發(fā)布時(shí)間：2018-06-04 03:07

  本文選題：出生人口質(zhì)量 + 早產(chǎn)�。� 參考：《北京協(xié)和醫(yī)學(xué)院》2011年碩士論文

【摘要】：[研究目的] 總目的：了解中國農(nóng)村地區(qū)出生人口質(zhì)量現(xiàn)狀并探討其影響因素 具體目標(biāo)： 1.調(diào)查四川、安徽、河南三省六縣早產(chǎn)、低出生體重、巨大兒的發(fā)生率 2.了解農(nóng)村地區(qū)早產(chǎn)率,低出生體重率和巨大兒率的人群和時(shí)間分布特點(diǎn) 3.比較六縣標(biāo)準(zhǔn)化的早產(chǎn)率,低出生體重率和巨大兒率 4.了解不同胎齡新生兒體重身長體格發(fā)育情況 5.探討婦女人口學(xué)特征、婚育情況、妊娠期疾病及孕期保健因素對(duì)早產(chǎn)和巨大兒的影響 [研究方法] 本研究為現(xiàn)況研究。在四川省(射洪縣和樂至縣)、安徽省(蚌埠和蒙城縣)和河南省(南樂縣和泌陽縣)分層抽取25個(gè)醫(yī)療機(jī)構(gòu),隨機(jī)和整群相結(jié)合的抽樣方法抽取2008年1月1日至2008年12月31日內(nèi)分娩的活產(chǎn)兒的產(chǎn)科病案,采用自制調(diào)查問卷摘錄相關(guān)變量。運(yùn)用描述性研究法和標(biāo)準(zhǔn)化的思想描述早產(chǎn)、低出生體重、巨大兒的發(fā)生率的三間分布特點(diǎn),運(yùn)用t檢驗(yàn),卡方檢驗(yàn)進(jìn)行單因素分析,運(yùn)用非條件Logistic回歸檢驗(yàn)進(jìn)行多因素分析。 [結(jié)果] 本次調(diào)查共獲得17805份合格調(diào)查表,最終合格率為98.9%。 1.率的三間分布 本次調(diào)查中,三省六縣農(nóng)村地區(qū)早產(chǎn)兒共829例,發(fā)生率為4.66%。低出生體重兒共823例,發(fā)生率為4.62%。巨大兒共1765例,發(fā)生率為9.91%。四川省樂至縣的早產(chǎn)和低出生體重率比較高,分別為8.16%和10.54%。安徽省蚌埠早產(chǎn)率和巨大兒率較高,分別為6.20%和10.96%。安徽省蒙城縣和河南省泌陽縣巨大兒率較高,兩者均高達(dá)15%以上。男嬰早產(chǎn)率和巨大兒率高于女嬰,女嬰低出生體重率高于男嬰。安徽省蒙城縣和河南省泌陽縣男性巨大兒率高達(dá)18%以上。春季巨大兒發(fā)生率高于其它三季。早產(chǎn)和低體重率暫未發(fā)現(xiàn)季節(jié)差異。 2.新生兒體格發(fā)育情況 新生兒平均出生體重為3308.2克,男嬰3360.9克,女嬰3249.0克,男嬰高于女嬰,兩者具有統(tǒng)計(jì)學(xué)差異(t'=14.86,P=0.000)。男女嬰的胎齡別曲線圖在34周以前的曲線均不規(guī)則,34-42周之前曲線走向較平穩(wěn),P50曲線表現(xiàn)為男性在40周達(dá)到峰值,女性在41周達(dá)到峰值,之后有回落趨勢,表明胎兒在胎齡達(dá)到41周后體重的發(fā)育速度可能有所減緩或停止。僅有男嬰體重超過4500克。新生兒平均身長為49.6厘米,男嬰498厘米,女嬰49.5厘米,男嬰長于女嬰,差異具有統(tǒng)計(jì)學(xué)意義(t=8.17,P=0.000)。男嬰身長的區(qū)間帶寬于女性,男嬰的身長發(fā)育變異相對(duì)較大,40周后基本停止發(fā)育。女嬰身長的變異相對(duì)較小,身長在39周時(shí)基本停止發(fā)育,僅有男性身長超過55厘米。 3.早產(chǎn)的影響因素 單因素分析表明婦女分娩年齡與早產(chǎn)率呈J型關(guān)系,35歲組的早產(chǎn)率為8.9%,小于20歲組的早產(chǎn)率為5.7%,25歲組分娩年齡早產(chǎn)率為4.0%；有早產(chǎn)史的婦女早產(chǎn)率為18.18%,遠(yuǎn)高于無早產(chǎn)史婦女的早產(chǎn)率(4.77%)；早產(chǎn)組中40.5%的婦女存在妊娠期疾病,高于足月產(chǎn)的24.2%；早產(chǎn)組中高危妊娠的比例為36.6%,足月產(chǎn)為15.5%；胎膜早破者中早產(chǎn)發(fā)生率為13.4%,高于未發(fā)生胎膜早破者的早產(chǎn)率(3.5%)；孕前消瘦的婦女早產(chǎn)率為8.0%,高于正常體重的婦女,也高于孕前超重和肥胖的婦女的早產(chǎn)率(5.5%左右)；孕期增重小于6千克的產(chǎn)婦,早產(chǎn)率為9.0%,而孕期增重在21千克以上者,早產(chǎn)率為2.9%,孕期增重越低,早產(chǎn)率越高。產(chǎn)婦分娩前BMI指數(shù)偏低者(BMI21),早產(chǎn)率高達(dá)15.3%,分娩前BMI指數(shù)在25-33之間者,早產(chǎn)率為4.2%。孕檢次數(shù)過少者的早產(chǎn)率為5.9%,高于孕檢次數(shù)在8次及以上的婦女的早產(chǎn)率(2.8%)。多因素分析結(jié)果表明分娩年齡≥35歲,有妊娠期疾病,胎膜早破,產(chǎn)檢次數(shù)少,男嬰是早產(chǎn)的危險(xiǎn)因素(P0.05),優(yōu)勢比分別是：2.32,2.24,4.37,2.7,1.45。孕期增重高是早產(chǎn)的保護(hù)性因素,孕期增重≥21kg的婦女早產(chǎn)的風(fēng)險(xiǎn)只有孕期增重6kg的1/5。 4.巨大兒的影響因素 單因素分析結(jié)果表明男嬰巨大兒發(fā)生率為12.01%,女嬰為7.54%；20-24歲年齡組巨大兒率為7.63%,25-29歲組上升至11.33%,30-34歲組上升至12.73%。孕周超過42周的婦女巨大兒發(fā)生率顯箸上升至17.16%,而42周以內(nèi)的婦女巨大兒發(fā)生率僅為9.69%。孕前BMI達(dá)到28的婦女巨大兒發(fā)生率高達(dá)18.45%,孕期增重超過18千克的婦女巨大兒發(fā)生率高達(dá)12.27%,產(chǎn)前保健較缺乏的婦女巨大兒發(fā)生率在12%以上。多因素分析結(jié)果表明男嬰、產(chǎn)婦年齡在25歲及以上、過期產(chǎn)、孕前超重和肥胖,孕期增重超過18kg、孕20周后才進(jìn)行首次產(chǎn)前檢查、產(chǎn)檢次數(shù)不詳是巨大兒的危險(xiǎn)因素,優(yōu)勢比分別1.81,1.33,1.91,1.98,3.20,1.80,3.60,1.85。 [結(jié)論] 1.三省六縣農(nóng)村地區(qū)出生人口質(zhì)量不好,僅據(jù)孕周和出生體重兩項(xiàng)客觀指標(biāo)計(jì)算,不良出生人口質(zhì)量者占到總出生人口的15%以上。 2.欠發(fā)達(dá)、貧困農(nóng)村地區(qū)巨大兒發(fā)生率高,10%的新生兒為巨大兒,且輕度巨大兒少,近20%的巨大兒體重超過4400克。 3.男嬰巨大兒率顯著高于女嬰,尤其是在安徽省蒙城縣和河南省泌陽縣,男嬰巨大兒率接近20%。 4.分娩年齡≥35歲,有妊娠期疾病,胎膜早破,產(chǎn)檢次數(shù)少,男嬰是早產(chǎn)的危險(xiǎn)因素。孕期增重多是早產(chǎn)的保護(hù)性因素 5.男嬰、產(chǎn)婦年齡在25歲及以上、過期產(chǎn)、孕前超重和肥胖,孕期增重超過18kg、孕20周后才進(jìn)行首次產(chǎn)前檢查、產(chǎn)檢次數(shù)不詳是巨大兒的危險(xiǎn)因素。 [政策建議] 1.鼓勵(lì)婦女在最佳生育年齡段生育,降低低齡產(chǎn)婦(20歲)和高齡產(chǎn)婦(35歲)的比例。 2.孕前健康狀況的監(jiān)測：通過公共衛(wèi)生監(jiān)測和相關(guān)研究機(jī)制,對(duì)婦女的孕前健康狀況進(jìn)行監(jiān)測。將孕前保健服務(wù)和業(yè)已存在的地方公共衛(wèi)生和相關(guān)領(lǐng)域的項(xiàng)目有機(jī)結(jié)合,既有普通人群干預(yù)策略又有高危人群干預(yù)策略。如計(jì)劃懷孕的夫婦雙方應(yīng)當(dāng)進(jìn)行一次體檢；調(diào)控好婦女BMI指數(shù)使其保持在理想范圍后再計(jì)劃懷孕；妊娠期控制血糖；開展疾病篩查,減少妊娠期疾病發(fā)生率。 3.兩次懷孕之間的保�。簩�(duì)有不良妊娠結(jié)局(流產(chǎn)、死產(chǎn)、早產(chǎn)、低出生體重兒等)的婦女提供高危人群特別的干預(yù)措施。 4.開展深入研究,科學(xué)制定孕期適宜增重標(biāo)準(zhǔn),提高孕產(chǎn)期保健水平,強(qiáng)調(diào)科學(xué)合理指導(dǎo)膳食的可操作性,并力爭提供個(gè)性化的優(yōu)生優(yōu)育的指導(dǎo)。 5.提倡自然分娩,降低巨大兒,尤其是輕度巨大兒的剖宮產(chǎn)率。
[Abstract]:[research purposes]
General purpose: to understand the quality of birth population in rural areas of China and to explore its influencing factors.
Specific objectives:
1. to investigate the incidence of premature birth, low birth weight and macrosomia in six counties of Sichuan, Anhui and Henan provinces.
2. understand the characteristics of population and time distribution of premature birth rate, low birth weight rate and macrosomia rate in rural areas.
3. compare the standardized premature birth rate, low birth weight rate and macrosomia rate in six counties.
4. to understand the physical development of newborns with different gestational age.
5. to explore the effects of demographic characteristics, marital status, pregnancy diseases and prenatal care on preterm labor and macrosomia.
[research methods]
In this study, 25 medical institutions were selected in Sichuan (Shehong county and Lezhi county), Anhui province (Bengbu and Mengcheng county) and Henan province (Nanye county and Biyang county). The obstetric case of childbirth in January 1, 2008 to December 31, 2008 was sampled by random and cluster sampling method, and the self-made questionnaire was used to pick out the medical records. Descriptive research and standardized ideas were used to describe the three distribution characteristics of preterm birth, low birth weight, and the incidence of gigantic infants. Single factor analysis was performed by t test, chi square test was performed, and multivariate analysis was carried out by non conditional Logistic regression test.
[results]
A total of 17805 qualified questionnaires were obtained from the survey, with a final pass rate of 98.9%.
Three distribution of 1. rates
In this survey, 829 cases of premature infants in three provinces and six counties in six counties had a total incidence of 823 cases of low birth weight infants with a total incidence of 1765 cases of 4.62%. gigantic infants. The incidence of premature birth and low birth weight ratio in Lezhi County, Sichuan province was higher, respectively, 8.16% and 10.54%. Anhui province Bengbu preterm birth rate and large infant rate higher, respectively 6, respectively. .20% and 10.96%. in Mengcheng County of Anhui province and Biyang County of Henan province are high, both of which are higher than 15%. The premature birth rate and the huge infant rate of male baby are higher than that of the female baby. The low birth weight rate of the female baby is higher than that of the male baby. The male rate of male in Mengcheng County of Anhui province and Biyang County of Henan province is up to above 18%. The occurrence rate of large infants in spring is higher than the other three seasons. The seasonal difference was not found at the low weight rate.
2. physical development of newborns
The average birth weight of the newborn was 3308.2 grams, 3360.9 grams of male baby, 3249 gram of female baby, and the male baby was higher than female baby. The difference was statistically different (t'=14.86, P=0.000). The curve of the gestational age of boys and girls was irregular before 34 weeks, and the curve trend was more stable before 34-42 weeks. The P50 curve showed that the male reached the peak at 40 weeks and the female was 41 weeks. After reaching the peak, there was a downward trend, indicating that the fetal body weight development speed may be slowed down or stopped after 41 weeks of fetal age. Only male babies weight more than 4500 grams. The average length of the newborn was 49.6 cm, the male baby was 498 cm, the female baby was 49.5 cm, the male baby was longer than the female baby, the difference was statistically significant (t=8.17, P=0.000). The male baby was long. The length of the length of the male baby is relatively large, and the development of the female baby is relatively small after 40 weeks. The variation of the length of the female baby is relatively small, and the length of the baby is basically stopped at 39 weeks, only the male length exceeds 55 centimeters.
3. factors affecting preterm labor
The single factor analysis showed that the women's birth age and the premature birth rate were J type, the premature birth rate of 35 year old group was 8.9%, the premature birth rate of the group less than 20 years old was 5.7%, the birth rate of the 25 year old group was 4%, the preterm birth rate was 18.18%, which was far higher than that of the women without preterm birth (4.77%); and the women in the premature birth group were pregnant with pregnancy disease. The disease was higher than 24.2% of full term birth; the proportion of high risk pregnancy in premature delivery group was 36.6%, full term was 15.5%, premature rupture of membranes was 13.4%, higher than that of non premature rupture of membranes (3.5%); prematurely pregnant women were 8%, higher than normal weight women, and the preterm birth of women who were overweight and obese before pregnancy. Rate (about 5.5%); pregnant women with weight gain less than 6 kilograms, the rate of premature birth was 9%, and the weight gain in pregnancy was 21 kg, the premature birth rate was 2.9%, the higher the weight gain in pregnancy was, the higher the premature birth rate was, the prelabor BMI index was lower (BMI21), the preterm birth rate was 15.3%, the BMI index before childbirth was 25-33, the premature birth rate was too few 4.2%. pregnancies. The preterm birth rate was 5.9%, which was higher than that of women with 8 times of pregnancy (2.8%). The results of multiple factors analysis showed that the birth age was more than 35 years old, the pregnancy disease, the premature rupture of the membrane, the less frequency of production, the male baby was the risk factor of preterm birth (P0.05), and the advantage ratio was the protective cause of the premature birth in the 2.32,2.24,4.37,2.7,1.45. pregnancy. The risk of premature delivery in pregnant women with weight gain of less than 21kg is only 1/5. during pregnancy and 6kg.
4. influential factors of the giant children
The single factor analysis showed that the incidence of gigantic infants was 12.01% and 7.54% for women, 7.63% in 20-24 years old and 11.33% in 25-29 years old. The incidence of gigantic infants in 30-34 year old groups rose to 17.16% in 12.73%. weeks for more than 42 weeks, and the incidence of giant children in 42 weeks was only BMI before 9.69%. pregnancy. The incidence of gigantic children in 28 was up to 18.45%. The incidence of gigantic infants in women with more than 18 kilograms during pregnancy was 12.27%, and the incidence of huge children was more than 12%. The results of multiple factors analysis showed that the male infant was 25 years old and above, overdue, overweight and obesity before pregnancy, more than 18kg in pregnancy, 20 pregnancy. Zhou Houcai conducted the first prenatal examination. The number of birth defects was a risk factor for macrosomia. The odds ratios were 1.81,1.33,1.91,1.98,3.20,1.80,3.60,1.85.
[Conclusion]
The quality of the births in the rural areas of the 1. provinces and the six counties was not good, only according to the two objective indicators of pregnancy and birth weight, and the quality of the poor birth population accounted for more than 15% of the total birth population.
2. less developed, the incidence of macrosomia in poor rural areas is high, 10% of newborns are macrosomia, and mildly large children and young children. Nearly 20% of the macrosomia weigh more than 4400 grams.
3. the rate of macrosomia in boys was significantly higher than that in girls, especially in Mengcheng County of Anhui province and Biyang County of Henan province. The rate of macrosomia was close to 20%.
4. the childbearing age is more than 35 years old. There are gestational diseases, premature rupture of membranes, and fewer birth examinations. Boys are a risk factor for preterm delivery. Weight gain during pregnancy is a protective factor for premature delivery.
5. male baby, the maternal age is 25 years old and above, the expired birth, overweight and obesity before pregnancy, the weight gain over 18kg during pregnancy, the first antenatal examination after 20 weeks of pregnancy, and the risk factor of the unknown number of labor.
[policy recommendations]
1. encourage women to give birth at the best childbearing age, and reduce the proportion of young women (20 years old) and elderly parturients (35 years old).
2. monitoring of pre pregnancy health: monitoring pre pregnancy health of women through public health monitoring and related research mechanisms. Combining pre pregnancy health services with existing local public health and related fields, there are both general population intervention strategies and high-risk group intervention strategies, such as planned pregnant husband. Both sides should have a physical examination; control the women's BMI index to keep it in the ideal area and plan for pregnancy; pregnancy control blood sugar; disease screening to reduce the incidence of pregnancy disease.
3. health care between the two pregnancies: special intervention measures for women with adverse pregnancy outcomes (abortion, stillbirths, premature birth, low birth weight infants, etc.).
4. to carry out in-depth research, to scientifically formulate the appropriate weight gain standards during pregnancy, to improve the level of health care in pregnancy, to emphasize the operability of the diet scientifically and rationally, and to provide the guidance of individualized eugenics and nurture.
5. advocate natural childbirth and reduce the cesarean section rate of macrosomia, especially for children with mild macrosomia.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2011
【分類號(hào)】：C924.25

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