本文選題：剖宮產(chǎn)　切入點(diǎn)：母嬰同室　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的調(diào)查剖宮產(chǎn)術(shù)后母嬰同室產(chǎn)婦(以下簡(jiǎn)稱產(chǎn)婦)睡眠質(zhì)量情況,分析其影響因素,探討綜合護(hù)理干預(yù)對(duì)產(chǎn)婦睡眠質(zhì)量、心理狀況及乳汁分泌的效果,為今后臨床護(hù)理人員借助通訊平臺(tái)開(kāi)展針對(duì)性的健康教育提供新思路。方法運(yùn)用質(zhì)性研究,對(duì)13名產(chǎn)婦進(jìn)行面對(duì)面、半結(jié)構(gòu)式的深入訪談,用Colaizzi分析法分析資料,了解產(chǎn)婦的睡眠質(zhì)量情況。采用自制睡眠質(zhì)量影響因素調(diào)查問(wèn)卷、匹茲堡睡眠質(zhì)量指數(shù)量表(PSQI)、愛(ài)丁堡產(chǎn)后抑郁量表(EPDS)和焦慮自評(píng)量表(SAS)對(duì)160名產(chǎn)婦進(jìn)行調(diào)查,分析產(chǎn)婦睡眠質(zhì)量的影響因素。抽取92名產(chǎn)婦隨機(jī)分成對(duì)照組和試驗(yàn)組,每組46例,對(duì)照組接受常規(guī)護(hù)理,試驗(yàn)組在常規(guī)護(hù)理基礎(chǔ)上實(shí)施綜合護(hù)理干預(yù),比較干預(yù)前后兩組產(chǎn)婦的睡眠情況、焦慮抑郁狀況及乳汁分泌始動(dòng)時(shí)間、乳汁分泌量和乳房脹痛發(fā)生率。結(jié)果1.提煉出5個(gè)主題:術(shù)后不適癥狀使產(chǎn)婦入睡困難、睡眠覺(jué)醒次數(shù)頻繁使產(chǎn)婦連續(xù)性睡眠時(shí)間減少、長(zhǎng)時(shí)間臥床使產(chǎn)婦睡眠效率降低、病房環(huán)境不適應(yīng)使產(chǎn)婦睡眠維持困難、相關(guān)支持缺乏使產(chǎn)婦心理壓力增加。2.(1)產(chǎn)婦PSQI評(píng)分為(9.84±2.62)分,其中125例(78.1%)產(chǎn)婦存在睡眠質(zhì)量問(wèn)題。(2)單因素分析結(jié)果顯示,EPDS評(píng)分、SAS評(píng)分、乳房脹痛、夜間母乳喂養(yǎng)、夜間嬰兒哭鬧、切口或?qū)m縮痛、產(chǎn)后褥汗、病房噪音、夜間護(hù)理操作或巡房及擔(dān)心不能適應(yīng)母親角色10個(gè)方面差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)多因素分析結(jié)果顯示,夜間母乳喂養(yǎng)、切口或?qū)m縮痛、乳房脹痛、產(chǎn)后褥汗及擔(dān)心不能適應(yīng)母親角色是影響產(chǎn)婦睡眠質(zhì)量的危險(xiǎn)因素。3.綜合護(hù)理干預(yù)后,試驗(yàn)組產(chǎn)婦睡眠質(zhì)量、睡眠時(shí)間、睡眠效率、日間功能及PSQI評(píng)分均低于對(duì)照組,且低于干預(yù)前(P0.05);試驗(yàn)組產(chǎn)婦EPDS、SAS評(píng)分均低于對(duì)照組,且低于干預(yù)前(P0.05);試驗(yàn)組產(chǎn)婦乳汁分泌始動(dòng)時(shí)間較對(duì)照組提前,兩組產(chǎn)婦不同時(shí)間段(24h、24~48h、48~72h)乳汁分泌例數(shù)、乳汁分泌量和乳房腫脹情況比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1.剖宮產(chǎn)術(shù)后母嬰同室產(chǎn)婦普遍存在睡眠質(zhì)量問(wèn)題。2.夜間母乳喂養(yǎng)、切口/宮縮痛、乳房脹痛、產(chǎn)后褥汗及擔(dān)心不能適應(yīng)母親角色是影響剖宮產(chǎn)術(shù)后母嬰同室產(chǎn)婦睡眠質(zhì)量的危險(xiǎn)因素。3.綜合護(hù)理干預(yù)能有效改善剖宮產(chǎn)術(shù)后母嬰同室產(chǎn)婦的睡眠質(zhì)量,緩解產(chǎn)后焦慮、抑郁情緒,提前乳汁分泌始動(dòng)時(shí)間,促進(jìn)乳汁分泌,減少乳房脹痛發(fā)生率,有利于母嬰身心健康,值得臨床推廣應(yīng)用。
[Abstract]:Objective to investigate the sleep quality of parturient (hereinafter referred to as parturient) after cesarean section, analyze its influencing factors, and discuss the effect of comprehensive nursing intervention on the quality of sleep, psychological condition and milk secretion of parturient. Methods using qualitative research, 13 pregnant women were interviewed face to face and semi-structured, and the data were analyzed by Colaizzi analysis. To understand the sleep quality of puerpera, 160 puerperas were investigated by self-made questionnaire of influencing factors of sleep quality, PSQI of Pittsburgh Sleep quality Index, EPDS of Edinburgh postpartum Depression scale and SASs of Self-Rating anxiety scale. 92 parturient women were randomly divided into control group and experimental group with 46 cases in each group. The control group received routine nursing, and the experimental group carried out comprehensive nursing intervention on the basis of routine nursing. The sleep, anxiety and depression, the onset time of milk secretion, the amount of milk secretion and the incidence of breast distending pain were compared between the two groups before and after intervention. The frequency of sleep awakening frequently reduced the continuous sleep time of the parturient, prolonged stay in bed reduced the sleep efficiency of the parturient, and the inadaptability of the ward environment made it difficult for the parturient to maintain sleep. The PSQI score of parturient was 9.84 鹵2.62), in which 125 cases (78.1) had sleep quality problem. The results of univariate analysis showed that EPDs score, breast distention, breast pain, breast feeding at night and crying at night. There were significant differences in incision or uterine contraction pain, puerperal perspiration, room noise, nocturnal nursing operation or visiting room, and fear of not adapting to the mother's role. Multivariate analysis showed that breast feeding at night, incision or uterine contraction pain. Breast pain, puerperal perspiration and worry about not adapting to the role of mother are the risk factors that affect the quality of maternal sleep. 3. After comprehensive nursing intervention, the quality of sleep, sleep time, sleep efficiency of the trial group, The scores of daytime function and PSQI were lower than those of the control group, and lower than those of the control group (P 0.05), the scores of the test group were lower than those of the control group (P 0.05), and the onset time of milk secretion in the trial group was earlier than that in the control group. The number of cases of milk secretion, the quantity of milk secretion and the condition of breast swelling were significantly different between the two groups at different time periods (P 0.05). Conclusion 1.Sleep quality problems are common in mothers and women in the same room after cesarean section. Incision / contractive pain, breast pain, Postpartum perspiration and fear of not adapting to the mother's role are the risk factors affecting the sleep quality of the mother and child after cesarean section. 3. Comprehensive nursing intervention can effectively improve the sleep quality of the mother and child after cesarean section, and relieve the postpartum anxiety. Depression, early onset time of milk secretion, promoting milk secretion, reducing the incidence of breast distention, is beneficial to the physical and mental health of mother and child, and is worthy of clinical application.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.71

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