跨专业共享决策在双胎妊娠孕妇中的应用研究

王凤英; 章翀; 尹宗智; 江楠; 钱悦; 赵保静; 司方圆

doi:10.16766/j.cnki.issn.1674-4152.003866

跨专业共享决策在双胎妊娠孕妇中的应用研究

doi: 10.16766/j.cnki.issn.1674-4152.003866

安徽医科大学第一附属医院产科二病区, 安徽合肥 230022

基金项目:

国家重点研发计划“生育健康及妇女儿童健康保障”重点专项 2023YFC2705904

安徽医科大学校科研基金立项资助项目 2021xkj281

详细信息

通讯作者:
章翀，E-mail: 18516225145@163.com

中图分类号: R714.23
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- 文章访问数: 7
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- 被引次数: 0
出版历程
- 收稿日期: 2024-05-31
- 网络出版日期: 2025-03-27

Application of interprofessional shared decision-making model for twin pregnancy

The Second Ward of Obstetrics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China

摘要

摘要: 目的探讨双胎孕妇参与跨专业共享决策方案的应用效果, 为促进孕产妇参与共享决策提供参考。方法选取2022年3—9月在安徽医科大学第一附属医院产科门诊孕检的108例双胎妊娠孕妇作为研究对象, 追踪至入院分娩。将孕妇按产检时间分为对照组与观察组, 各54例, 对照组采用常规干预方法实施指导, 观察组在对照组的基础上参与跨专业共享决策方案。比较分析2组围产儿的不良结局、临床决策参与程度、医疗决策参与满意度与医院焦虑抑郁情绪。结果干预后, 2组胎儿的双胎生长不一致、低出生体重儿和低血糖发生率比较, 差异有统计学意义(P < 0. 05)。对照组医患共同决策问卷患者版得分为(25. 24±4. 18)分, 观察组为(40. 50± 6. 25)分, 差异有统计学意义(P < 0. 001)。观察组医疗决策参与满意度得分为(68. 17 ± 9. 50) 分, 对照组为(45. 83±11. 38)分, 差异有统计学意义(P < 0. 001)。观察组医院焦虑抑郁得分为[3. 00(2. 00, 4. 00)分], 对照组为[7. 00(6. 00, 8. 00)分], 差异有统计学意义(P < 0. 001)。结论双胎孕妇在参与跨专业共享决策后, 可以改善围产儿不良结局, 提高临床决策参与程度、提升医疗决策参与满意度, 降低产后焦虑和抑郁情绪。
- 双胎妊娠 /
- 跨专业共享决策 /
- 决策参与 /
- 满意度 /
- 焦虑抑郁
Abstract: Objective To explore the effectiveness of interprofessional shared decision-making model for pregnant women with twins and to provide reference for promoting shared decision-making in clinical practice. Methods A total of 108 cases of pregnant women with twins in the Second Ward of Obstetrics, the First Affiliated Hospital of Anhui Medical University were selected as research objects and divided into a control group and an observation group randomly, with 54 cases in each group. The control group was guided by conventional intervention methods during pregnancy, while the observation group participated in the interprofessional shared decision-making model in addition to the standard care. The adverse outcomes of perinatal infants, level of participation in clinical decision-making, satisfaction with medical decisionmaking, and hospital anxiety and depression were compared between the two groups. Results After the intervention, the incidence of inconsistent twin growth, low birth weight, and hypoglycemia showed significant differences between the two groups (P < 0. 05). The SDM-Q-9 scores were significantly higher in the observation group (40. 50±6. 25) than in the group (25. 24±4. 18, P < 0. 001). The satisfaction score of medical decision-making participation in the observation group was also significantly higher, with a score of 68. 17±9. 50 compared to 45. 83±11. 38 in the control group (P < 0. 001). The hospital anxiety and depression scores were significantly lower in the observation group [3. 00(2. 00, 4. 00)] compared to the control group [7. 00(6. 00, 8. 00), P < 0. 001]. Conclusion Participation in the interprofessional shared decision-making model can improve perinatal adverse outcomes, increase participation in clinical decision-making and satisfaction in medical decisions, and reduce anxiety and depression in pregnant women.
- Twin pregnancy /
- Interprofessional shared decision-making model /
- Decision-making participation /
- Satisfaction /
- Anxiety and depression

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表 1 2组双胎孕妇一般资料比较

Table 1. Comparison of general data of pregnant women with twins in 2 groups

项目	对照组	观察组	统计量	P值
年龄(x±s, 岁)	31.00±4.84	31.28±3.57	-0.697^a	0.486
产次[M(P₂₅, P₇₅), 次]	1(0, 1)	0(0, 1)	-1.240^b	0.215
孕次[M(P₂₅, P₇₅), 次]	2(1, 3)	2(1, 3)	-0.216^b	0.829
住院时间[M(P₂₅, P₇₅), d]	6(5, 9)	6(5, 11)	-0.006^b	0.995
文化程度(例)			1.968^b	0.374
高中及中专	5	3
大专	20	15
本科及以上	29	36
工作状态(例)			0.354^c	0.552
在职	32	35
待业	22	19
人均年收入(例)			0.995^b	0.608
5万元~10万元	8	10
>10万元~20万元	22	25
20万元以上	24	19
注：^a为t值，^b为Z值，^c为χ²值。

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表 2 跨专业共享决策方案实施步骤

Table 2. Implementation steps of interprofessional shared decision-making model

决策阶段	决策主题	具体内容
启动	评估	1.评估孕妇生理、对产检结果了解程度
		2.评估影响自我决策的不利因素
		3.评估孕妇保健知识水平、价值观等
	发起决策	4.帮助孕妇意识到现存问题或风险及存在的医疗选择，鼓励其发起决策
辅导	信息支持	5.开展孕产期宣教，采取文字、图谱、视频、手册等形式，实施个体化围产保健
	价值偏好	6.开展决策对话，明确保健偏好和价值观、对分娩效果的合理期望
	分析利弊	7.利用风险沟通原则及双胎分娩风险来比较分娩时机、方式等利弊
制定	保健、分娩方案	8.形成双方一致认可的保健方案和初步分娩计划，签署知情同意书
	医疗环境	9.建立营养门诊
		10.开辟绿色通道
实施	物品设备	11.营养门诊配备人体成分分析仪等仪器
	人力资源	12.多学科医疗专业人员构成合理、共同参加决策辅助相关培训
	实际保健、分娩方案	13.根据孕妇意愿，实施线上与线下相结合的孕妇学校课程
		14.提供可参考的决策方案，走出决策困境
		15.持续提供心理疏导
		16.动态调整决策，及时反馈体验
核查	孕期保健、分娩结局效果评估	17.动态评估选择方案效果并记录
		18.围产儿结局
评价	决策满意度	19.评价IP-SDM有效性和医疗服务满意度
	决策参与度	20.评价孕妇参与度
	医院焦虑抑郁程度	21.评价产后负面情绪

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表 3 2组双胎孕妇产后围生儿并发症发生率比较[例(%)]

Table 3. Comparison of the incidence of perinatal complications between two groups of twin pregnant women after delivery[cases (%)]

组别	例数	双胎生长发育不一致	低出生体重儿	低血糖	出生缺陷
观察组	54	6(11.11)	6(11.11)	5(9.26)	1(1.85)
对照组	54	14(25.93)	15(27.78)	17(31.48)	3(5.56)
χ²值		3.927	4.788	8.220	0.260
P值		0.048	0.029	0.004	0.610

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表 4 2组双胎孕妇产后临床决策参与程度与医疗决策参与满意度比较(x±s, 分)

Table 4. Comparison of the degree of clinical decision-making participation and satisfaction with medical decision-making participation between two groups of twin pregnant women after delivery(x±s, points)

组别	例数	医患共同决策问卷得分	医疗决策参与满意度量表得分
观察组	54	40.50±6.25	68.17±9.50
对照组	54	25.24±4.18	45.83±11.38
t值		14.926	11.069
P值		＜0.001	＜0.001

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表 5 2组双胎孕妇产后医院焦虑抑郁量表得分比较[M(P₂₅, P₇₅), 分]

Table 5. Comparison of hospital anxiety and depression scale scores between two groups of twin pregnant women after delivery[M(P₂₅, P₇₅), points]

组别	例数	总分	抑郁得分	焦虑得分
观察组	54	3.00(2.00, 4.00)	1.00(0.75, 2.00)	2.00(1.00, 2.00)
对照组	54	7.00(6.00, 8.00)	3.00(3.00, 4.00)	4.00(3.00, 5.00)
Z值		-8.244	-7.906	-7.707
P值		＜0.001	＜0.001	＜0.001

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