本文選題：分娩方式 + 母嬰��； 參考：《山東大學(xué)》2008年碩士論文

【摘要】： 目的探討分娩方式對產(chǎn)婦和兒童心理、行為及健康狀況的的影響及發(fā)生原因,為規(guī)范產(chǎn)科醫(yī)生的職業(yè)行為,促進母嬰身心健康水平提供科學(xué)依據(jù)。 對象與方法 分娩方式對兒童免疫系統(tǒng)的影響:隨機選擇濟寧市第一人民醫(yī)院、濟寧市中區(qū)婦幼保健院、濟寧市第二人民醫(yī)院順產(chǎn)與社會因素剖宮產(chǎn)新生兒各100名,按其分娩方式分為順產(chǎn)組和社會因素剖宮產(chǎn)組。在每個產(chǎn)婦生產(chǎn)過程中各取臍靜脈血6ml,分別采用Sysmex Kx-21血細(xì)胞儀測定全血白細(xì)胞和單抗橋聯(lián)酶標(biāo)法測定T細(xì)胞亞群(CD_3、CD_4)。比較兩組免疫細(xì)胞水平。 分娩方式對兒童遠(yuǎn)期作用的影響:采用整群抽樣方式,在濟寧、日照兩市各隨機抽取城區(qū)和郊區(qū)小學(xué)一年級學(xué)生共九個班453名學(xué)生,根據(jù)家長回憶和查閱有關(guān)產(chǎn)科記錄將以上兒童分為順產(chǎn)組和剖宮產(chǎn)組。按照預(yù)先設(shè)計好的“兒童心理、行為調(diào)查表”由統(tǒng)一培訓(xùn)好的調(diào)查員講解后,由其父母根據(jù)兒童近半年的表現(xiàn)進行填寫,將調(diào)查結(jié)果按照“兒童行為、感覺統(tǒng)合能力發(fā)展評定量表”進行評分,比較兩組的評分結(jié)果。 分娩方式對產(chǎn)婦婦科疾病發(fā)病率的影響: 于2007年6月對以上濟寧、日照兩市隨機抽取453名小學(xué)一年級學(xué)生的母親進行回顧性調(diào)查。在調(diào)查人員統(tǒng)一講解有關(guān)內(nèi)容和填寫方法的前提下,根據(jù)現(xiàn)場調(diào)查和產(chǎn)科記錄,比較剖宮產(chǎn)組和順產(chǎn)組兩組產(chǎn)婦出現(xiàn)腹部不適、腹腔臟器粘連、子宮肌瘤、子宮內(nèi)膜異位癥、盆腔炎等并發(fā)癥的發(fā)病率。 不同分娩方式的產(chǎn)婦激素水平的比較:以濟寧市第一人民醫(yī)院、濟寧市中區(qū)婦幼保健院、濟寧市第二人民醫(yī)院的200名產(chǎn)婦為研究對象,按其分娩方式分為順產(chǎn)組和社會剖宮產(chǎn)組。在每個產(chǎn)婦生產(chǎn)過程中各取肘靜脈血2ml,采用放射免疫法測定兩組產(chǎn)婦的皮質(zhì)醇和雌二醇含量并進行比較分析。 結(jié)果 剔除項目填寫不全者及多胎、家族精神和遺傳病史、出生缺陷、顱腦外傷史、急癥剖宮產(chǎn)等,共收回有效問卷399份,其中男孩194人,女孩205人(男:女=9:10);年齡分布為6-7歲;順產(chǎn)221例,剖宮產(chǎn)178例。 兩組產(chǎn)婦及兒童的一般情況比較:兩組產(chǎn)婦的文化程度、家庭經(jīng)濟狀況差異沒有顯著性(P＞0.05)。 社會因素剖宮產(chǎn)組新生兒白細(xì)胞、中性粒細(xì)胞分別為12.3±3.48×10~9/L和0.42±0.094%,順產(chǎn)組新生兒分別為15.9±3.86×10~9/L和0.53±0.084%,后者明顯多于前者,兩組之間差異有顯著性(P＜0.05)。而社會因素剖宮產(chǎn)組嬰兒CD_3、CD_4分別為0.49±0.076%和0.374±0.075%,順產(chǎn)組嬰兒CD_3、CD_4分別為0.48±0.042%和0.362±0.047%,雖然前者高于后者,但兩組之間差異并沒有顯著性(P＞0.05)。 此外,在對分娩方式對兒童遠(yuǎn)期行為的影響時發(fā)現(xiàn):順產(chǎn)組兒童感覺統(tǒng)合失調(diào)征的發(fā)病率為26.0%、而社會因素剖宮產(chǎn)組為43.0%,兩組之間差異有顯著性(P＜0.05);在CBCL調(diào)查中,共發(fā)現(xiàn)86例行為異常兒童,發(fā)病率21.6%,其中剖宮產(chǎn)組兒童47例(47/178),順產(chǎn)組兒童39例(39/221),兩組之間差異有顯著性(P＜0.05)。 不同分娩方式產(chǎn)婦的婦科疾病發(fā)生率比較。結(jié)果發(fā)現(xiàn),實行剖宮產(chǎn)的178名產(chǎn)婦出現(xiàn)宮外孕5例、內(nèi)膜異位癥9例、腸粘連17例、抵抗力下降70例、子宮肌瘤23例和盆腔炎31例,明顯高于順產(chǎn)產(chǎn)婦(宮外孕1例、內(nèi)膜異位癥3例、腸粘連4例、抵抗力下降37例、子宮肌瘤8例和盆腔炎16例),兩組之間除宮外孕外差異有顯著性(P＜0.05)。 不同分娩方式產(chǎn)婦的激素水平比較。結(jié)果發(fā)現(xiàn),自然分娩組產(chǎn)婦的皮質(zhì)醇與雌二醇水平[18.032±3.066;1299.18±71.71]明顯高于剖宮產(chǎn)組產(chǎn)婦[7.805±1.987;646.0±93.659]水平,兩組之間差異有顯著性(P＜0.05)。 結(jié)論 結(jié)果顯示,剖宮產(chǎn)組兒童的非特異性免疫力有所降低,但特異性免疫力降低不明顯;剖宮產(chǎn)組兒童感覺統(tǒng)合失調(diào)、行為異常發(fā)病率高于順產(chǎn)組兒童。剖宮產(chǎn)產(chǎn)婦產(chǎn)后婦科疾病發(fā)病率高于順產(chǎn)組產(chǎn)婦,雌二醇及皮質(zhì)醇的分泌低。提示我們,為了提高產(chǎn)婦和兒童的身心健康,醫(yī)生在診療過程中,除非有明確的剖宮產(chǎn)適應(yīng)征,盡量不要對產(chǎn)婦采取剖宮產(chǎn)的分娩方式。 剖宮產(chǎn)后婦女婦科疾病發(fā)病率增高可能與體內(nèi)激素水平的變化有關(guān)。
[Abstract]:Objective to explore the effect of delivery mode on the psychology, behavior and health status of mothers and children and their causes, and to provide a scientific basis for standardizing the occupational behavior of Obstetricians and promoting the level of maternal and mental health.
Object and method
The effect of delivery mode on the immune system of children: randomly selected the first people's Hospital in Jining, the maternity and child health care hospital in the Middle District of Jining, 100 newborns of the birth and social factors in Jining Second People's Hospital. According to the mode of childbirth, they were divided into the parturition group and the social factor caesarean section. 6ml, Sysmex Kx-21 hemocytometer was used to determine the T cell subsets (CD_3, CD_4) of whole blood leucocytes and McAb bridging enzyme labelling respectively. The level of immune cells in the two groups was compared.
The effect of the way of delivery on the long-term effect of children: a total of 453 students in nine classes of first grade students in urban and suburban primary schools were randomly selected by cluster sampling in two cities of Jining and sunshine. According to the recollection of the parents and the related obstetric records, the above children were divided into the parturition group and the caesarean section. The behavior questionnaire was explained by a unified trained investigator, and the parents were filled out by their parents according to the children's performance in the near half year. The results were scored according to the "child behavior, sensory integration capacity development scale" and the results of the two groups were compared.
The effect of delivery mode on the incidence of gynecological diseases:
In June 2007, a retrospective survey was conducted on the mothers of 453 primary school students who were randomly selected from two cities of Jining and Rizhao. On the premise of the investigation and obstetric records, the abdominal discomfort, abdominal viscera adhesion and uterus were compared between the two groups of cesarean section and the obstetric group. The incidence of complications such as myoma, endometriosis, pelvic inflammatory disease and so on.
The comparison of the levels of parturients with different delivery methods: 200 parturient women in Jining first people's Hospital, Jining Middle District Maternal and child health care hospital and Jining Second People's Hospital were divided into parturition group and social caesarean section according to their delivery methods. The 2ml of elbow vein blood was taken in each parturient process and radioimmunoassay was adopted. The contents of cortisol and estradiol in two groups were measured and compared.
Result
A total of 399 effective questionnaires were recovered from incomplete and multiple births, family spirit and genetic history, birth defects, history of craniocerebral trauma, and emergency caesarean section, including 194 boys, 205 girls (male: =9:10), 6-7 years of age, 221 partys and 178 caesarean section.
The general situation of two groups of mothers and children was compared: there was no significant difference in the educational level and family economic status between the two groups (P > 0.05).
The neutrophils in the cesarean section group were 12.3 + 3.48 x 10~9/L and 0.42 + 0.094% respectively. The newborns were 15.9 + 3.86 x 10~9/L and 0.53 + 0.084% respectively, and the latter were significantly more than the former. The difference between the two groups was significant (P < 0.05). The social factors of caesarean section were CD_3, CD_4 was 0.49 + 0.076% and 0.374, respectively. (0.075%) the CD_3 and CD_4 of infants in the spontaneous delivery group were 0.48 + 0.042% and 0.362 + 0.047% respectively, although the former was higher than that of the latter group, but there was no significant difference between the two groups (P > 0.05).
In addition, in the effect of childbirth on the long-term behavior of children, it was found that the incidence of sensory integration disorder was 26% in the parturition group and 43% in the social factor caesarean section, and the difference between the two groups was significant (P < 0.05). In the CBCL survey, 86 children with abnormal behavior were found, the incidence rate was 21.6%, of which 47 cases in caesarean section (47/17 8) there were 39 cases (39/221) in the spontaneous delivery group, and there was a significant difference between the two groups (P < 0.05).
The incidence of gynecologic diseases in parturients with different modes of delivery was compared. The results showed that 5 cases of ectopic pregnancy appeared in 178 parturients, 9 cases of endometriosis, 17 cases of intestinal adhesion, 70 cases of resistance decline, 23 cases of uterine myoma and 31 cases of pelvic inflammation, obviously higher than parturients (1 cases of ectopic pregnancy, 3 cases of endometriosis, 4 cases of intestinal adhesion, 4 resistance, 37 resistance decreased by 37. There were 8 cases of uterine fibroids and 16 cases of pelvic inflammatory disease. There was significant difference between the two groups except ectopic pregnancy (P < 0.05).
The results showed that the levels of cortisol and estradiol in parturients in the natural childbirth group were [18.032 + 3.066, and 1299.18 + 71.71] were significantly higher than those of the cesarean section group ([7.805 + 1.987 and 646 + 93.659]), and the difference between the two groups was significant (P < 0.05).
conclusion
The results showed that the non specific immunity of the children in the caesarean section was lower, but the specific immunity decreased not obviously; the incidence rate of the children in caesarean section was higher than that in the parturient group. The incidence of postpartum gynecologic diseases in cesarean section women was higher than that of the parturient women in the parturient group, and the secretion of estradiol and cortisol was low. In order to improve the physical and mental health of the mothers and children, in the process of diagnosis and treatment, unless there is a clear indication of caesarean section, try not to take the way of cesarean delivery.
The increased incidence of gynecological diseases after cesarean section may be related to changes in hormone levels in the body.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2008
【分類號】：R719.8;R395

【引證文獻】

相關(guān)期刊論文 前1條

1 徐長慧;;剖宮產(chǎn)術(shù)的研究進展[J];醫(yī)學(xué)信息(中旬刊);2011年08期

相關(guān)碩士學(xué)位論文 前1條

1 楊仁梅;圍生期因素對學(xué)齡前兒童心理行為影響的研究[D];南京醫(yī)科大學(xué);2011年

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本文編號：1794610