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目的 系统评价非药物干预对体外受精-胚胎移植(IVF-ET)患者负性情绪及妊娠结局的影响，为选择最佳干预方法提供参考。方法 计算机检索PubMed、Embase、Cochrane Library、Web of Science、CINAHL、中国知网、中国生物医学文献数据库、维普数据库、万方数据库，检索时间为建库至2022年11月，搜集非药物干预对IVF-ET患者负性情绪及妊娠结局影响的随机对照试验。2名研究者对文献筛选、数据提取并进行方法学质量评价后，采用RevMan5.4.1软件和Stata17.0软件分别对不同结局指标进行直接Meta分析和网状Meta分析。结果 共纳入45项研究，涉及8种非药物干预方法，总样本量为5 641例。Meta分析结果显示：与常规护理相比，认知行为疗法、正念疗法、耳穴贴压、聚焦解决模式、曼陀罗彩绘疗法、音乐疗法可降低IVF-ET患者焦虑水平(P<0.05);认知行为疗法、正念疗法、曼陀罗彩绘疗法、音乐疗法可降低IVF-ET患者抑郁水平(P<0.05);认知行为疗法、耳穴贴压、音乐疗法、经皮穴位电刺激可提高IVF-ET患者临床妊娠率(P<0.05)。SUCRA概率排序结果显示：正念疗法改善IVF-ET患者负性情绪的效果最佳，认知行为疗法提高IVF-ET患者临床妊娠率的效果最佳。结论 在改善IVF-ET患者负性情绪方面，正念疗法是最佳的非药物干预方法；在提高IVF-ET患者临床妊娠率方面，认知行为疗法最具有优势。仍需开展更多随机对照试验进一步验证上述结论。
Abstract：Objective:To systematically evaluate the efficacy of non-drug interventions on negative emotions and pregnancy outcome in patients undergoing IVF-ET,and to provide a reference for selecting the best interventions.Methods:PubMed, Embase, Cochrane Library, Web of Science, CINAHL,CNKI,CBM,VIP and Wanfang Database were searched from the establishment of the database to November 2022. The randomized controlled trials involved the effects of non-drug interventions on negative emotions and pregnancy outcomes in patients with IVF-ET were retrieved. After literature screening, data extraction, and methodological quality evaluation were conducted by two researchers, and direct meta-analysis and network meta-analysis of different outcome indicators were performed by RevMan 5.4.1 and Stata 17.0 software.Results:A total of 45 studies involving 8 non-drug interventions were included, with a total sample size of 5 641 patients. The results of meta-analysis showed that compared with routine nursing therapy, the cognitive behavioral therapy, mindfulness therapy, auricular point sticking, focused solution model, mandala painting therapy and music therapy could reduce anxiety in patients with IVF-ET(P<0.05). Cognitive behavioral therapy, mindfulness therapy, mandala painting therapy and music therapy could reduce depression in patients with IVF-ET(P<0.05). Cognitive behavioral therapy, auricular point sticking, music therapy, and transcutaneous electrical acupoint stimulation could improve the clinical pregnancy rate of patients with IVF-ET(P<0.05). SUCRA probability ranking results showed that mindfulness therapy had the best effect on improving negative emotions in patients with IVF-ET,and cognitive behavioral therapy had the best effect on improving the clinical pregnancy rate in patients with IVF-ET.Conclusions:Mindfulness therapy is the best non-drug intervention for improving negative emotions in patients with IVF-ET. Cognitive behavioral therapy has the greatest advantage in improving the clinical pregnancy rate in patients with IVF-ET. However, more randomized controlled trials are needed to confirm these conclusions.
[1] Zhou Z,Zheng D,Wu H,et al.Epidemiology of infertility in China:a population-based study[J].BJOG,2018,125:432-441.
[2] Xu H,Ouyang N,Li R,et al.The effects of anxiety and depression on in vitro fertilisation outcomes of infertile Chinese women[J].Psychol Health Med,2017,22:37-43.
[3] 周悦，孙振高，宋景艳.焦虑和抑郁状态对体外受精-胚胎移植结局影响的研究进展[J].浙江大学学报(医学版),2023,52:61-67.
[4] 林悦，廖娟，常亚丽，等.初次体外受精-胚胎移植患者生育生活质量现状及影响因素分析[J].生殖医学杂志，2020,29:764-769.
[5] Frederiksen Y,Farver-Vestergaard I,Skovg?rd NG,et al.Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men:a systematic review and meta-analysis[J/OL].BMJ Open,2015,5:e006592.
[6] Higgins JP,Altman DG,G?tzsche PC,et al.The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials[J].BMJ,2011,343:d5928.
[7] 孙晶.试管婴儿孕产妇应用认知行为疗法配合护理干预的效果[J].医疗装备，2018,31:153-154.
[8] 杨广清，徐丽平，吴方贵，等.认知行为疗法对体外授精-胚胎移植伴睡眠障碍患者睡眠质量改善的作用[J].国际护理学杂志，2014,33:1170-1172.
[9] 杨娟.认知护理干预在IVF-ET患者中的应用效果[J].中国卫生标准管理，2016,7:246-248.
[10] 王苏梅，郑琛琛，谢丽萍.心理干预在体外受精胚胎移植术中的应用[J].黑龙江医药科学，2004,27:24-25.
[11] 曹莹丽，吴春梅，刘丽萍，等.认知行为疗法干预体外受精胚胎移植的效果评价[J].中国药物与临床，2016,16:851-852.
[12] 卢惠燕，冯国梅，赖雁琼.团体认知行为疗法对行试管婴儿助孕女性心理状况的影响[J].健康女性，2021,33:1.
[13] 柯鑫.认知干预在接受体外受精-胚胎移植患者中的应用[J].护理实践与研究，2015,12:68-69.
[14] Gorayeb R,Borsari AC,Rosa-e-Silva AC,et al.Brief cognitive behavioral intervention in groups in a Brazilian assisted reproduction program[J].Behav Med,2012,38:29-35.
[15] Czamanski-Cohen J,Sarid O,Cwikel J,et al.Practice makes perfect:The effect of cognitive behavioral interventions during IVF treatments on women’s perceived stress,plasma cortisol and pregnancy rates[J].J Reprod Health Med,2016,2(suppl 1):S21-S26.
[16] Shu-Hsin L.Effects of using a nursing crisis intervention program on psychosocial responses and coping strategies of infertile women during in vitro fertilization[J].J Nurs Res,2003,11:197-208.
[17] 张耀.健康教育联合正念减压疗法在行体外受精联合胚胎移植妇女护理中的应用效果观察[J].内科，2019,14:242-244.
[18] 叶丽芳.正念减压法在体外受精-胚胎移植患者中的效果研究[J].东方药膳，2020,23:126.
[19] 刘凯，林仙华，李蓉，等.正念减压疗法对试管婴儿患者知觉压力及心理状态的影响[J].现代生物医学进展，2017,17:4668-4671.
[20] 吴小妹，陈佳静，陈淑贤，等.正念减压疗法(MBSR)对试管婴儿患者自我感受负担及知觉压力的影响[J].按摩与康复医学，2020,11:56-58.
[21] 吴彩萍.正念干预对接受体外受精-胚胎移植治疗不孕患者生命质量及心理状态的影响[J].护理实践与研究，2017,14:73-75.
[22] 王丹萍，彭熠华，魏琴华.正念减压疗法对行试管婴儿技术女性生活质量及妊娠结局的影响[J].中外医学研究，2020,18:100-102.
[23] 莫静.正念干预对接受体外受精-胚胎移植治疗不孕患者生命质量及不良情绪的影响[J].世界最新医学信息文摘，2018,18:217,219
[24] 林佳楠，董伟，程萌，等.正念干预对接受体外受精-胚胎移植治疗不孕患者生命质量及心理状态的影响[J].医药界，2019,8:110-111.
[25] Kalhori F,Masoumi SZ,Shamsaei F,et al.Effect of mindfulness-based group counseling on depression in infertile women:Randomized Clinical Trial Study[J].Int J Fertil Steril,2020,14:10-16.
[26] Panagopoulou E,Montgomery A,Tarlatzis B.Experimental emotional disclosure in women undergoing infertility treatment:are drop outs better off?[J].Soc Sci Med,2009,69:678-681.
[27] 唐晖，赵雪燕，徐健荧，等.耳穴压豆疗法对体外受精-胚胎移植患者焦虑抑郁情绪及手术结局的影响[J].山西中医，2022,38:43-44.
[28] 马春梅.耳穴贴压对体外受精-胚胎移植患者心理压力和妊娠结局的影响研究[D].杭州：浙江大学，2018.
[29] 邓超，马冉，王月燊，等.耳穴贴压辅助治疗体外受精-胚胎移植反复移植失败临床观察[J].时珍国医国药，2021,32:126-128.
[30] Qu F,Zhang D,Chen LT,et al.Auricular acupressure reduces anxiety levels and improves outcomes of in vitro fertilization:a prospective,randomized and controlled study[J].Sci Rep,2014,4:5028.
[31] 田晓.耳穴疗法与焦虑患者IVF-ET疗效的相关性研究[D].济南：山东中医药大学，2021.
[32] 范楷.耳穴贴压镇痛在IVF-ET经阴道超声穿刺取卵术中的应用[D].济南：山东中医药大学，2016.
[33] 徐丽，沈亚，褚蓓，等.基于医护合作聚焦解决模式调节初次IVF-ET患者自我效能及焦虑抑郁水平的应用分析[J].南通大学学报(医学版),2020,40:350-353.
[34] 孙利洁，范莉莉，阮颖超.聚焦解决模式对改善不孕症患者负性情绪的效果评价[J].现代实用医学，2019,31:1539-1540.
[35] 廖娟，高明霞，赵晴，等.曼陀罗彩绘疗法对体外受精-胚胎移植患者焦虑、抑郁情绪干预效果的研究[J].解放军护理杂志，2022,39:30-33.
[36] Aba YA,Avci D,Guzel Y,et al.Effect of music therapy on the anxiety levels and pregnancy rate of women undergoing in vitro fertilization-embryo transfer:a randomized controlled trial[J].Appl Nurs Res,2017,36:19-24.
[37] Moragianni VA,Hopkins J,Somkuti SG,et al.Randomized trial of harp music therapy in IVF-ET[J].Fertil Steril,2009,92(suppl 3):S147-S148.
[38] Murphy EM,Nichols J,Somkuti SG,et al.Randomized trial of harp therapy during in vitro fertilization-embryo transfer[J].J Evid Based Complementary Altern Med,2014,19:93-98.
[39] Stocker L,Hardingham K,Ying C.A randomized controlled trial assessing whether listening to music at time of embryo transfer effects anxiety levels[J].Gynecol Obstet,2016,6:1-7.
[40] 张红梅，薛志红，张建华，等.音乐疗法在体外受精胚胎移植中的应用[J].护理研究，2014,28:1380-1381.
[41] 曹文静，许淑艳，李晓玲.音乐干预在不孕妇女促排卵治疗中的应用[J].国际护理学杂志，2016,35:1351-1353.
[42] 李桂英，张玉莹.音乐治疗辅助心理护理对体外受精-胚胎移植妊娠结局的影响[J].国际护理学杂志，2019,38:3128-3131.
[43] 董英辉，李慧，董英新，等.音乐治疗对多囊卵巢综合征(PCOS)患者IVF-ET助孕结局的影响[J].中国性科学，2018,27:142-145.
[44] 许晓立，李慧，戴芳芳，等.中医五行音乐治疗对试管婴儿妊娠结局的影响[J].中国性科学，2017,26:113-115.
[45] 帅振虹，杨卓欣.经皮穴位电刺激对高龄IVF-ET患者卵巢颗粒细胞凋亡及妊娠结局的影响[J].中国现代药物应用，2019,13:142-143.
[46] 帅振虹，李雪梅，李天凤，等.经皮穴位电刺激对IVF中POI患者卵巢功能影响的临床观察[J].中国优生与遗传杂志，2019,27:888-890.
[47] 董光苹，王晶，周娟，等.经皮穴位电刺激序贯疗法对行体外受精-胚胎移植不孕患者影响的临床研究[J].上海中医药杂志，2018,52:54-57.
[48] 杜文静.基于母胎免疫探讨经皮穴位电刺激对反复种植失败患者妊娠结局的影响[D].济南：山东中医药大学，2020.
[49] Qu F,Wang FF,Wu Y,et al.Transcutaneous electrical acupoint stimulation improves the outcomes of in vitro fertilization:a prospective,randomized and controlled study[J].Explore(NY),2017,13:306-312.
[50] Zheng Y,Feng X,Mi H,et al.Effects of transcutaneous electrical acupoint stimulation on ovarian reserve of patients with diminished ovarian reserve in in vitro fertilization and embryo transfer cycles[J].J Obstet Gynaecol Res,2015,41:1905-1911.
[51] Feng X,Zhu N,Yang S,et al.Transcutaneous electrical acupoint stimulation improves endometrial receptivity resulting in improved IVF-ET pregnancy outcomes in older women:a multicenter,randomized,controlled clinical trial[J].Reprod Biol Endocrinol,2022,20:127.
[52] Wang X,Wang Y.The Effectiveness of mindfulness-based intervention on emotional states of women undergoing fertility treatment:a Meta-analysis[J].J Sex Marital Ther,2023,49:249-258.
[53] Parikh SV,Quilty LC,Ravitz P,et al.Canadian Network for Mood and Anxiety Treatments(CANMAT) 2016 clinical guidelines for the management of adults with major depressive disorder:Section 2.Psychological treatments[J].Can J Psychiatry,2016,61:524-539.
[54] Zou T,Wu C,Fan X.The Clinical value,principle,and basic practical technique of mindfulness intervention[J].Shanghai Arch Psychiatry,2016,28:121-130.
[55] Gotink RA,Vernooij MW,Ikram MA,et al.Meditation and yoga practice are associated with smaller right amygdala volume:the Rotterdam study[J].Brain Imaging Behav,2018,12:1631-1639.
[56] Otte C.Cognitive behavioral therapy in anxiety disorders:current state of the evidence[J].Dialogues Clin Neurosci,2011,13:413-421.
[57] 常亚丽，高明霞，林悦，等.认知行为疗法对体外受精-胚胎移植患者焦虑抑郁及妊娠结局影响的Meta分析[J].护士进修杂志，2020,35:696-700.
[58] Li YQ,Shi Y,Xu C,et al.Cognitive behavioural therapy improves pregnancy outcomes of in vitro fertilization-embryo transfer treatment:a systematic review and meta-analysis[J].J Int Med Res,2021,49:3000605211050798.
[59] 林慧，蔡柳洪，邢卫杰，等.认知行为疗法对肥胖型多囊卵巢综合征不孕妇女心理状态和辅助生殖结局的影响[J].中华生殖与避孕杂志，2018,38:860-863.
基本信息:
中图分类号:R473.71
引用信息:
[1]杨卓群,刘琳,王笑艳,等.非药物干预对体外受精-胚胎移植患者负性情绪及妊娠结局影响的网状Meta分析[J].生殖医学杂志,2023,32(10):1522-1533.
基金信息:
兰州市人才创新创业项目(2022-RC-47); 兰州大学医学科研创新能力提升项目(lzuyxcx-2022-191)
2023-03-28
2023
2023-09-08
2023
2023-04-30
1
2023-10-15
2023-10-15