| 摘要: | 背景：不孕婦女於求子過程中生理及心理承受多重壓力，焦慮是不孕婦女常見的情緒困擾。然而，目前對於不孕族群之縱貫性情緒及生理變化仍有待探討。
目的：探討不孕婦女於接受人工生殖輔助治療過程中，其焦慮症狀與心率變異變化軌跡，以及預測因子與懷孕結果之關聯。
方法：本研究採前瞻性世代研究，研究對象為北部某教學醫院生殖中心的122位不孕婦女，資料收集時間為2018年11月至2019年6月。研究工具包括基本屬性資料表、中文版情境焦慮量表、中文版憂鬱量表、臺灣版五因素正念量表及生育生活品質量表。採多點時間資料收集，分別於決定接受人工生殖輔助治療的基線測量、濾泡期、植入日、與驗孕日。統計分析包括描述性統計、及軌跡分析、邏輯斯迴歸、與存活分析等推論性統計。
結果：研究對象平均年齡為37歲 (標準差=4)，多數大學畢業 (n=76, 62%)。不孕治療期間，不孕婦女的焦慮變化呈現二組變化軌跡，分別為高度焦慮變化組 (61%)與低度焦慮變化組 (39%)。焦慮變化軌跡的顯著預測因素包括家庭年收入 (Odds Ratio, OR=0.3, 95% Confidence interval, CI:0.1-0.8)、正念程度 (OR= 0.2, 95% CI:0.1-0.6)、自覺睡眠品質 (OR=0.3, 95% CI:0.1-0.8)以及LF/HF ratio (OR=2.4, 95% CI:1.2-4.5)等因素影響。不孕婦女的LF%變化呈現二組變化軌跡，分別為高程度LF%變化組 (55%)與低程度LF%變化組 (45%)。不孕婦女的HF%變化呈現二組變化軌跡，分別為高程度HF%變化組 (41%)與低程度HF%變化組 (59%)。規律運動習慣顯著預測LF%變化軌跡 (OR=0.3, 95% CI:0.1-0.9)與HF%變化軌跡 (OR=2.7, 95% CI:0.8-8.7)。調整焦慮與心率變異之影響後，大於38歲的婦女發生懷孕事件的機會較低 (aHR=0.3, 95% CI:0.1-0.7)。
結論：多數婦女於不孕治療期間具有高度焦慮變化、高度LF%變化及
低度HF%變化軌跡。焦慮症狀變化軌跡與心率變異性具顯著關聯，可提供不孕婦女臨床照護之參考。
Background: Infertility women often experience physical and psychological stress during infertility treatment journey. Anxiety is one of the common emotional disturbance. The changes in anxiety symptoms and heart rate variability one time remain unclear in infertility women.
Aim: To investigate the trajectories of anxiety symptoms and HRV changes overtime and its impact on pregnancy.
Methods: A prospective cohort study was conducted in this study. A sample of 122 women in a fertility clinic in the north teaching hospital was recruited. The period of data collection was from November 2018 to June 2019. The structured questionnaires and HRV tools were used. The questionnaires included baseline characteristics and the Chinese version of State-Trait Anxiety Inventory State Anxiety, the Chinese version of the Beck Depression Inventory, the Taiwanese version of the Five-Factor Mindfulness Scale, and the Fertility Quality of Life Questionnaire was used. The data was collected at multiple times which are at the baseline measurement when the decision was made to receive reproductive treatment, follicular phase, on the day of implantation and pregnancy. Data analysis includes descriptive statistics, independent-sample t test, trajectory analysis, logistic regression and survival analysis.
Results: The average age of the infertility women was 37 (SD=4), most of them were college educated (n=76, 62%). Two distinctive classes of anxiety symptoms trajectory were identified, included class with high anxiety (61%) and class with low anxiety (39%). The significant predictors of the trajectory of anxiety symptoms were household income (Odds Ratio, OR=0.3, 95% Confidence interval, CI:0.1-0.8), quality of sleep (OR=0.3, 95% CI:0.1-0.8), mindfulness (OR=0.2, 95% CI:0.1-0.6), and LF/HF ratio (OR=2.4, 95% CI:1.2-4.5). Two trajectories of changes in LF% of the infertility women were identified: the group with high level of LF% (55%) and the group with low level of LF% (45%). Two trajectories of changes in HF% of the infertility women were identified: the group with high level of HF% (41%) and those with low level of HF% (59%). Regular exercise significantly predicted the trajectories of changes in LF% (OR=0.3, 95% CI:0.1-0.9) and HF% (OR=2.7, 95% CI:0.8-8.7). After adjusting for the influences of anxiety symptoms and HRV, the women over 38 years old had lower odds of pregnancy (aHR:0.3, 95% CI:0.1-0.7).
Conclusion: Most of infertility women experienced high level of changes in anxiety symptoms, high level of changes in LF and low level of changes in HF. The trajectory of changes in anxiety symptoms and the HRV were significantly related. This result suggests that a fine coordination of physical and psychological nursing is worth to be emphasized in clinical treatment for infertility women. |
