国际生殖健康/计划生育杂志

国际生殖健康/计划生育杂志 ›› 2025, Vol. 44 ›› Issue (6): 453-458.doi: 10.12280/gjszjk.20250474

• 论著 • 上一篇    下一篇

输卵管妊娠患者术后生育生活质量变化轨迹及其与生育忧虑的关系

邵蓉, 姜涛(), 陈醒   

  1. 210036 南京医科大学第一附属医院（江苏省人民医院）妇科
  • 收稿日期:2025-09-12 出版日期:2025-11-15 发布日期:2025-11-18
  • 通讯作者: 姜涛，E-mail：jiangtao2002@yeah.net

The Trajectory of Fertility and Life Quality in Reproductive-Aged Patients after Tubal Pregnancy Surgery and Its Relationship with Reproductive Concerns

SHAO Rong, JIANG Tao(), CHEN Xing   

  1. Department of Gynecology, The First Affiliated Hospital with Nanjing Medical University(Jiangsu Provincial People′s Hospital), Nanjing 210036, China
  • Received:2025-09-12 Published:2025-11-15 Online:2025-11-18
  • Contact: JIANG Tao, E-mail: jiangtao2002@yeah.net

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摘要：

目的：探究输卵管妊娠患者手术后生育生活质量变化轨迹，并分析与生育忧虑的关系。方法：采用便利抽样法选取2022年1月—2024年6月南京医科大学第一附属医院（我院）收治的234例输卵管妊娠患者为调查对象。所有患者于输卵管妊娠手术后1周（T1）、术后4周（T2）、术后8周（T3）、术后12周（T4）、术后16周（T5）使用生育生活质量（The Fertility Quality of Life，FertiQoL）量表调查术后生育生活质量水平；术后16周（T5）参照癌症后生育忧虑量表（Reproductive Concerns After Cancer Scale，RCAC）中文版调查术后生育忧虑水平。应用潜在类别增长模型识别生育生活质量变化轨迹的潜在类别，并采用方差分析探究不同生育生活质量潜在类别育龄期输卵管妊娠患者的生育忧虑评分差异。结果：输卵管妊娠患者术后T1~T5不同时间点FertiQoL评分分别是27~53（39.16±4.26）分、28~65（45.50±6.69）分、43~92（65.53±9.40）分、50~90（70.20±7.82）分和51~97（74.02±8.81）分。潜在类别增长模型识别出育龄期输卵管妊娠患者术后3种生育生活质量水平变化轨迹类型，其中低生育生活质量-平缓提升组（A1）占比33.33%，中生育生活质量-渐进改善组（A2）占比40.60%，高生育生活质量-稳步优化组（A3）占比26.07%。以A1组为参照，与年龄35~45岁的患者相比，年龄<35岁的患者术后生育生活质量轨迹类型更容易归为A2组（OR=2.558），居住地为城镇、农村及无生育意愿的患者更容易归为A1组（OR分别为0.256、0.185和0.476）；与年龄35~45岁的患者相比，年龄<35岁的患者术后生育生活质量轨迹类型更容易归为A3组（OR=2.324），居住地为农村及无生育意愿的患者更容易归为A1组（OR分别为0.119和0.212）（均P<0.05）。3种不同潜在类别输卵管妊娠患者的RCAC总分比较，差异有统计学意义（F=2 327.324，P<0.001）。结论：建议临床重点关注低生育生活质量的输卵管妊娠患者，借助互联网平台、公益讲座、新闻媒体等多种形式加大普及异位妊娠尤其是输卵管妊娠的治疗和护理知识力度，提升患者及其家属、有生育需求的女性等重点人群对异位妊娠的认知度、理解度和宽容度，并加强对患者的心理疏导，降低生育忧虑，促进其生育生活质量提高。

关键词: 妊娠, 异位, 妊娠, 输卵管, 生活质量, 生育力, 计划生育服务, 潜在类别分析

Abstract:

Objective: To explore the change trajectory of fertility and life quality in the reproductive-aged patients after tubal surgery due to ectopic pregnancy, and analyze the relationship with fertility anxiety. Methods: A convenient sampling method was used to select 234 reproductive-aged patients with ectopic pregnancy, who were admitted to the First Affiliated Hospital with Nanjing Medical University from January 2022 to June 2024 as the research subjects. All patients were surveyed using The Fertility Quality of Life (FertiQoL) Scale at 1 week(T1), 4 weeks(T2), 8 weeks(T3), 12 weeks(T4), and 16 weeks(T5) after tubal pregnancy surgery. At 16 weeks postoperatively(T5), the level of postoperative fertility anxiety was surveyed using the Chinese version of the Reproductive Concerns After Cancer Scale(RCAC). A latent class growth model was applied to identify the potential categories of trajectories in the fertility and life quality, and analysis of variance was used to explore the differences in the fertility anxiety score among reproductive-aged patients with ectopic pregnancy across different potential categories of fertility and life quality. Results: The FertiQoL scores of reproductive-aged patients with ectopic pregnancy at different time points (T1 to T5) after tubal surgery were 27-53 (39.16±4.26), 28-65 (45.50±6.69), 43-92 (65.53±9.40), 50-90 (70.20±7.82), and 51-97 (74.02±8.81), respectively. The latent category growth model identified 3 types of trajectory types of change in fertility and life quality in reproductive-aged patients after tubal surgery due to ectopic pregnancy, with 33.33% in the low fertility quality of life-steady increase group (A1), 40.60% in the medium fertility quality of life-improvement significant group (A2), and 26.07% in the high fertility quality of life-rapid increase group (A3). In multivariable analyses using the A1 group as the referent, age<35 years (vs. 35-45 years) was significantly associated with increased odds of belonging to the A2 group (OR=2.558). Factors associated with the A1 group included residence in towns (OR=0.256), rural areas (OR=0.185), and having no fertility intention (OR=0.476). Similarly, age<35 years was associated with the A3 group (OR=2.324), while rural residence (OR=0.119) and no fertility intention (OR=0.212) were associated with the A1 group (all P<0.05). The comparison of the 3 latent categories of RCAC scores showed a significant difference(F=2 327.324, P<0.001). Conclusions: It is suggested that those tubal pregnancy patients with low fertility-related quality of life should be focused in clinical practice. Various forms such as internet platforms, public welfare lectures and news media should be used to strengthen the popularization of knowledge on the treatment and nursing of ectopic pregnancy, especially tubal pregnancy, so as to improve the awareness, understanding and tolerance of key groups including patients, their family members and women with fertility needs towards ectopic pregnancy. In addition, psychological counseling for those patients should be strengthened to reduce their fertility anxiety and improve their fertility-related quality of life.

Key words: Pregnancy, ectopic, Pregnancy, tubal, Quality of life, Fertility, Family planning services, Latent class analysis