本文選題：不育 + 女(雌)性生殖技術(shù)��； 參考：《安徽醫(yī)科大學(xué)》2007年碩士論文

【摘要】： 目的了解安徽省某醫(yī)院生殖中心不孕癥婦女在接受體外受精-胚胎移植治療期間的焦慮、抑郁癥狀及其在不同治療階段的變化趨勢(shì),比較不同治療階段焦慮、抑郁癥狀與應(yīng)付方式、婚姻調(diào)適的關(guān)系,探討與焦慮、抑郁癥狀相關(guān)聯(lián)的因素,為開(kāi)展不孕婦女心理健康促進(jìn)提供依據(jù)。 方法選取2006年5月28日～2006年11月28日期間在安徽省某醫(yī)院生殖中心接受體外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)或卵胞漿內(nèi)單精子注射(intracytoplasmic sperm injection,ICSI)治療的225例不孕癥婦女為研究對(duì)象,采用匿名方式進(jìn)行問(wèn)卷調(diào)查。分別在不孕癥婦女接受治療過(guò)程中不同階段的4個(gè)治療時(shí)點(diǎn)進(jìn)行調(diào)查,對(duì)過(guò)去一周的焦慮和抑郁癥狀進(jìn)行回顧性自評(píng)。其中Ⅰ期在治療的開(kāi)始;Ⅱ期為胚胎移植前的1～2小時(shí);Ⅲ期為胚胎移植后9～10天,即移植后等待期;Ⅳ期為胚胎移植后20天,即移植后結(jié)局期。Ⅰ期有225名不孕癥婦女接受調(diào)查,Ⅱ期、Ⅲ期和Ⅳ期的調(diào)查人數(shù)均為212例。問(wèn)卷調(diào)查內(nèi)容包括不孕癥婦女的社會(huì)人口學(xué)特征、健康狀況、不孕癥因素、既往治療情況、本次治療過(guò)程中的情況、焦慮自評(píng)量表(SAS)、流調(diào)中心用抑郁量表(CES-D)、應(yīng)付方式問(wèn)卷、Locke-Wallace婚姻調(diào)適測(cè)定等。使用焦慮自評(píng)量表(SAS)對(duì)調(diào)查對(duì)象在治療過(guò)程Ⅰ～Ⅳ期進(jìn)行焦慮癥狀評(píng)定,以粗分≥40分界定為有焦慮癥狀;使用流調(diào)中心用抑郁量表(CES-D)對(duì)調(diào)查對(duì)象在治療過(guò)程Ⅰ～Ⅳ期進(jìn)行抑郁癥狀評(píng)定,粗分≥20分界定為有抑郁心理癥狀。分析不孕癥婦女的社會(huì)人口學(xué)特征、不孕癥情況;IVF-ET/ICSI治療4個(gè)時(shí)期的焦慮和抑郁癥狀檢出率、癥狀評(píng)分及其變化趨勢(shì);用χ2檢驗(yàn)分析社會(huì)人口學(xué)因素、不孕癥及既往治療因素、本次治療中的因素與4個(gè)治療時(shí)期的不孕婦女的焦慮和抑郁癥狀關(guān)系;用t檢驗(yàn)比較在4個(gè)治療時(shí)期應(yīng)付方式的6個(gè)因子分、婚姻調(diào)適總分與焦慮、抑郁癥狀的關(guān)系;多元Logistic回歸分析影響4個(gè)治療時(shí)期不孕婦女焦慮、抑郁癥狀的相關(guān)因素。 結(jié)果225名接受調(diào)查的不孕癥婦女的年齡為21~44歲,平均30.9歲;人均年收入平均為2.2萬(wàn)元;受教育程度為初中者占35.6%,高中及以上占64.4%;婚齡最長(zhǎng)18年,平均6.1年;長(zhǎng)期居住城市者為75.6%。不孕癥持續(xù)時(shí)間最長(zhǎng)為17.0年,平均5.3年;不孕癥既往治療時(shí)間最長(zhǎng)為14.0年,平均3.2年;引起不孕癥的因素中男方因素占14.6%,女方因素占54.2%,雙方因素占27.8%,不明原因占3.3%;接受IVF-ET/ICSI的次數(shù)中第1次者占84.0%,第2次者占12.0%,第3次者占4.0%;既往不孕癥治療費(fèi)用平均1.9萬(wàn)元。 本研究結(jié)果顯示,不孕癥婦女在治療的4個(gè)時(shí)期的焦慮癥狀檢出率分別為15.1%,17.5%,18.4%, 25.9%;抑郁癥狀檢出率分別為32.1%,27.4%,30.2%,47.2%;焦慮和抑郁癥狀共患率分別為:9.4%,12.7%,12.7%,25.0%;Ⅳ期(移植后結(jié)局期)的焦慮、抑郁癥狀檢出率和焦慮、抑郁共患率均高于Ⅰ期(治療開(kāi)始期)、Ⅱ期(移植前期)和Ⅲ期(移植后等待期),差異有統(tǒng)計(jì)學(xué)意義。4個(gè)治療時(shí)期的焦慮和抑郁癥狀得分均存在正相關(guān),其中Ⅳ期的焦慮和抑郁癥狀評(píng)分呈高度正相關(guān),表明各期的焦慮和抑郁癥狀存在伴隨現(xiàn)象,Ⅳ期的焦慮和抑郁癥狀伴隨現(xiàn)象最為明顯。 在Ⅰ期(治療開(kāi)始)時(shí),人均年收入低于1.8萬(wàn)元婦女焦慮癥狀高于年收入大于1.8萬(wàn)元者;不孕癥婦女的抑郁癥狀檢出率在受教育程度為初中、人均年收入低于1.8萬(wàn)元、婚齡10年以上、居住農(nóng)村者分別高于受教育程度為高中及以上、人均年收入1.8萬(wàn)元以上、10年以下婚齡、城市居住者;不孕癥持續(xù)時(shí)間為5.5年以上、既往治療費(fèi)用2萬(wàn)元以上、不孕原因由女方和夫婦雙方因素引起的婦女焦慮癥狀均較高,差異有統(tǒng)計(jì)學(xué)意義;多元Logistic回歸分析結(jié)果顯示,人均年收入低于1.8萬(wàn)元和不孕癥既往治療費(fèi)用2萬(wàn)元以上婦女的焦慮癥狀危險(xiǎn)性增加到3倍;婚齡在10年以上婦女抑郁癥狀的危險(xiǎn)性是婚齡10年及以下者的7倍,居住城市的婦女有抑郁癥狀的危險(xiǎn)性是居住農(nóng)村者的1/3。 在Ⅱ期(胚胎移植前期)的不孕癥婦女焦慮和抑郁自評(píng)結(jié)果表明,居住農(nóng)村婦女抑郁癥狀高于居住城市者;焦慮和抑郁癥狀與受教育程度、人均年收入、婚齡等因素未發(fā)現(xiàn)統(tǒng)計(jì)學(xué)關(guān)聯(lián)。男方因素引起不孕癥的婦女抑郁癥狀高于由女方和雙方因素引起者,受精率低于74%和卵裂率低于80%者抑郁癥狀檢出率較高,隨著IVF-ET/ICSI婦女在治療過(guò)程中發(fā)生卵巢過(guò)度刺激綜合征(ovarian hyperstimulation syndrome, OHSS)的程度加重,焦慮和抑郁癥狀檢出率升高。多元Logistic回歸分析結(jié)果顯示,發(fā)生中度OHSS者有抑郁和焦慮癥狀危險(xiǎn)性是無(wú)OHSS者的2～3倍;高齡、既往治療時(shí)間長(zhǎng)和本次促排卵用藥時(shí)間長(zhǎng)增加焦慮癥狀的危險(xiǎn)性;人均年收入高、本次促排卵用藥時(shí)間長(zhǎng)增加抑郁癥狀的危險(xiǎn)性;卵裂率低于80%者發(fā)生抑郁癥狀的風(fēng)險(xiǎn)是卵裂率在80%及以上者約2倍。 Ⅲ期(移植后等待期)婦女的焦慮和抑郁癥狀與社會(huì)人口學(xué)特征未發(fā)現(xiàn)統(tǒng)計(jì)學(xué)關(guān)聯(lián);既往治療時(shí)間低于2.5年的婦女抑郁癥狀較高;本次治療中受精率低于74%、卵裂率低于80%和不知道自己移植胚胎個(gè)數(shù)者抑郁癥狀檢出率較高,隨著IVF-ET/ICSI婦女在治療過(guò)程中發(fā)生OHSS的程度加重,焦慮和抑郁癥狀檢出率升高。多元Logistic回歸分析結(jié)果顯示,發(fā)生中度OHSS者有抑郁和焦慮癥狀危險(xiǎn)性是無(wú)OHSS者的2.5倍;人均年收入高、本次促排卵用藥時(shí)間長(zhǎng)增加焦慮癥狀的危險(xiǎn)性;不孕癥持續(xù)時(shí)間長(zhǎng)和IVF-ET/ICSI婦女抑郁癥狀危險(xiǎn)性降低有關(guān);卵裂率高于80%和知道移植胚胎個(gè)數(shù)發(fā)生抑郁癥狀的危險(xiǎn)性是卵裂率低于80%和不知道移植胚胎個(gè)數(shù)者的0.3和0.4倍。 在Ⅳ期(移植后結(jié)局期),居住在農(nóng)村的不孕癥婦女的焦慮癥狀高于居住城市者,既往治療時(shí)間低于2.5年的婦女焦慮癥狀較高,擁有冷凍胚胎和生化妊娠者的焦慮和抑郁癥狀檢出率較低,差異有統(tǒng)計(jì)學(xué)意義。冷凍胚胎數(shù)目多的婦女抑郁癥狀檢出率降低。多元Logistic回歸分析結(jié)果顯示,IVF-ET/ICSI治療次數(shù)每增加1次,焦慮癥狀的危險(xiǎn)性增加到2.6倍;既往治療時(shí)間長(zhǎng)的婦女焦慮和抑郁癥狀降低,已明確生化妊娠婦女發(fā)生焦慮和抑郁癥狀的危險(xiǎn)性約是未妊娠者的1/4,冷凍胚胎數(shù)目多和抑郁癥狀降低與擁有冷凍胚胎和焦慮癥狀危險(xiǎn)性的降低有關(guān)。 本研究的單因素分析和多元Logistic回歸分析的結(jié)果均顯示,不孕癥婦女在IVF-ET/ICSI治療的4個(gè)時(shí)期中,隨著解決問(wèn)題因子分升高,不孕癥婦女在Ⅲ期(移植后等待期)發(fā)生焦慮癥狀的危險(xiǎn)性降低,在Ⅰ期(治療開(kāi)始前期)和Ⅳ期(移植后結(jié)局期)出現(xiàn)抑郁癥狀的危險(xiǎn)性減少;求助因子分增加與Ⅰ期的抑郁癥狀降低有關(guān);Ⅱ期(移植前期)和Ⅳ期的焦慮癥狀與Ⅰ期、Ⅱ期和Ⅲ期的抑郁癥狀危險(xiǎn)性均隨著自責(zé)因子分增加而顯著升高;而幻想因子分的增加與Ⅲ期和Ⅳ期的焦慮、抑郁癥狀危險(xiǎn)性升高均顯著相關(guān)聯(lián)。不孕癥婦女的婚姻調(diào)適評(píng)分增加與Ⅱ期和Ⅲ期出現(xiàn)抑郁癥狀的危險(xiǎn)性降低有關(guān)聯(lián)。 結(jié)論不孕癥婦女在IVF-ET/ICSI治療4個(gè)階段均普遍存在焦慮和抑郁癥狀,尤其是Ⅳ期最為多見(jiàn),焦慮與抑郁癥狀存在較高的共患現(xiàn)象。居住農(nóng)村、婚齡10年以上、不孕癥持續(xù)時(shí)間長(zhǎng)、治療費(fèi)用高于2萬(wàn)元、本次治療發(fā)生中度OHSS、卵裂率低于80%、冷凍胚胎情況、生化妊娠以及采取的應(yīng)付方式和婚姻調(diào)適狀況,分別與不同治療階段的焦慮和抑郁癥狀相關(guān)。應(yīng)關(guān)注IVF-ET/ICSI治療婦女的心理健康狀況,通過(guò)多途徑的方法改進(jìn)應(yīng)付方式、促進(jìn)社會(huì)與家庭支持,降低IVF-ET/ICSI治療婦女的心理健康問(wèn)題的發(fā)生。
[Abstract]:Objective to understand the anxiety, depressive symptoms and changes in different treatment stages of infertility women during the treatment of in vitro fertilization and embryo transfer in the reproductive center of a hospital in Anhui Province, and to compare the anxiety, depressive symptoms and coping styles in different treatment stages, the relationship between the marital adjustment and the factors associated with anxiety and depression. To provide basis for promoting mental health of infertile women.
Methods from May 28, 2006 to November 28, 2006, 225 women with infertility were treated with in vitro fertilization and embryo transfer, IVF-ET, or intracytoplasmic sperm injection (intracytoplasmic sperm injection, ICSI) in a hospital reproductive center of Anhui province. A questionnaire survey was conducted on 4 points of treatment at different stages of the treatment of infertility women, and a retrospective review of the anxiety and depressive symptoms of the past week was carried out. The first stage was at the beginning of the treatment, the second stage was 1~2 hours before the embryo transfer, and the third stage was 9~10 days after the embryo transfer, that is, the waiting period after the transplantation; Stage IV was 20 days after the embryo transfer, that is, the outcome period after transplantation. In phase I, 225 women with infertility were investigated, and 212 cases were investigated in stage II, stage III and IV. The questionnaire included the social demographic characteristics of infertility women, health status, infertility factors, both treatment and anxiety. The rating scale (SAS), the Depression Scale (CES-D), the coping style questionnaire and the Locke-Wallace marriage adjustment were used in the flow center. The anxiety symptom was evaluated by the self rating Anxiety Scale (SAS), and the anxiety symptoms were defined as greater than 40, and the Depression Scale (CES-D) was used in the center of flow modulation. The depressive symptoms were evaluated in stage I to IV of the treatment process. The gross score was more than 20 points as depressive psychological symptoms. The social demography characteristics of infertility women and infertility were analyzed; the prevalence of anxiety and depression in the 4 periods of IVF-ET/ICSI treatment, the symptom score and the trend of change, and the analysis of social demography factors and infertility were analyzed by the chi chi 2 test. The factors of disease and previous treatment were related to the anxiety and depression symptoms of infertile women in the 4 period of treatment; the t test was used to compare the 6 factors of coping styles in the 4 period of treatment, the relationship between the total score of the marriage adjustment and the anxiety and the depressive symptoms, and the analysis of the multiple Logistic return to the anxiety of the infertile women during the treatment period. Related factors of depression symptoms.
Results the age of 225 women with infertility was 21~44 years, an average of 30.9 years, average annual income of 22 thousand yuan per capita, 35.6% for junior high school students, 64.4% for high school and above, 18 years for marriage, and 6.1 years on average. The longest duration of 75.6%. infertility in long lived cities was 5.3 years, with an average of 5.3 years of infertility. The longest time for treatment was 14 years, an average of 3.2 years. Among the factors causing infertility, male and female factors accounted for 14.6%, women accounted for 54.2%, both factors accounted for 27.8%, and 3.3% of unexplained reasons were 27.8%, 84% in the number of IVF-ET/ICSI, 12% and third in 12%, and third in 4%, and the average cost of infertility treatment was 19 thousand.
The results showed that the rate of anxiety symptoms in the 4 periods of the treatment of infertility was 15.1%, 17.5%, 18.4%, 25.9%, and the rate of depressive symptoms was 32.1%, 27.4%, 30.2%, 47.2%, respectively: 9.4%, 12.7%, 12.7%, 25%; the anxiety, the detection rate of depressive symptoms and the focus in stage IV (post transplant). The prevalence of depression was higher than phase I (initial stage of treatment), stage II (pre transplant) and stage III (post transplant waiting period). There was a positive correlation between the scores of anxiety and depressive symptoms during the period of.4 treatment. The scores of anxiety and depressive symptoms in stage IV were highly positive, indicating that the symptoms of anxiety and depressive symptoms at all stages were associated with each other. The incidence of anxiety and depression in stage IV is the most obvious.
At the first stage (treatment start), the annual income per capita was less than 18 thousand yuan in women's anxiety symptoms higher than that of the annual income of more than 18 thousand yuan; the prevalence rate of depressive symptoms in women with infertility was lower than 18 thousand yuan per capita, and the age of marriage was over 10 years. More than 18 thousand yuan, more than 10 years of marriage age, urban residents; infertility duration of more than 5.5 years, previous treatment costs more than 20 thousand yuan, the reasons for infertility caused by women and the couple factors caused by women's anxiety symptoms are higher, the difference is statistically significant; multivariate Logistic regression analysis results show that per capita income is less than 18 thousand yuan per capita. The risk of anxiety symptoms of women with past 20 thousand yuan of infertility increased to 3 times, and the risk of depressive symptoms for women aged more than 10 years was 7 times that of those who were married 10 years and below. The risk of depressive symptoms for women living in urban areas was the 1/3. of rural residents.
The self evaluation results of anxiety and depression in women with infertility in stage II (early embryo transfer) showed that the depression symptoms of women living in rural areas were higher than those in urban residents. There was no statistical correlation between anxiety and depression symptoms and factors such as the degree of education, annual income per capita, marriage age and so on. The positive rate of depressive symptoms was higher than that of 74% and the rate of cleavage rate below 80%. With the increase of the degree of ovarian hyperstimulation syndrome (ovarian hyperstimulation syndrome, OHSS) in the treatment of IVF-ET/ICSI women, the prevalence of anxiety and depression was increased. The results of multivariate Logistic regression analysis showed that hair was found. The risk of depression and anxiety in patients with moderate and moderate OHSS was 2~3 times as high as that of those without OHSS; older age, longer duration of treatment and longer time for oovulation increased the risk of anxiety symptoms; per capita annual income was high, the time of ovulating for this time increased the risk of depressive symptoms; the rate of cleavage was lower than the risk of depressive symptoms of 80%. The rate of cleavage is about 2 times more than that of 80% or more.
There was no statistical correlation between the anxiety and depressive symptoms of women in stage III (post transplant waiting period) and social demography characteristics; women who had a previous treatment time of less than 2.5 years had higher depressive symptoms. The rate of fertilization was lower than 74% in this treatment, the rate of cleavage was lower than 80% and the rate of depressive symptoms was higher in those who did not know the number of their own transplanting embryos, with IVF-ET/ICSI The degree of OHSS in the treatment of women was aggravated and the prevalence of anxiety and depressive symptoms increased. The multivariate Logistic regression analysis showed that the risk of depression and anxiety in those with moderate OHSS was 2.5 times as high as those without OHSS; the per capita annual income was higher, the risk of prolonged anxiety in this period of ovulation induction increased the risk of anxiety, and the duration of infertility persisted. The length of the interval was associated with a decrease in the risk of depressive symptoms in IVF-ET/ICSI women; the cleavage rate was higher than 80% and the risk of depressive symptoms of the number of transplanted embryos was 0.3 and 0.4 times the cleavage rate less than 80% and those who did not know the number of transplanted embryos.
The anxiety symptoms of infertile women living in rural areas were higher than those in urban residents, with higher anxiety symptoms for women who had been treated for less than 2.5 years, and the rates of anxiety and depression with frozen embryos and biochemical pregnancies were lower, the difference was statistically significant. Women with a large number of frozen embryos were depressed. The multiple Logistic regression analysis showed that the risk of anxiety and depression in women with a long period of treatment increased by 1 times, and the risk of anxiety and depression decreased. The risk of anxiety and depressive symptoms in women who had been treated for a long period of time was about the 1/4 of the non pregnant women and the number of frozen embryos. Deb and depression were associated with decreased risk of frozen embryos and anxiety symptoms.
The results of single factor analysis and multiple Logistic regression analysis in this study showed that in the 4 periods of IVF-ET/ICSI treatment in women with infertility, the risk of anxiety symptoms was reduced in stage III (the waiting period after transplantation) with the increase of the problem factor, and in phase I (initial stage of treatment) and stage IV (post transplant outcome period). The risk of depressive symptoms decreased; the increase in help factor scores was associated with the depression of stage I; the risk of anxiety in stage II (pre transplant) and stage IV and the risk of depressive symptoms in stage I, stage II and stage III increased significantly with the increase of self blame factors; and the increase of fantasy factor and anxiety in stage III and IV, depression There was a significant association between risk elevation and increased marital adjustment score in women with infertility.
Conclusion there are general symptoms of anxiety and depression in the 4 stages of IVF-ET/ICSI treatment for women with infertility, especially the most common in stage IV, and there is a higher codevelopment in anxiety and depressive symptoms. Living in the countryside, the age of marriage is more than 10 years, the duration of infertility is longer and the cost of treatment is higher than 20 thousand yuan. This treatment has moderate OHSS, the cleavage rate is lower than 80%, cold and cold. The conditions of frozen embryos, biochemical pregnancies, coping styles and marital adjustment are related to the symptoms of anxiety and depression at different stages of treatment. Attention should be paid to the psychological health of IVF-ET/ICSI in the treatment of women, to improve coping styles, to promote social and family support and to reduce the psychology of IVF-ET/ICSI in the treatment of women. The occurrence of health problems.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2007
【分類(lèi)號(hào)】：R714.8;R395

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相關(guān)期刊論文 前3條

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