【摘要】：研究背景開展孕前保健工作可以從源頭上消除或減少日后不良妊娠結局發(fā)生的幾率,有效提高婦女及其后代健康水平,降低衛(wèi)生保健服務的費用。如今我國計劃生育基本國策面臨重大調整,"全面二孩"政策正式實施,放寬生育限制后我國人口形勢也將發(fā)生重大變化。新的人口發(fā)展形勢下,加快完善孕前保健服務,切實保障母嬰健康,是符合國情的必然選擇。中醫(yī)優(yōu)生干預在孕前保健中有其獨特的優(yōu)勢,通過中醫(yī)保健措施來促進育齡婦女及后代健康兼具針對性和安全性,具有重要的現(xiàn)實意義。已有研究顯示,基于中醫(yī)體質學的孕前優(yōu)生干預不僅能夠改善育齡婦女體質,還可以減少孕期并發(fā)癥及新生兒疾病的發(fā)生。目前常規(guī)的孕前優(yōu)生干預措施仍主要以西醫(yī)為基礎,中醫(yī)孕前優(yōu)生干預尚未大規(guī)模普及,擁有巨大的發(fā)展空間。另外,孕前體質干預研究多局限于對育齡婦女體質改善的效果評價,評估對其后代健康影響時也僅限于如身高、體重等體格發(fā)育指標,對智能發(fā)育的影響評價仍處于空白階段,因而開展有關孕前體質干預對促進嬰兒智能發(fā)育的效果評價研究勢在必行。研究目的本研究通過比較中醫(yī)孕前體質干預對象與常規(guī)孕前干預對象所生嬰兒智能發(fā)育水平的差異,為探索中醫(yī)孕前優(yōu)生干預對嬰兒智能發(fā)育的影響提供科學依據(jù)及數(shù)據(jù)支持,可為日后將中醫(yī)體質學應用于孕前保健領域、推進優(yōu)生優(yōu)育工作的順利開展提供建議。研究方法采用現(xiàn)場試驗研究的方法,選擇北京市平谷區(qū)作為研究現(xiàn)場,按照社會經濟發(fā)展狀況基本可比原則,將平谷區(qū)劃分為兩個區(qū)域,隨機設置試驗區(qū)與對照區(qū)。采取整群抽樣的方法,篩選所有符合干預對象納入標準的育齡婦女,按照其所在鄉(xiāng)鎮(zhèn)的分組情況,依次進入試驗組和對照組,對試驗組婦女實施中醫(yī)體質干預與常規(guī)優(yōu)生干預相結合的干預措施,對照組婦女實施常規(guī)孕前優(yōu)生干預。(1)對所有干預對象進行追蹤隨訪,待其懷孕并生產后,采用格賽爾嬰幼兒智能發(fā)育量表對孕前體質干預組與常規(guī)優(yōu)生干預組育齡婦女所生嬰兒在滿6、9、12月齡時進行智能發(fā)育水平測評,比較兩組嬰兒大運動及語言能區(qū)發(fā)育商得分差異;(2)采用分層分析法對混雜因素進行調整,進一步比較嬰兒大運動及語言能區(qū)發(fā)育商組間差異。研究結果1.研究對象基本情況干預后一年內,孕前體質干預試驗組婦女懷孕率為80.49%,常規(guī)優(yōu)生干預對照組懷孕率為78.65%,經檢驗兩組婦女懷孕率無統(tǒng)計學差異。根據(jù)研究對象納入與排除標準,共納入131例嬰兒及其母親,其中試驗組64例,對照組67例。嬰兒母親年齡、文化程度、職業(yè)、家庭人均月收入分布情況在兩組間均無顯著性差異。嬰兒母親平均年齡為26.09歲,中專以上文化程度居多,占94.66%,工作方面以私營企業(yè)與個體經營者居多,合計46.56%,其次是在事業(yè)單位與公務員或國企工作者,占35.11%。除嬰兒母親妊娠期被動吸煙率在組間差異有統(tǒng)計學意義外(P=0.03),其它妊娠相關情況包括妊娠期患病、營養(yǎng)不良及分娩方式在兩組間均無顯著性差異。孕前體質干預試驗組和常規(guī)優(yōu)生干預對照組嬰兒性別、喂養(yǎng)方式、添加輔食時間及早期教育情況無統(tǒng)計學差異,兩組均未見患苯丙酮尿癥、高膽紅素血癥等影響智能發(fā)育的新生兒疾病的嬰兒。2.嬰兒母親體質干預效果干預前,孕前體質干預試驗組和常規(guī)優(yōu)生干預對照組嬰兒母親平和質得分無顯著性差異(P=0.78)。3個月干預后,試驗組嬰兒母親平和質得分均值由59.23±13.69提升至64.52±16.95,干預前后平和質得分均值差為5.29±14.97,對照組嬰兒母親的平和質得分均值由60.49±13.36變?yōu)?0.74±12.45,干預前后平和質均值差為0.25±13.29;兩組嬰兒母親干預前后平和質得分均值差經檢驗具有統(tǒng)計學差異(P=0.03),試驗組嬰兒母親平和質得分變化高于對照組嬰兒母親平和質得分的變化,中醫(yī)孕前體質干預對育齡人群偏頗體質的改善效果優(yōu)于常規(guī)優(yōu)生干預的效果。3.試驗組與對照組嬰兒體格發(fā)育比較采用重復測量方差分析法比較兩組嬰兒的身長、體重,組內效應的檢驗結果顯示,嬰兒身長6、9、12月齡三個測試時點間具有顯著性差異(P=0.00),嬰兒體重在3個測試時點間同樣具有顯著性差異(P=0.00),孕前體質干預試驗組和常規(guī)優(yōu)生干預對照組嬰兒身長、體重均隨著時間而增長;組間效應方差分析結果表明,孕前體質干預試驗組和常規(guī)優(yōu)生干預對照組婦女生育的嬰兒在身長方面無顯著性差異(P=0.43),兩組嬰兒在體重方面同樣無顯著性差異(P=0.84)。4.試驗組與對照組嬰兒智能發(fā)育比較對試驗組和對照組嬰兒6、9、12月齡的大運動及語言領域智能發(fā)育水平進行重復測量方差分析。組內效應的檢驗結果顯示嬰兒大運動及語言能區(qū)發(fā)展商在6、9、12月齡三個時點間無統(tǒng)計學差異。組間效應方差分析結果顯示試驗組和對照組婦女生育的嬰兒在大運動及語言能區(qū)發(fā)展商均無顯著性差異(P0.05)。鑒于本研究嬰兒母親妊娠期被動吸煙情況在試驗組和對照組間并不均衡,可能造成混雜影響,對嬰兒母親妊娠期有無被動吸煙情況進行分層分析,在控制了潛在混雜因素后,孕前體質干預試驗組和常規(guī)優(yōu)生干預對照組婦女生育的嬰兒大運動及語言能區(qū)智能水平均無顯著性差異(P0.05)。結論1.體格發(fā)育方面,孕前體質干預試驗組與常規(guī)優(yōu)生干預對照組嬰兒身長、體重均未見顯著性差異(P0.05)。2.試驗組與對照組嬰兒大運動及語言能區(qū)發(fā)展商均未見顯著性差異(P0.05)。控制了妊娠期被動吸煙因素影響后對試驗組與對照組嬰兒大運動及語言能區(qū)發(fā)展商進行比較,兩組嬰兒大運動及語言能區(qū)發(fā)育水平仍未見顯著性差異(P0.05)。3.本研究結果尚不能確定在育齡婦女中實施孕前優(yōu)生干預對其生育嬰兒在身長、體重以及大運動、語言能區(qū)發(fā)育方面是否存在促進效果,需擴大樣本量、延長干預時間展開進一步研究。
[Abstract]:Research background to carry out pre pregnancy health care work can eliminate or reduce the incidence of adverse pregnancy outcomes from the source, improve the health level of women and their offspring and reduce the cost of health care services. Today, the basic national policy of family planning in China is faced with a major adjustment, the "overall two child" policy is formally implemented and after the birth restriction is relaxed, I In the new population development situation, it is an inevitable choice to accelerate the improvement of pre pregnancy health service and ensure the health of mother and child. The intervention of traditional Chinese medicine has its unique advantages in pre pregnancy health care and the health care measures of traditional Chinese medicine to promote the health and safety of women and children of childbearing age. Sex is of great practical significance. Previous studies have shown that pre pregnancy intervention based on physical constitution of traditional Chinese medicine can not only improve the physical fitness of women of childbearing age, but also reduce the complications of pregnancy and the occurrence of neonatal diseases. The current intervention measures for prepregnancy eugenics are still based on Western medicine, and the intervention of prepregnancy eugenics is not large in large scale. In addition, there is a huge space for development. In addition, pre pregnancy physical intervention studies are mostly limited to the evaluation of the effect of physical improvement on women of childbearing age. The assessment of the health effects on their offspring is limited to the physical development indicators such as height and weight, and the evaluation of the influence of intellectual development is still in the empty stage. It is imperative to study the effect evaluation of infant intelligence development. The purpose of this study is to provide scientific basis and data support for exploring the influence of pre pregnancy eugenic intervention on infant intelligence development by comparing the difference of the level of intellectual development of infants born before pregnant and prepregnancy intervention. Medical physique is applied to the field of pre pregnancy health care and advices on the smooth development of eugenic and eugenic work. The method of field experiment is used to select Pinggu District of Beijing as the research site. According to the basic principle of social and economic development, the Pinggu zoning is divided into two regions, and the experimental area and the control area are randomly set up. The method of cluster sampling was adopted to screen all the women of childbearing age who were in accordance with the standard of intervention. According to the group situation in the villages and towns in which they were located, they entered the experimental group and the control group in turn. The intervention measures were carried out to the women in the experimental group, and the control group was treated with the routine prepregnancy intervention. (1) All the subjects were followed up, and after their pregnancy and production, the intelligence development level of the pre pregnancy physical intervention group and the conventional eugenic intervention group was evaluated by the Gesell infant intelligence development scale, and the differences in the scores of the two groups were compared in the two groups. (2) A stratified analysis was used to adjust the confounding factors to further compare the difference between the big sports and the developmental quotient groups in the language energy area. Results 1. in the first year of the study, the pregnancy rate of women in the pre pregnancy physical intervention group was 80.49%, the pregnancy rate in the routine eugenics intervention group was 78.65%, and the pregnancy rate of two groups of women was tested. There was no statistical difference. According to the inclusion and exclusion criteria, 131 infants and their mothers were included, including 64 cases in the experimental group and 67 cases in the control group. There was no significant difference between the infant mother's age, educational level, occupation and family per capita monthly income distribution between the two groups. The average age of the baby mother was 26.09 years, and the secondary school and higher education level was at the higher level. More, accounting for 94.66%, the majority of the work in the private sector and the individual operator, the total number of 46.56%, secondly in the institutions and civil servants or state-owned enterprises workers, 35.11%. except infant mother pregnancy passive smoking rate between groups is statistically significant (P=0.03), other pregnancy related pregnancy related conditions include pregnancy disease, malnutrition and childbirth There was no significant difference between the two groups. There was no statistical difference between the pre pregnancy physical intervention test group and the routine eugenics intervention control group, the feeding mode, the supplementary feeding time and the early education situation, and the two groups did not have the infant.2. infant's constitution of infantile diseases such as hyperbilirubinuria and hyperbilirubinemia. Before intervention, there was no significant difference (P=0.78) between pre pregnancy physical intervention test group and routine eugenic intervention control group (P=0.78) for.3 months, the average score of level and quality of infant mother in test group increased from 59.23 + 13.69 to 64.52 + 16.95, and the average difference of level and quality score before and after intervention was 5.29 + 14.97, and the control group of infant mother The average average score of the level and quality of the parents changed from 60.49 + 13.36 to 60.74 + 12.45, and the average difference between the level and quality of the parents before and after intervention was 0.25 + 13.29. The average difference between the average level and quality score of the two groups of infants before and after intervention was statistically different (P=0.03). The changes in the level of level and quality of the mothers of the infants in the experimental group were higher than that in the control group. The effect of pre pregnancy physical intervention on the physique of children of childbearing age was better than that of conventional eugenics..3. test group and control group compared with the control group, the body length, weight, and Intraday Effect of the two groups of infants were compared with the control group. The results showed that the three time points of the baby's length of age were obvious between the three test points. In P=0.00, the baby body weight was also significantly different between the 3 test time points (P=0.00). The pre pregnancy physical intervention test group and the routine eugenics control group had long body weight, and the body weight increased with the time. The results of the inter group effect variance analysis showed that the pre pregnancy physical intervention test group and the routine eugenics intervention control group were pregnant women. There was no significant difference in the length of body length (P=0.43), and there was no significant difference in weight between the two groups of infants (P=0.84) the.4. test group and the control group were compared with the control group for the repeated measurement of variance analysis of the large exercise and the intelligence development level in the language field of the experimental and control groups at the age of 6,9,12. The test of intra group effect The results showed that there was no statistical difference between the big sports and the language energy area developers at the three time points of 6,9,12 months. The results of the inter group effect variance analysis showed that there was no significant difference between the test group and the control group in the big sports and the language area developers (P0.05). The disequilibrium between the experimental group and the control group may result in a mixed effect. There is a stratified analysis on whether the baby's mother has no passive smoking during pregnancy. After controlling the potential confounding factors, there is no significant difference between the pre pregnancy physical intervention test group and the routine eugenics control group. Difference (P0.05). Conclusion 1. body development, pre pregnancy physical intervention test group and routine eugenics control group have no significant difference (P0.05) there is no significant difference (P0.05) between the.2. test group and the control group, there is no significant difference between the big sports and the language energy area developers (P0.05). After the control of the influence of pregnancy passive smoking factors on the experimental group Compared with the control group, there was no significant difference between the two groups of big sports and language energy area developers (P0.05).3.. The results of this study were not determined to determine whether the prenatal eugenics were implemented in women of childbearing age for their fertility, body weight and large exercise, and the development of language energy areas. To promote the effect, we need to expand the sample size and extend the intervention time to further study.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R211

【參考文獻】

相關期刊論文 前10條

1 吳國連;白麗霞;王海霞;王曉暉;王惠梅;金春華;李瑞莉;陳博文;;太原市城區(qū)893例0～6兒童發(fā)育測查結果及其影響因素分析[J];中國兒童保健雜志;2016年04期

2 陳國珠;;淺論小兒高熱驚厥的發(fā)病原因及急救護理方法[J];當代醫(yī)藥論叢;2016年04期

3 林燕飛;;嬰兒早期游泳撫觸配合穴位按摩對生長發(fā)育的影響觀察[J];中國醫(yī)學創(chuàng)新;2016年04期

4 葉侃;羅曉明;金華;雷潔;古桂雄;;BSID-Ⅲ認知量表在中國應用初探[J];中國兒童保健雜志;2015年10期

5 丁園輝;徐燕婷;林鳳瓊;;妊娠期婦女被動吸煙對胎兒影響的研究[J];中國實用醫(yī)藥;2015年22期

6 唐樸勤;丁霞;;中醫(yī)參與孕產婦健康管理效果評價[J];中國婦幼保健;2015年21期

7 汪天英;張艷麗;;新生兒健康狀況與孕早中期準父母中醫(yī)體質分型關系研究[J];中國中醫(yī)藥信息雜志;2015年05期

8 孫大中;修宗昌;;治未病思想與體質偏頗、亞健康狀態(tài)關系探討[J];中國中醫(yī)藥現(xiàn)代遠程教育;2015年09期

9 武穎;劉雁峰;張瑩;;300例育齡孕前女性體質及相關因素分析[J];世界中西醫(yī)結合雜志;2015年02期

10 李素月;宋沅瑾;董建榮;趙勝俠;章依文;姜艷蕊;徐小娟;孫莞綺;王燕;江帆;;不同分娩方式對嬰幼兒生長發(fā)育的影響[J];中國婦幼健康研究;2014年06期

，

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