳承诺疗法 /
- 胎儿异常 /
- 积极心理学 /
- 产后抑郁
Abstract: Objective To investigate the effectiveness of acceptance and commitment therapy (ACT) in women who have had an abortion because of a fetal abnormality. Methods A total of 139 eligible participants were recruited from a tertiary A hospital in Anhui province, China, and were divided into two groups based on the temporal sequence of pregnancy termination: an experimental group (70 subjects) and a control group (69 subjects).The experimental group received 6 treatment sessions based on an acceptance and commitment therapy protocol, and the control group received routine psychological care.The generalized anxiety disorder (GAD-7), the Edinburgh postnatal depression scale (EPDS), and the family adaptability and cohesion evaluation scale (FACES-Ⅱ-CV) were used to assess the participants.Data were analyzed using SPSS. Results Before the intervention, there was no significant difference in the GAD-7 and FACES-Ⅱ-CV scores between the two groups (all P>0.05), and there was no significant difference in the incidence of postpartum depression between the two groups (P>0.05).In the experimental group, the mean score of GAD-7 after the intervention (6th week) was significantly lower than in the control group[2.00(1.00, 6.00) points vs.4.00(2.00, 7.00) points, P < 0.05], the average score of FACES-Ⅱ-CV was higher than the control group[(71.84±5.96) points, (61.87±5.31) points vs.(66.41±8.88) points, (56.83±5.12) points, all P < 0.05]. Conclusion Acceptance and commitment therapy may be an appropriate psychological intervention to reduce the symptoms of women who terminate pregnancy for fetal abnormality and to help them improve psychological flexibility, family cohesion and adaptability.These findings may help guide effective interventions to improve the mental state of women who terminate pregnancy for fetal abnormality.
- Acceptance and commitment therapy /
- Fetal abnormality /
- Positive psychology /
- Postpartum depression

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表 1 2组胎儿异常引产妇女一般资料比较

Table 1. Comparison of general data between two groups of women with termination of pregnancy for fetal abnormality

组别	例数	年龄 (x±s，岁)	孕周 (x±s，周)	学历(例)					宗教信仰(例)		婚姻状况(例)		受孕方式(例)
组别	例数	年龄 (x±s，岁)	孕周 (x±s，周)	小学	初中	高中或中专	大专	本科及以上	有	无	未婚	已婚	自然受孕		人工受孕
对照组	69	30.45±4.92	22.90±4.24	1	10	6	32	20	2	67	1	68	66		3
试验组	70	30.44±4.62	21.81±3.77	4	17	7	20	22	3	67	2	68	65		5
统计量		0.008^a	1.605^a	1.125^b					0.193^c		0.326^c		0.500^c
P值		0.994	0.111	0.261					0.661		0.568		0.479

组别	例数	家庭人均月收入(例)					本次妊娠意愿(例)		孕次(例)				产次(例)
组别	例数	3 001~6 000元	6 001~8 000元	8 001~10 000元	＞10 000元		计划内妊娠	计划外妊娠	1	2	3	＞3	0	1	2	3
对照组	69	19	30	15	5		66	3	24	17	18	10	35	29	4	1
试验组	70	20	32	14	4		66	4	23	22	15	10	35	30	3	2
统计量		0.359^b					0.136^c		0.149^b				0.083^b
P值		0.719					0.713		0.881				0.934
注：^a为t值，^b为Z值, ^c为χ²值。

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表 2 胎儿异常引产妇女接纳承诺疗法干预流程

Table 2. Intervention process of acceptance and commitment therapy in women with termination of pregnancy for fetal abnormality

时间	主题	内容
第1次(入产房2 h内)	知情同意，初步评估	(1)简要介绍接纳承诺疗法内容及干预流程。(2)使用量表评估患者心理状况，与患者交谈，了解患者当下心理体验。(3)指导进行5 min的正念呼吸练习。
第2次(引产后2 h)	接纳情绪，认知解离	(1)通过“随溪漂流的落叶”隐喻，帮助患者接纳情绪。识别患者认知融合的因素，引导患者正确面对自己的负性情绪。(2)指导患者引产后康复相关知识。(3)进行“我现在有这样一个想法……”的练习；进行5 min的正念呼吸练习。
第3次(引产后第1天)	以己为境，明确价值	(1)通过“棋盘”隐喻，帮助患者感受身体、情绪和行为的变化，回忆自我过往克服困难的经历。(2)识别患者最想要实现的价值，让患者思考“哪件事情对你来说最有意义？”“你最想实现什么？”。(3)进行10 min的正念呼吸练习。
第4次(引产后第2天)	制定目标，承诺行动	(1)基于患者的价值观，协助患者找到自己最为重视的领域，制定目标计划清单，付诸行动。(2)进行10 min的正念呼吸练习。告知患者每日坚持10 min的正念呼吸练习。
第5次(引产后第42天)	巩固练习，效果总结	(1)进行10 min的正念呼吸练习。(2)请患者分享行动过程中的收获和障碍。(3)使用量表评估患者的心理状况，总结干预后的效果，感谢患者参与。

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表 3 2组胎儿异常引产妇女干预前后广泛性焦虑量表得分比较[M(P₂₅, P₇₅)，分]

Table 3. Comparison of scores GAD-7 scores between two groups of women with termination of pregnancy for fetal abnormality before and after intervetion[M(P₂₅, P₇₅), points]

组别	例数	干预前	干预后
对照组	69	6.00(3.00，11.00)	4.00(2.00，7.00)
试验组	70	6.50(4.00，12.25)	2.00(1.00，6.00)
Z值		0.749	-2.454
P值		0.454	0.014

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表 4 2组胎儿异常引产妇女干预前后产后抑郁发生情况比较[例(%)]

Table 4. Comparison of the incidence of postpartum depression between two groups of women with termination of pregnancy for fetal abnormality before and after intervetion[cases (%)]

组别	例数	干预前			干预后
组别	例数	严重抑郁	抑郁	无抑郁	严重抑郁	抑郁	无抑郁
对照组	69	6(8.70)	25(36.23)	38(55.07)	3(4.35)	15(21.74)	51(73.91)
试验组	70	8(11.43)	22(31.43)	40(57.14)	0	8(11.43)	62(88.57)
χ²值		0.076			2.278
P值		0.939			0.023

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表 5 2组胎儿异常引产妇女干预前后家庭亲密度和适应性得分比较(x±s，分)

Table 5. Comparison of family adaptability and cohesion evaluation scale between two groups of women with termination ofpregnancy for fetal abnormality before andafter intervention (x±s, points)

组别	例数	家庭亲密度得分		家庭适应性得分
组别	例数	干预前	干预后	干预前	干预后
对照组	69	61.07±10.84	66.41±8.88	50.87±9.33	56.83±5.12
试验组	70	61.26±11.08	71.84±5.96	50.93±9.27	61.87±5.31
t值		0.099	4.242	0.037	5.697
P值		0.921	< 0.001	0.970	< 0.001

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