The impact of integrated preventive nursing interventions based on causal analysis on pregnancy outcomes and postpartum efficacy in patients with severe preeclampsia
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摘要:
目的 重度子痫前期(PE)是妊娠合并高血压疾病分度中较为严重的一类，对孕妇和婴儿都有极大的威胁。本研究对重度PE患者采用基于因果分析的预防护理集成干预方案，旨在探讨该干预方案是否能减少不良妊娠结局，改善产后自我效能。 方法 选取湖州市妇幼保健院收治的80例重度PE患者作为研究对象，其中2021年1月—2022年5月收治的40例患者为对照组，给予常规护理；2022年6月—2023年4月收治的40例患者为观察组，在对照组的基础上给予基于因果分析的预防护理集成干预。对比2组患者心理状态[焦虑自评量表(SAS)、抑郁自评量表(SDS)]、不良妊娠结局(产后出血、羊水异常、胎膜早破)发生情况及产后自我效能感。 结果 干预后，观察组患者SAS及SDS评分均低于对照组[(31.13±4.15)分、(24.40±4.40)分vs.(35.60±4.07)分、(28.28±4.42)分]，差异有统计学意义(P < 0.05)；观察组妊娠不良结局总发生率[10.00%(4/40)]低于对照组[22.50%(9/40)]，但2组比较差异无统计学意义(P>0.05)；观察组产后自我效能感优于对照组，差异有统计学意义(P < 0.05)。 结论 对重度PE患者采用基于因果分析的预防护理集成干预方案可有效改善患者的心理状态，提高产后自我效能，且具有减少不良妊娠结局的趋势。 Abstract:Objective Severe preeclampsia (PE) is one of the more severe types of gestational hypertension, posing a great threat to both pregnant women and infants. This study attempts to use a causal analysis-based integrated intervention for prevention and care in patients with severe PE, aiming to explore whether this intervention program can reduce adverse pregnancy outcomes and improve postpartum self-efficacy. Methods Eighty patients with severe PE admitted to the Maternity and Child Health Hospital of Huzhou were prospectively selected as the research subjects. Among them, 40 patients admitted from January 2021 to May 2022 were included in the control group and received routine nursing care. Another 40 patients admitted from June 2022 to April 2023 were assigned to the observation group, which received an integrated intervention of preventive nursing based on causal analysis in addition to the routine nursing provided to the control group. The mental state (self-rating anxiety scale, SAS, and self-rating depression scale, SDS), occurrence of adverse pregnancy outcomes (postpartum hemorrhage, abnormal amniotic fluid, and premature rupture of membranes), and postpartum self-efficacy were compared between the two groups. Results Following the intervention, the observation group exhibited lower SAS and SDS scores compared to the control group [(31.13±4.15) points, (24.40±4.40) points vs. (35.60±4.07) points, (28.28±4.42) points], with the differences being statistically significant (P < 0.05); The observation group had a lower total incidence of adverse pregnancy outcomes at 10.00% (4/40) compared to the control group at 22.50% (9/40), though this difference was not statistically significant (P>0.05); The postpartum self-efficacy in the observation group was superior to that in the control group, the difference being statistically significant (P < 0.05). Conclusion For patients with severe PE, an intervention plan based on causal analysis in integrated preventive nursing can effectively enhance their psychological well-being, boost postpartum self-efficacy, and show a trend in reducing adverse pregnancy outcomes. -
Key words:
- Eclampsia /
- Gestation /
- Causal analysis /
- Preventive care /
- Integrated intervention
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表 1 2组重度PE患者一般资料比较
Table 1. Comparison of general information between two groups of severe PE patients
组别 例数 年龄(x±s，岁) 孕周(x±s，周) 产妇类型[例(%)] 受教育程度[例(%)] 血压(x±s，mmHg) 经产妇 初产妇 初中 高中 大学 舒张压 收缩压 观察组 40 27.11±2.58 31.78±1.11 21(52.50) 19(47.50) 9(22.50) 16(40.00) 15(37.50) 120.44±10.27 176.71±16.08 对照组 40 26.89±2.48 31.62±1.36 22(55.00) 18(45.00) 7(17.50) 19(47.50) 14(35.00) 120.14±9.67 178.15±17.66 统计量 0.435a 0.643a 0.050b 0.099c 0.135a 0.381a P值 0.665 0.552 0.823 0.922 0.893 0.704 注：1 mmHg=0.133 kPa。a为t值，b为χ2值，c为Z值。 
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表 2 2组重度PE患者干预前后心理状态比较(x±s, 分)
Table 2. Comparison of psychological status between two groups of severe PE patients before and after intervention (x±s, points)
组别 例数 SAS SDS 干预前 干预后 干预前 干预后 观察组 40 51.15±6.27 31.13±4.15b 48.65±5.51 24.40±4.40b 对照组 40 50.33±5.24 35.60±4.07b 48.85±5.72 28.28±4.42b 统计量 0.639a 22.639c 0.159a 15.150c P值 0.525 < 0.001 0.874 0.001 注：a为t值，c为F值；与同组干预前比较，bP < 0.05。
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表 3 2组重度PE患者妊娠不良结局比较[例(%)]
Table 3. Comparison of adverse pregnancy outcomes between two groups of severe PE patients [cases(%)]
组别 例数 产后出血 羊水异常 胎膜早破 总发生 观察组 40 2(5.00) 1(2.50) 1(2.50) 4(10.00) 对照组 40 4(10.00) 3(7.50) 2(5.00) 9(22.50) 注：2组妊娠不良结局总发生率比较，χ2=2.296，P=0.130。
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表 4 2组重度PE患者产后自我效能比较[例(%)]
Table 4. Comparison of postpartum self efficacy between two groups of severe PE patients [cases(%)]
组别 例数 非常高 较高 较低 非常低 观察组 40 16(40.00) 11(27.50) 10(25.00) 3(7.50) 对照组 40 10(25.00) 7(17.50) 11(27.50) 12(30.00) 注：2组产后自我效能比较，Z=1.798，P=0.003。
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