产后抑郁症的护理

论文编号:HL199  论文字数:8161.页数:17

论文题目：产后抑郁症的护理
摘　要
 目的：了解孕期心理状况及产后抑郁的发病情况；阐明孕期心理状态与产后抑郁的关系；探讨产后抑郁的危险因素和保护因素。
 方法：采用分层整群抽样方法，抽取一所三级甲等医院和一所二级甲等医院及一所妇幼保健医院 2010 年 3 月至 2010 年 10 月在这 3 所医院进行住院分娩的 314 例孕妇，在妊娠期采用自编产妇一般情况及产科、社会心理因素调查表、焦虑自评量表（SAS）、抑郁自评量表（SDS）进行调查。其中 304 例用爱丁堡产后抑郁量表（EPDS）、产后情况调查表、焦虑、抑郁自评量表跟踪调查至 产后42d。所有资料均采用 SPSSll．5 统计软件处理。统计方法包括描述性的统计分析、χ2检验、单因素和多因素非条件 logistic 分析。
 结果：1.调查中发放问卷共 314 份，有效问卷 304 份，有效率 96.8％。1．孕期焦虑发生率为 22.7％，孕期抑郁发生率为 17.1％。经χ2检验，焦虑和抑郁症状具有极显著相关性（P<0．01）；2.产后抑郁发生率为 16.8％；3.孕期心理状态与产后抑郁的关系：孕期焦虑或抑郁与产后抑郁显著相关（P=0.000）。
 结论：1.部分妇女在产后 6 周内可出现不同程度的抑郁性障碍，而产后抑郁对母婴、家庭危害大，因此应引起高度重视。2.孕期部分孕妇可出现焦虑、抑郁等情绪障碍，其发生率与产后抑郁相比并不少见，母亲孕期的心理健康状况对妊娠母亲及新生儿的健康及发展有不良的影响，其产后抑郁的发生率较高，应受到广大医护人员的重视。
 关键词：产后抑郁，产前心理状态，Edinburg 产后抑郁量表
 

Title: Prevention and care of postpartum hemorrhage
ABSTRACT
Objective
 To investigate the incidence rate of postpartum depression and its relatedpregnancy nutrition and psychosocial factors.
Methods
 The study was carried out in four hospitals selected by stratified sampling inshihezi city. 314 nullipara women who met the designed including criteria at 6 weeks postpartum were recruited by cluster sampling from the three hospitals between March 2010 and October 2010. Participants were assessed by using Edinburgh Postpartum Depression Scale (EPDS), self-designed demographic and obstetrical and psychosocial factors questionnaires. The EPDS is a 10-item self-report scale, specially designed to screen for postpartum depression (PPD). Each item is scored on a 4-point scale from "No, not at all"(0) to "Yes, most of the time"(3), the minimum and maximum total score ranging from 0 to 30,respectively. The cutoff scores of 13 on the EPDS are used to screen for clinical depression. Participants are asked to underline the response that is the most true for them within the past 7 days. The sensitivity for the detection of major depression was 81.82%, the specificity 95.83%. The split-half reliability was 0.59. All statistical analyses were done using the SPSS program, Version 11.5. Descriptive analyses, Chi-square test, simple and multiple factor non-conditional logistic regression analyses were performed.
Results
 l.ln this study completed records were obtained on 304 women, yielding a completion rate of 96.8%.2.The incidence rate of depressive symptoms, an EPDS score of 13 or more, was 16.8% at the 6 weeks postpartum. 3.Anxiety and depression during pregnancy are more prone to Post Natal Depression.
Conclusions
 The 6 weeks after childbirth appears to be a time of heightened vulnerability for the development of depression in some women. Depression in the postpartum period needs our special attention as it can have severe consequences not only for the mother, but also for the infant and the whole family. The study shows that there are four obstetrical risk factors, including medication during pregnancy, Maternal Education Level, history of stillbirth, and fetal distress, including prenatal anxiety breast-feeding. And the study also suggests that there are four psychosocial risk factors, including cadre and clerisy, poor living conditions, female and inadequate family supports, and two protective factors, Expectations Children. In addition preventive intervention should be taken actively to help prevent against postpartum depression.

Key words: postpartum depression, EPDS ,pregnancy psychosocial status

                                目 录

1 绪论 1
1.1 背景及意义 1
1.2 研究目的及目标 2
1.3 关键词及定义 2
1.4 文献回顾 2
2 研究设计 4
2.1 研究类型 4
2.2 研究对象 4
2.3 研究方法 4
2.3.1 焦虑自评量表(Self-rating anxiety scale, SAS) 4
2.3.2 抑郁自评量表(Self-rating depression scales, SDS ) 4
2.3.3 围产相关因素调查问卷 4
2.3.4 相关社会因素调查问卷 5
2.3.5 Edinburgh产后抑郁量表 5
2.4 研究步骤 5
2.5 统计方法 5
3 研究结果 7
3.1 一般资料 7
3.2 产前心理状态及其影响因素分析 7
3.2.1 产前心理总体状况分析 7
3.2.2 产前焦虑、抑郁单因素分析 8
3.2.3 产前焦虑、抑郁的多因素分析 8
4 讨论 10
5 推论及建议 11
5.1 结论 11
5.2 本文的局限和展望 11
6 致    谢 12
7 参考文献 13
附件： 14