【作者】 张红梅；

【导师】 吴爱勤；

【作者基本信息】 苏州大学 ， 精神病与精神卫生学， 2004， 硕士

【摘要】 目的：本研究主要探讨心理社会因素与孕产妇及胎儿心理生理反应、产科并发症及产后抑郁之间的相互关系，初步探讨产后抑郁神经内分泌和免疫中介机制，以提高对产后抑郁的早期辨别和干预能力，有助于围产期孕产妇及胎儿心身健康保健工作的深入开展。 方法：围产期门诊随机抽样抽取129例自愿参加测试、无分娩史及引产史的孕妇，孕周≥36周，既往无精神病史、无重大器质性疾病史。产前完成一般情况问卷、生活事件量表（LES）、A型行为问卷（TABQ）、艾森克个性问卷（EPQ）、生活满意度指数B（LSIB）、社会支持评定量表（SSRS）、症状自评量表（SCL-90）、特质焦虑量表（TAI），产后一周内完成爱丁堡产后抑郁量表（EPDS）和状态焦虑量表（SAT），并对孕妇实施胎心率监护，检测血清T₃、T₄、TSH、IL-2、IL-6。按照所测结果，将产妇分为产后抑郁组（EPDS≥10）和正常组（EPDS＜10）、产科并发症组和正常组、胎心率反应异常组和正常组。用t检验、x²检验、相关分析、多元逐步回归分析等方法，应用SSPS11.0软件完成数据统计。 结果：（1）生活事件总量与胎心率加速和反应呈负相关；家庭经济收入高、社会支持利用度高、生活满意度高的孕妇，其胎儿的胎动、胎心率加速及反应均较好。（2）产后抑郁与产科并发症无明显相关。（3）产后抑郁组受教育年限明显低于正常组。产后抑郁组负性事件高于正常组，社会支持总分、客观支持分和主观支持分低于正常组。神经质、A型行为与产后抑郁密切相关。（4）产后抑郁组产前抑郁、焦虑、敌对、强迫、人际关系敏感性因子分均显著高于正常组。（5）产后抑郁组产后IL-6水平显著高于正常组，产前T₄显著低于正常组、TSH高于正常组。 结论：心理社会因素影响孕妇和胎儿心身健康。产前情绪变化能够预测产后抑郁的发生。社会支持、密切的医疗关注可以降低产后抑郁的发生。应激可能通过神经内分泌、免疫调节机制影响产后抑郁发生。个性因素、生活应激、社会支持也相互影响、相互作用，共同影响孕产妇心理健康状态。更多还原

【Abstract】 Objective: The study attempted to investigate the association between psychosocial factor and psychophysiologic reaction of mother and fetus, and obstetrics complication, and post partum depression(PPD), to find out neuro-endocrine and Immune mediator of PPD and identify PPD before episode and intervene at the earlier period of PPD, and to prompt mother and fetus to successfully pass through perinatal stage.Methods: In perinatal period ,129 volunteers were involved in study by random sampling at out-patient clinic, who were gravidas over 36 pregnant week and without history of parturition or induced labor or organic diseases or psychosis. All subjectives in trimester of pregnancy completed the following questionnaires: general condition questionnaire , LES, TABQ, EPQ, LSIB, SSRS, SCL-90 and TAI, and completed EPDS and SAI within one week after parturition. They received FHR custodial and were detected T3, T4, TSFL IL-2, IL-6. According to outcome, subjectives were divided into PPD group (EPDS >10) and normal group (EPDS<10). obstetrics complication group and normal group , FHR disorder group and normal group. Utilizing t test, %2 test, correlation analysis and stepwise regression analysed the collected data in SPSS11.0.Results: (1) Total amount of life events was reversely related to FHR acceleration and response. Furthermore , in these gravidas with higher family income and higher degree of utilizating social support and living satisfaction , their fetuses’ movement and FHR acceleration and response were all better than controls. (2) The PPD had no significant correlation with obstetrics complication. (3) Time limit of receiving education in PPD women was longer than controls. Negative livingAbstractevents were more in PPD women, however, total social support score and subjective and objective support score were lower. Neuroticism and A form behavior were closely related to PPD. (4) The factor scores of antepartum depression , anxiety ,. rivalry, compulsion and relation sensibility in PPD group were all higher than control group. (5) The serum level of postpartum IL-6 in PPD group was higher, however, antepartum T4 level was lower and antepartum TSH level was higher.Conclusion: psychosocial factors exerted effects both on gravidas and on fetuses. The changes of antepartum emotion could predict PPD. Social support and intimate medical focus on gravidas and parturiens could prevent the episode of PPD. There existed nerve -endocrine and Immune mediator that influenced the episode of PPD. Personality and living stress and social support were interacted by each other, and these factors were involved in influencing the mental health of gravidas and parturien.更多还原