卢娜 富宏怡 王琰

[摘要] 目的 探討高龄不孕女性压力反应、压力应对方式与二胎生育压力的关系及压力应对方式的中介效应。 方法 对2016年1月～2017年6月沧州中西医结合医院生殖中心门诊就诊的初诊高龄不孕女性1360例进行问卷式调查，所有患者均为计划二胎的经产妇。使用自制调查问卷对入选患者进行基本资料调查，应用压力反应、特质应对问卷以及生育压力量表对入选者进行问卷观察。采取结构方程模型来考察压力反应、压力应对方式与生育压力的关系，以及积极应对压力方式与消极应对压力方式在此类患者生育压力中的中介效应。 结果 压力反应总评分与生育压力评分中各维度及其总评分呈正相关（P < 0.05）；排除“父母角色需要”这一项，积极应对与生育压力各维度的评分及其总评分均呈负相关（P < 0.05）；而消极应对评分与生育压力各维度及其总分则均呈正相关（P < 0.05）。压力反应、积极应对压力与生育压力的结构方程拟合度理想，积极应对在生育压力中的中介效应显著（P < 0.05）。压力反应、消极应对与生育压力的结构方程模型拟合较理想，消极应对在生育压力的中介效应不显著（P > 0.05）。 结论 压力反应、压力应对方式与生育压力具有相关性，高龄不孕女性二胎的生育压力在积极应对与消极应对压力方式中会产生不同的影响，且积极应对生育压力的中介效应显著。

[关键词] 二胎；压力反应；压力应对方式；生育压力

[中图分类号] R395.5 [文献标识码] A [文章编号] 1673-7210（2018）05（b）-0062-05

Mediating effect on infertility-related stress and coping strategies in infertile women of advanced reproductive age already have one child

LU Na FU Hongyi WANG Yan

Department of Reproductive Medicine， Cangzhou Hospital of Integrated TCM-WM， our hospital Hebei Province， Cangzhou 061001， China

[Abstract] Objective To explore the mediating effects of coping strategies in the relationship between stress reaction， coping strategies and infertility with infertility-related stress in infertile women of advanced reproductive age already have one child. Methods The study was conducted in 1360 women of advanced reproductive age who were planned second child， initially diagnosed with infertility in Reproductive Medical Center of Cangzhou Hospital of Integrated TCM-WM from January 2016 to June 2017. Self-made questionnaires was used for selected patients basic information survey. Stress reaction questionnaire， coping strategies questionnaire and fertility problem inventory were used to analyze the relationship between stress reaction， coping strategies and infertility-related stress， and the mediating effects of positive and negative coping strategies on infertility-related stress in infertile women of advanced reproductive age. Results There was a positive correlation between stress reaction questionnaire score and all dimensions of the infertility - related stress score and its total score （P < 0.05）. In addition to the need for parenthood， the score of positive coping strategies was negatively correlated with the score of the infertility-related stress score and its total score （P < 0.05）. The score of negative coping strategies was positively correlated with the score of the infertility-related stress score and its total score （P < 0.05）. The structural equation of stress response， positively related with pressure and fertility pressure was ideal， and the mediating effect of positive coping strategies on infertility - related stress was significant （P < 0.05）. The structural equation of stress response， negative response to pressure and fertility pressure was relatively ideal， but the mediating effect of positive coping strategies on infertility - related stress was not significant （P > 0.05）. Conclusion The effect of stress response on positive response to pressure and negative response to pressure can affect the infertile women of advanced reproductive age already have one child. The mediating effect of positive coping strategies is significant.

[Key words] Second child； Stress reaction； Coping strategies infertiliy-related stress； Infertiliy-related stress

受工作生活压力、药物滥用、食品安全、环境污染等因素的影响，不孕症患者呈逐年增加的趋势，且高龄育龄女性的卵巢功能减退、染色体非整倍体畸形和退化增加，同时流产率及孕育子代的染色体异常率则增加[1-2]。而随着我国“全面二孩政策”的全国开展，“高龄追生”现象日益增多，高龄女性对生育要求不断增加，高龄不孕已然成为我国重要的卫生医疗问题[3]。……