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目的在心理应激框架下,研究IVF治疗过程中患者诸心理因素的变化情况,并探索这些心理因素对IVF治疗结果的影响作用。方法纳入接受IVF治疗的患者324例为被试,分别于周期第2日、取卵前当日晨、移植前当日晨和孕检前4个时点进行PSS、STAI、SDS和MCMQ问卷测量。分析其压力感知、情绪状况、应对方式变化情况及与IVF治疗结果的关系。结果患者基线水平的状态-特质焦虑分数与常模相比均无显著性差异。PSS分数和抑郁分数分别为25.26±4.944和44.41±9.812,均显著高于常模(P<0.05)。患者的医学应对方式3个分量表得分均高于常模(P>0.01)。IVF治疗过程中的不同时点间状态焦虑(F=21.688,P<0.01)及抑郁水平(F=4.938,P<0.01)差异显著,两者总体均呈上升趋势。将心理因素及患者一般情况数据对IVF治疗结果进行Logistic回归,“回避”及“屈服”及“年龄”进入方程。其标准回归系数OR分别为1.124、0.903和0.944,其中“回避”为保护性因素,而“屈服”及年龄为危险因素,3因素的P<0.05。结论刚进入周期的IVF患者已存在一定的抑郁情绪,且其焦虑和抑郁水平在治疗过程中还会逐步升高。采取“回避”应对方式的患者似乎更有可能成功妊娠。研究结果说明对IVF患者进行心理干预有其必要性,并提示了一种可能的干预方向。
Objective To study the changes of psychological factors in patients with IVF during the psychological stress frame and explore the influence of these psychological factors on the outcome of IVF. Methods A total of 324 patients with IVF were enrolled in the study. PSS, STAI, SDS and MCMQ were measured on the 2nd day of the cycle, the day before ovulation, the day before transplantation and the 4 points before the pregnancy. Analysis of the pressure perception, emotional status, changes in coping style and IVF treatment outcome. Results There was no significant difference in the baseline state-trait anxiety score between patients and the norm. PSS score and depression score were 25.26 ± 4.944 and 44.41 ± 9.812, respectively, which were significantly higher than those of the normotensive group (P <0.05). Patients’ medical coping style scores were higher than the three subscales (P> 0.01). There were significant differences in state anxiety (F = 21.688, P <0.01) and depression (F = 4.938, P <0.01) between the different time points in IVF treatment, both of which showed an overall upward trend. Logistic regression, “avoidance”, “yield”, and “age” were used to enter the equation based on psychological factors and general data of patients. The standard regression coefficients OR were 1.124,0.903 and 0.944, respectively. Among them, “avoidance” was the protective factor, and “yield” and age were the risk factors, and the three factors were P <0.05. Conclusions Some patients with IVF who have just entered the cycle have some depression, and their anxiety and depression levels will gradually increase during the treatment. Patients who take the “avoidance” coping seem to be more likely to have successful pregnancies. The findings suggest the need for psychological intervention in patients with IVF and suggest a possible direction of intervention.