發(fā)布時(shí)間：2018-07-10 04:07

  本文選題：孕前體重 + 孕期體重管理　； 參考：《西南醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討孕前體重指數(shù)及孕期體重變化對(duì)妊娠結(jié)局的影響。方法:選擇3924例單胎妊娠孕婦,分析妊娠并發(fā)癥發(fā)生情況(妊娠期糖尿病、妊娠高血壓病、妊娠膽汁淤積癥、胎膜早破、胎盤早剝、產(chǎn)后出血、產(chǎn)褥感染)、不良妊娠結(jié)局發(fā)生情況(胎兒窘迫、早產(chǎn)、死胎)、分娩方式、及新生兒健康總體狀況(Apgar評(píng)分、體重、身長(zhǎng)、巨大兒、低體重兒、入住NICU),按孕前BMI分為BMI正常組(n=3126),高BMI組(n=434)及低BMI組(n=364),比較各組妊娠并發(fā)癥發(fā)生情況、不良妊娠結(jié)局發(fā)生情況、分娩方式和新生兒情況,其中3126名孕前BMI正常組孕婦按孕期體重增長(zhǎng)情況分為增長(zhǎng)正常組(n=2426),增長(zhǎng)不足組(n=107)及增長(zhǎng)過(guò)多組(n=593),比較各組妊娠并發(fā)癥發(fā)生情況、不良妊娠結(jié)局發(fā)生情況、分娩方式和新生兒情況。結(jié)果:3924例孕婦妊娠高血壓發(fā)病率為4.46%(175/3924)妊娠期糖尿病發(fā)病率10.19%(400/3924),妊娠膽汁淤積癥發(fā)病率為0.94%(37/3924)。胎膜早破發(fā)生率為4.13%(162/3924);胎盤早剝發(fā)生率為1.12%(44/3924),產(chǎn)后出血3.62%,產(chǎn)褥感染發(fā)生率0.87%(140/3924)。胎兒窘迫發(fā)生率為1.73%(68/3924),早產(chǎn)發(fā)生率2.70%(106/3924),死胎發(fā)生率為0.17%(7/3924)。剖宮產(chǎn)率為51.38%(2016/3924);3924名新生兒Apgar評(píng)分(9.90±0.36),體重平均(3312±51.75)g,身長(zhǎng)(50.56±1.24)cm,巨大兒比例為6.75%(265),低體重兒比例為1.34%(53/3924),入住NICU比例為3.16%(124/3924)。低BMI組與BMI正常組妊娠高血壓病發(fā)病率無(wú)顯著差異(X~2=3.104,p=0.078),高BMI組妊娠高血壓發(fā)病率高于BMI正常組(X~2=20.394,p=0.000)及低BMI組組(X~2=16.458,p=0.000);低BMI組妊娠糖尿病發(fā)病率低于BMI正常組(X~2=31.507,p=0.000)及BMI增高組(X~2=65.195,p=0.000),高BMI組妊娠糖尿病發(fā)病率高于BMI正常組(X~2=30.186,p=0.000);低BMI組妊娠膽汁淤積癥發(fā)病率與BMI正常組(X~2=0.038,p=0.845)及高BMI組(X~2=0.214,p=0.643)無(wú)顯著差異。高BMI組妊娠膽汁淤積癥發(fā)病率與BMI正常組無(wú)顯著差異(X~2=0.203,p=0.652);低BMI組與BMI正常組妊胎膜早破發(fā)生率無(wú)顯著差異(X~2=0.086,p=0.769),高BMI組胎膜早破發(fā)生率高于BMI正常組(X~2=149.128,p=0.000)及低BMI組(X~2=40.034,p=0.000);低BMI組胎盤早剝發(fā)病率同BMI正常組無(wú)顯著差異(X~2=0.006,p=0.938),高BMI組胎盤早剝發(fā)病率高于低BMI組(X~2=5.227,p=0.022)及BMI正常組(X~2=18.677,p=0.000);低BMI組產(chǎn)后出血發(fā)生率同BMI正常組無(wú)顯著差異(X~2=0.710,p=0.400),同高BMI組無(wú)顯著差異(X~2=0.063,p=0.802),高BMI組同BMI正常組產(chǎn)后出血發(fā)生率無(wú)顯著差異(X~2=1.845,p=0.174);低BMI組產(chǎn)褥感染發(fā)生率同BMI正常組無(wú)顯著差異(X~2=0.450,p=0.502),低于高BMI組(X~2=5.477,p=0.019),高BMI組產(chǎn)褥感染發(fā)生率高于BMI正常組(X~2=31.713,p=0.0000);低BMI組胎兒窘迫發(fā)病率同BMI正常組無(wú)顯著差異(X~2=0.387,p=0.531),高BMI組胎兒窘迫發(fā)病率高于低BMI組(X~2=15.296,p=0.000)及BMI正常組(X~2=82.088,p=0.000);低BMI組早產(chǎn)發(fā)生率同BMI正常組無(wú)顯著差異(X~2=0.001,p=0.987),高BMI組早產(chǎn)發(fā)病率高于低BMI組(X~2=28.680,p=0.000)及BMI正常組(X~2=130.228,p=0.000);低BMI組死胎發(fā)生率與BMI正常組(X~2=0.487,p=0.485)及高BMI組(X~2=0.185,p=0.667)無(wú)顯著差異。高BMI組死胎發(fā)生率與BMI正常組無(wú)顯著差異(X~2=2.510,p=0.113);低BMI組剖宮產(chǎn)率高于BMI正常組(X~2=4.887,p=0.027),與高BMI組無(wú)顯著差異(X~2=1.553,p=0.213),高BMI組剖宮產(chǎn)率高于對(duì)BMI正常組(X~2=16.780,p=0.000);BMI正常組新生兒Apgar評(píng)分高于低BMI組(t=7.146,p=0.014)及高BMI組(t=7.615,p=0.010),低BMI組Apgar評(píng)分同高BMI組無(wú)明顯差異(t=0.064,p=0.816);BMI正常組新生兒體重小于高BMI組(t=5.296,p=0.009),高于低BMI組(t=9.174,p=0.003);BMI正常組新生兒身長(zhǎng)與低BMI組(t=2.176,p=0.062)及高BMI組無(wú)顯著差異(t=1.205,p=0.147),高BMI組新生兒身長(zhǎng)高于低BMI組(t=4.286,p=0.029)。BMI正常組巨大兒發(fā)生率高于低BMI組(X~2=8.296,p=0.004),低于高BMI組(X~2=37.277,p=0.000),高BMI組巨大兒發(fā)生率高于低BMI組(X~2=34.083,p=0.000);BMI正常組低體重兒發(fā)生率低于低BMI組(X~2=32.527,p=0.000),與高BMI組無(wú)顯著差異(X~2=0.098,p=0.754),高BMI組低體重兒發(fā)生率低于低BMI組(X~2=9.140,p=0.003);BMI正常組新生兒入住NICU率低于低BMI組(X~2=4.193,p=0.041)及高BMI組(X~2=5.697,p=0.017),低BMI組與高BMI組新生兒入住NICU發(fā)生率無(wú)顯著差異(X~2=0.012,p=0.911)。增長(zhǎng)不足組與增長(zhǎng)正常組妊娠高血壓病發(fā)病率無(wú)顯著差異(X~2=0.442,p=0.506),增長(zhǎng)過(guò)多組妊娠高血壓發(fā)病率高于增長(zhǎng)正常組(X~2=71.543,p=0.000)及增長(zhǎng)不足組(X~2=4.090,p=0.027);增長(zhǎng)不足組妊娠糖尿病發(fā)病率低于增長(zhǎng)正常組(X~2=8.802,p=0.003)及增長(zhǎng)過(guò)多組(X~2=28.535,p=0.000),增長(zhǎng)過(guò)多組妊娠糖尿病發(fā)病率高于增長(zhǎng)正常組(X~2=102.065,p=0.000);增長(zhǎng)不足組妊娠膽汁淤積癥發(fā)病率與增長(zhǎng)正常組(X~2=0.006,p=0.940)及增長(zhǎng)過(guò)多組(X~2=0.048,p=0.826)無(wú)顯著差異,增長(zhǎng)過(guò)多組妊娠膽汁淤積癥發(fā)病率與增長(zhǎng)正常組無(wú)顯著差異(X~2=0.514,p=0.473);增長(zhǎng)正常組胎膜早破發(fā)生率低于增長(zhǎng)不足組(X~2=18.711,p=0.000)與增長(zhǎng)過(guò)多組(X~2=13.997,p=0.000),增長(zhǎng)不足組與增長(zhǎng)過(guò)多組胎膜早破發(fā)生率無(wú)顯著差異(X~2=2.465,p=0.116);增長(zhǎng)正常組胎盤早剝發(fā)生率低于增長(zhǎng)不足組(X~2=11.501,p=0.001)與增長(zhǎng)過(guò)多組(X~2=6.909,p=0.009),增長(zhǎng)不足組與增長(zhǎng)過(guò)多組胎盤早剝發(fā)生率無(wú)顯著差異(X~2=1.533,p=0.216);增長(zhǎng)正常組產(chǎn)后出血發(fā)生率低于增長(zhǎng)不足組(X~2=20.750,p=0.000),增長(zhǎng)過(guò)多組產(chǎn)后出血發(fā)生率高于增長(zhǎng)不足組(X~2=6.710,p=0.010)及增長(zhǎng)正常組(X~2=11.800,p=0.001);增長(zhǎng)正常組產(chǎn)褥感染發(fā)生率低于于增長(zhǎng)不足組(X~2=21.964,p=0.001)及增長(zhǎng)過(guò)多組(X~2=21.964,p=0.001),增長(zhǎng)不足組與增長(zhǎng)過(guò)多組產(chǎn)褥感染發(fā)生率無(wú)顯著差異(X~2=0.890,p=0.346)。增長(zhǎng)正常組胎兒窘迫發(fā)生率低于增長(zhǎng)不足組(X~2=124.859,p=0.000)與增長(zhǎng)過(guò)多組(X~2=17.907,p=0.000),增長(zhǎng)不足組與增長(zhǎng)過(guò)多組胎兒窘迫發(fā)生率無(wú)顯著差異(X~2=1.835,p=0.176);增長(zhǎng)正常組早產(chǎn)發(fā)生率低于增長(zhǎng)不足組(X~2=10.994,p=0.001)與增長(zhǎng)過(guò)多組(X~2=6.057,p=0.014),增長(zhǎng)不足組與增長(zhǎng)過(guò)多早產(chǎn)發(fā)生率無(wú)顯著差異(X~2=1.520,p=0.218);增長(zhǎng)正常組死胎發(fā)生同增長(zhǎng)不足組(X~2=0.132,p=0.176)及增長(zhǎng)過(guò)多組(X~2=0.073,p=0.787)無(wú)顯著差別;增長(zhǎng)正常組剖宮產(chǎn)率同增長(zhǎng)不足組無(wú)顯著差異(X~2=0.021,p=0.555),增長(zhǎng)過(guò)多組剖宮產(chǎn)率高于增長(zhǎng)不足組(X~2=6.710,p=0.010)及增長(zhǎng)正常組(X~2=37.874,p=0.000);增長(zhǎng)正常組新生兒Apgar評(píng)分高于增長(zhǎng)不足組(t=5.296,p=0.017)及增長(zhǎng)過(guò)多組(t=6.545,p=0.010),增長(zhǎng)不足組Apgarp評(píng)分同增長(zhǎng)過(guò)多組無(wú)明顯差異(t=0.217,p=0.658);增長(zhǎng)正常組新生兒體重高于增長(zhǎng)不足組(t=8.076,p=0.008),低于增長(zhǎng)過(guò)多組(t=9.142,p=0.002);增長(zhǎng)正常組新生兒身長(zhǎng)高于增長(zhǎng)不足組(t=3.179,p=0.012),低于增長(zhǎng)過(guò)多組(t=4.576,p=0.008);增長(zhǎng)正常組巨大兒發(fā)生率高于增長(zhǎng)不足組(X~2=5.604,p=0.018),低于增長(zhǎng)過(guò)多組(X~2=42.494,p=0.000);增長(zhǎng)正常組低體重兒發(fā)生率同增長(zhǎng)過(guò)多組無(wú)顯著差異(X~2=0.024,p=0.877);低于增長(zhǎng)不足組(X~2=109.119,p=0.000)。增長(zhǎng)正常組入住NICU率低于增長(zhǎng)不足組(X~2=23.925,p=0.000)及增長(zhǎng)過(guò)多組(X~2=36.794,p=0.000)。結(jié)論:孕前BMI異常以及孕期體重增長(zhǎng)異常增加產(chǎn)婦妊娠中晚期并發(fā)癥風(fēng)險(xiǎn),影響胎兒的健康發(fā)育,也是不良妊娠結(jié)局的原因之一,并影響新生兒的健康,在妊娠前要合理控制體重,孕期科學(xué)營(yíng)養(yǎng),進(jìn)行孕期體重管理,降低妊娠風(fēng)險(xiǎn),改善妊娠質(zhì)量。
[Abstract]:Objective: To investigate the effect of pre pregnancy body mass index and pregnancy weight on pregnancy outcome. Methods: 3924 pregnant women with single pregnancy were selected to analyze pregnancy complications (gestational diabetes, pregnancy induced hypertension, pregnancy cholestasis, premature rupture of membranes, placental abruption, postpartum hemorrhage, puerperal infection), pregnancy outcome (fetus). Fetal distress, preterm birth, stillbirth), mode of delivery, and the overall health of the newborn (Apgar score, weight, length, gigantic, low weight, NICU), BMI divided into normal BMI group (n=3126), high BMI group (n=434) and low BMI group (n=364), compare the occurrence of complications of pregnancy, adverse pregnancy outcome, delivery mode and new birth. In the case of 3126 pre pregnancy BMI normal groups, pregnant women were divided into normal group (n=2426), inadequate growth group (n=107) and increasing group (n=593) according to the weight growth of pregnancy, compared with each group of pregnancy complications, adverse pregnancy outcome, childbirth formula and newborns. Results: the incidence of pregnancy hypertension in 3924 pregnant women. The incidence of gestational diabetes was 10.19% (400/3924) for 4.46% (175/3924). The incidence of pregnancy cholestasis was 0.94% (37/3924). The incidence of premature rupture of membranes was 4.13% (162/3924), placental abruption was 1.12% (44/3924), postpartum hemorrhage was 3.62%, puerperal infection was 0.87% (140/3924). The incidence of fetal distress was 1.73% (68/3924), and the incidence of premature birth was 2. .70% (106/3924), the incidence of stillbirth was 0.17% (7/3924). The cesarean section rate was 51.38% (2016/3924); 3924 newborn Apgar scores (9.90 + 0.36), weight average (3312 + 51.75) g, length (50.56 + 1.24) cm, 6.75% (265), low weight infant ratio 1.34% (53/3924), and NICU ratio was 3.16% (124/3924). Low BMI group and normal BMI group pregnancy There was no significant difference in the incidence of hypertension (X~2=3.104, p=0.078). The incidence of hypertension in high BMI group was higher than that of normal BMI group (X~2=20.394, p=0.000) and low BMI group (X~2=16.458, p=0.000), and the incidence of gestational diabetes in low BMI group was lower than that of BMI normal group (X~2=31.507, 0) and higher group. There was no significant difference in the incidence of cholestasis between the low BMI group and the normal group of BMI (X~2=0.038, p=0.845) and the high BMI group (X~2=0.214, p=0.643). The incidence of pregnancy cholestasis in the high BMI group was not significantly different from that of the normal group of BMI (X~2=0.214, p=0.643). There was no significant difference (X~2=0.086, p=0.769). The incidence of premature rupture of membranes in high BMI group was higher than that in normal BMI group (X~2=149.128, p=0.000) and low BMI group (X~2=40.034, p=0.000). The incidence of placental abruption in low BMI group was not significantly different from that of BMI normal group (X~2=0.006,), and the incidence of placental abruption was higher than that of low BMI group and normal group. (X~2=18.677, p=0.000), the incidence of postpartum hemorrhage in the low BMI group was not significantly different from that of the normal BMI group (X~2=0.710, p=0.400), and there was no significant difference in the same high BMI group (X~2=0.063, p=0.802). There was no significant difference in the incidence of postpartum hemorrhage between the high BMI group and the BMI normal group (X~2=1.845,), and there was no significant difference in the incidence of puerperal infection in the low group. P=0.502), the incidence of puerperal infection in the high BMI group was higher than that of the high BMI group (X~2=5.477, p=0.019), and the incidence of puerperal infection in the high BMI group was higher than that of the normal BMI group (X~2=31.713, p=0.0000), and the incidence of fetal distress in the low BMI group was not significantly different from that of the BMI normal group (X~2=0.387, p=0.531). The incidence of preterm labor in group MI was not significantly different from that in normal BMI group (X~2=0.001, p=0.987). The incidence of premature birth in high BMI group was higher than that in low BMI group (X~2=28.680, p=0.000) and normal BMI group (X~2=130.228, p=0.000). There was no significant difference in the normal group of MI (X~2=2.510, p=0.113), and the rate of caesarean section in the low BMI group was higher than that of the normal BMI group (X~2=4.887, p=0.027), and there was no significant difference between the high BMI group (X~2=1.553, p=0.213), and the caesarean section in the high BMI group was higher than that of the normal BMI group. The Apgar score in the low BMI group was not significantly different from that in the high BMI group (t=0.064, p=0.816), and the weight of the newborn in the normal BMI group was less than the high BMI group (t=5.296, p=0.009), higher than the low BMI group (t=9.174, Apgar). The incidence of giant infants in the normal group of low BMI (t=4.286, p=0.029).BMI was higher than that in the low BMI group (X~2=8.296, p=0.004), which was lower than the high BMI group (X~2=37.277, p=0.000), and the incidence of giant infants in the high BMI group was higher than that of the low BMI group. =0.754), the incidence of low weight infants in high BMI group was lower than that in low BMI group (X~2=9.140, p=0.003), and the rate of NICU in BMI normal group was lower than that of low BMI group (X~2=4.193, p=0.041) and high BMI group (X~2=5.697,). There was no significant difference in the incidence of blood pressure disease (X~2=0.442, p=0.506). The incidence of hypertension in the increasing group of pregnancy was higher than that in the normal growth group (X~2=71.543, p=0.000) and the group (X~2=4.090, p=0.027). The incidence of gestational diabetes was lower than that of the normal group (X~2=8.802, p=0.003) and the increasing group (X~2=28.535, p=0.000). The incidence of multiple groups of gestational diabetes was higher than that in the normal group (X~2=102.065, p=0.000); there was no significant difference between the incidence of pregnancy cholestasis in the low growth group and the normal growth group (X~2=0.006, p=0.940) and the increasing group (X~2=0.048, p=0.826). There was no significant difference in the incidence of cholestasis of pregnancy with the normal group (X~2=0.514, p=). 0.473): the rate of premature rupture of membranes in the normal growth group was lower than that of the insufficient group (X~2=18.711, p=0.000) and the increasing group (X~2=13.997, p=0.000). There was no significant difference in the incidence of premature rupture of fetal membranes (X~2=2.465, p=0.116), and the incidence of placental abruption in the normal group was lower than that of the insufficient group (X~2=11.501, p=0.001) and growth in the normal group. There was no significant difference in the incidence of placental abruption in too many groups (X~2=6.909, p=0.009) (X~2=1.533, p=0.216), and the incidence of postpartum hemorrhage in the normal growth group was lower than that in the inadequate growth group (X~2=20.750, p=0.000), and the incidence of postpartum hemorrhage in the overgrowth group was higher than that in the inadequate growth group (X~2=6.710, p=0.010) and the normal growth group (X~2=11.8). 00, p=0.001); the incidence of puerperal infection in the normal growth group was lower than that in the low growth group (X~2=21.964, p=0.001) and the increasing group (X~2=21.964, p=0.001). There was no significant difference in the incidence of puerperal infection in the growth group and the overgrowth group (X~2=0.890, p=0.346). The rate of fetal distress in the growth normal group was lower than that of the inadequate growth group (X~2=124.859, p=0.000). There was no significant difference in the rate of fetal distress (X~2=1.835, p=0.176) in the overgrowth group (X~2=17.907, p=0.000), and the incidence of premature birth in the normal group was lower than that in the less growth group (X~2=10.994, p=0.001) and the increasing group (X~2=6.057, P =0.014), and there was no significant difference in the incidence of premature birth (X, P =0.014) (X, X). ~2=1.520, p=0.218); there was no significant difference between the normal growth group and the group (X~2=0.132, p=0.176) and the excessive growth group (X~2=0.073, p=0.787). There was no significant difference in the rate of caesarean section (X~2=0.021, p=0.555) in the normal growth group (X~2=0.021, p=0.555), and the higher rate of caesarean section in the growth group was higher than that of the inadequate growth group (X~2=6.710, p=0.010) and normal growth. Group (X~2=37.874, p=0.000); the neonatal Apgar score in the normal growth group was higher than that in the inadequate growth group (t=5.296, p=0.017) and the increasing group (t=6.545, p=0.010). There was no significant difference in the Apgarp score between the growth insufficiency group and the overgrowth group (t=0.217, p=0.658). The growth of the normal group was higher than that of the insufficient growth group (t=8.076, p=0.008), lower than the increase of excessive growth. Group (t=9.142, p=0.002); the growth of the normal group was higher than that of the undergrowth group (t=3.179, p=0.012), lower than the growth group (t=4.576, p=0.008); the growth rate in the normal group was higher than that in the undergrowth group (X~2=5.604, p=0.018), lower than the growth group (X~2=42.494, p=0.000), and the rate of growth in the normal group was too much in the increase group. There was no significant difference (X~2=0.024, p=0.877); lower than the lack of growth group (X~2=109.119, p=0.000). The rate of NICU in the normal growth group was lower than that of the inadequate growth group (X~2=23.925, p=0.000) and increased group (X~2=36.794, p=0.000). Conclusion: abnormal pregnant BMI and abnormal weight gain during pregnancy increase the risk of middle and late pregnancy complications in pregnant women, and affect the health of the fetus. The development of Kang is also one of the causes of bad pregnancy outcome, and affects the health of the newborns. It is necessary to control weight reasonably before pregnancy, scientific nutrition during pregnancy, carry out weight management during pregnancy, reduce the risk of pregnancy and improve the quality of pregnancy.
【學(xué)位授予單位】：西南醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R714.7

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