剖宫产术后母婴同室产妇睡眠质量影响因素分析及干预研究

发布时间：2018-03-23 08:44

本文选题：剖宫产　切入点：母婴同室　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的调查剖宫产术后母婴同室产妇(以下简称产妇)睡眠质量情况,分析其影响因素,探讨综合护理干预对产妇睡眠质量、心理状况及乳汁分泌的效果,为今后临床护理人员借助通讯平台开展针对性的健康教育提供新思路。方法运用质性研究,对13名产妇进行面对面、半结构式的深入访谈,用Colaizzi分析法分析资料,了解产妇的睡眠质量情况。采用自制睡眠质量影响因素调查问卷、匹兹堡睡眠质量指数量表(PSQI)、爱丁堡产后抑郁量表(EPDS)和焦虑自评量表(SAS)对160名产妇进行调查,分析产妇睡眠质量的影响因素。抽取92名产妇随机分成对照组和试验组,每组46例,对照组接受常规护理,试验组在常规护理基础上实施综合护理干预,比较干预前后两组产妇的睡眠情况、焦虑抑郁状况及乳汁分泌始动时间、乳汁分泌量和乳房胀痛发生率。结果1.提炼出5个主题:术后不适症状使产妇入睡困难、睡眠觉醒次数频繁使产妇连续性睡眠时间减少、长时间卧床使产妇睡眠效率降低、病房环境不适应使产妇睡眠维持困难、相关支持缺乏使产妇心理压力增加。2.(1)产妇PSQI评分为(9.84±2.62)分,其中125例(78.1%)产妇存在睡眠质量问题。(2)单因素分析结果显示,EPDS评分、SAS评分、乳房胀痛、夜间母乳喂养、夜间婴儿哭闹、切口或宫缩痛、产后褥汗、病房噪音、夜间护理操作或巡房及担心不能适应母亲角色10个方面差异均有统计学意义(P0.05)。(3)多因素分析结果显示,夜间母乳喂养、切口或宫缩痛、乳房胀痛、产后褥汗及担心不能适应母亲角色是影响产妇睡眠质量的危险因素。3.综合护理干预后,试验组产妇睡眠质量、睡眠时间、睡眠效率、日间功能及PSQI评分均低于对照组,且低于干预前(P0.05);试验组产妇EPDS、SAS评分均低于对照组,且低于干预前(P0.05);试验组产妇乳汁分泌始动时间较对照组提前,两组产妇不同时间段(24h、24~48h、48~72h)乳汁分泌例数、乳汁分泌量和乳房肿胀情况比较,差异均有统计学意义(P0.05)。结论1.剖宫产术后母婴同室产妇普遍存在睡眠质量问题。2.夜间母乳喂养、切口/宫缩痛、乳房胀痛、产后褥汗及担心不能适应母亲角色是影响剖宫产术后母婴同室产妇睡眠质量的危险因素。3.综合护理干预能有效改善剖宫产术后母婴同室产妇的睡眠质量,缓解产后焦虑、抑郁情绪,提前乳汁分泌始动时间,促进乳汁分泌,减少乳房胀痛发生率,有利于母婴身心健康,值得临床推广应用。
[Abstract]:Objective to investigate the sleep quality of parturient (hereinafter referred to as parturient) after cesarean section, analyze its influencing factors, and discuss the effect of comprehensive nursing intervention on the quality of sleep, psychological condition and milk secretion of parturient. Methods using qualitative research, 13 pregnant women were interviewed face to face and semi-structured, and the data were analyzed by Colaizzi analysis. To understand the sleep quality of puerpera, 160 puerperas were investigated by self-made questionnaire of influencing factors of sleep quality, PSQI of Pittsburgh Sleep quality Index, EPDS of Edinburgh postpartum Depression scale and SASs of Self-Rating anxiety scale. 92 parturient women were randomly divided into control group and experimental group with 46 cases in each group. The control group received routine nursing, and the experimental group carried out comprehensive nursing intervention on the basis of routine nursing. The sleep, anxiety and depression, the onset time of milk secretion, the amount of milk secretion and the incidence of breast distending pain were compared between the two groups before and after intervention. The frequency of sleep awakening frequently reduced the continuous sleep time of the parturient, prolonged stay in bed reduced the sleep efficiency of the parturient, and the inadaptability of the ward environment made it difficult for the parturient to maintain sleep. The PSQI score of parturient was 9.84 卤2.62), in which 125 cases (78.1) had sleep quality problem. The results of univariate analysis showed that EPDs score, breast distention, breast pain, breast feeding at night and crying at night. There were significant differences in incision or uterine contraction pain, puerperal perspiration, room noise, nocturnal nursing operation or visiting room, and fear of not adapting to the mother's role. Multivariate analysis showed that breast feeding at night, incision or uterine contraction pain. Breast pain, puerperal perspiration and worry about not adapting to the role of mother are the risk factors that affect the quality of maternal sleep. 3. After comprehensive nursing intervention, the quality of sleep, sleep time, sleep efficiency of the trial group, The scores of daytime function and PSQI were lower than those of the control group, and lower than those of the control group (P 0.05), the scores of the test group were lower than those of the control group (P 0.05), and the onset time of milk secretion in the trial group was earlier than that in the control group. The number of cases of milk secretion, the quantity of milk secretion and the condition of breast swelling were significantly different between the two groups at different time periods (P 0.05). Conclusion 1.Sleep quality problems are common in mothers and women in the same room after cesarean section. Incision / contractive pain, breast pain, Postpartum perspiration and fear of not adapting to the mother's role are the risk factors affecting the sleep quality of the mother and child after cesarean section. 3. Comprehensive nursing intervention can effectively improve the sleep quality of the mother and child after cesarean section, and relieve the postpartum anxiety. Depression, early onset time of milk secretion, promoting milk secretion, reducing the incidence of breast distention, is beneficial to the physical and mental health of mother and child, and is worthy of clinical application.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.71

【相似文献】