【摘要】：研究背景近年來(lái),人們深知女性的身心健康對(duì)提高全人類健康水平有著至關(guān)重要的作用。對(duì)于提高藏區(qū)婦女的身心健康,隨著女性研究生的不斷增多,深入研究藏醫(yī)婦科學(xué)為之已做出了一定的貢獻(xiàn)。但是關(guān)于某地區(qū)常見婦科病的患病率、危險(xiǎn)因素、主要和次要因素、高發(fā)人群、因素間的交互作用、危險(xiǎn)因素與婦科病的關(guān)系、婦科病的縱橫轉(zhuǎn)歸,相應(yīng)預(yù)防策略待需要進(jìn)一步加強(qiáng)研究。研究目的本研究運(yùn)用婦女全生命周期保健新視角的思路,首先解析各年齡段的女性飲食與行為保健措施;其次總結(jié)各年齡段的主要婦科病的種類及患病率;再次探討藏醫(yī)學(xué)結(jié)合公共衛(wèi)生學(xué)的三級(jí)預(yù)防策略等作為主要研究目的。第一,通過(guò)藏醫(yī)學(xué)的文獻(xiàn)研究,明確各重要年齡段的劃分標(biāo)準(zhǔn)及生理特征,解析女性特殊時(shí)期的飲食與行為保健措施,探討五大婦科病的分類及各年齡段的縱橫轉(zhuǎn)歸。第二,通過(guò)公共衛(wèi)生學(xué)的文獻(xiàn)研究,總結(jié)各年齡段高發(fā)婦科病的種類、患病率及主要死因,吸收國(guó)內(nèi)外婦幼衛(wèi)生示范項(xiàng)目的經(jīng)驗(yàn)及有效實(shí)施方案,探討藏醫(yī)學(xué)結(jié)合公共衛(wèi)生學(xué)待需要完成的初步預(yù)防工作。第三,通過(guò)調(diào)查研究,查明澤庫(kù)縣各年齡段常見婦科病的種類及患病率,篩選危險(xiǎn)人群及鄉(xiāng)鎮(zhèn),提出三級(jí)危險(xiǎn)因素,探討主要和次要危險(xiǎn)因素,分析危險(xiǎn)因素與婦科病的關(guān)系,總結(jié)目前婦幼衛(wèi)生項(xiàng)目的經(jīng)驗(yàn),結(jié)合文獻(xiàn)研究?jī)?nèi)容初步策劃待續(xù)實(shí)施的項(xiàng)目及具體措施,為社區(qū)預(yù)防工作提供參考。研究方法本研究采取了理論研究與實(shí)證分析相結(jié)合的方法,綜合運(yùn)用了文獻(xiàn)研究、實(shí)地考察、問(wèn)卷調(diào)查、訪談、其它相關(guān)數(shù)據(jù)的分析等進(jìn)行研究。文獻(xiàn)研究方面:運(yùn)用比較、分析、歸納、總結(jié)等文獻(xiàn)研究方法對(duì)藏醫(yī)學(xué)經(jīng)典書籍、公共衛(wèi)生學(xué)論著、期刊文獻(xiàn)、視頻、政策文件等相關(guān)內(nèi)容進(jìn)行剖析。在實(shí)地考察方面,考察婦幼衛(wèi)生項(xiàng)目的示范基地,并請(qǐng)教相關(guān)工作人員,為理論與實(shí)踐相結(jié)合提供向?qū)�。�?wèn)卷調(diào)查方面:運(yùn)用橫向研究法,選取偶遇非隨機(jī)抽樣,采用自行設(shè)計(jì)的問(wèn)卷對(duì)參加青海大學(xué)澤庫(kù)縣惠民服務(wù)活動(dòng)中的204名藏族牧區(qū)育齡婦女進(jìn)行調(diào)查,其內(nèi)容主要包括一般情況、現(xiàn)病史、孕產(chǎn)史、分娩史等女性特殊時(shí)期婦科病的危險(xiǎn)因素。訪談方面:訪問(wèn)了當(dāng)?shù)馗挥信R床經(jīng)驗(yàn)的十名婦幼衛(wèi)生工作人員,為問(wèn)卷調(diào)查獲得的定量數(shù)據(jù)分析結(jié)果提供進(jìn)一步的解釋。采集其它相關(guān)數(shù)據(jù)方面:對(duì)參加青海大學(xué)澤庫(kù)縣惠民服務(wù)活動(dòng)中,進(jìn)行婦科常規(guī)檢查和全科檢查的1128例病人和參與免費(fèi)宮頸癌篩查項(xiàng)目的1723例婦女的檢測(cè)結(jié)果等原始數(shù)據(jù)進(jìn)行回顧性分析。在統(tǒng)計(jì)分析方面,對(duì)定性資料的錄音內(nèi)容均轉(zhuǎn)錄為文字,并結(jié)合其它數(shù)據(jù)進(jìn)行分析;對(duì)定量數(shù)據(jù)應(yīng)用Stata14統(tǒng)計(jì)軟件,采用Fisher檢驗(yàn)、卡方檢驗(yàn)、方差分析、logistic回歸等方法進(jìn)行分析。研究結(jié)果第一,藏醫(yī)學(xué)文獻(xiàn)研究的主要結(jié)果包括:1.各重要年齡段的特殊時(shí)期劃分方面,分析影響女性生殖健康的孕期十五個(gè)關(guān)鍵周次和五個(gè)月份;出生后年、月、日及十九個(gè)各年齡段的關(guān)鍵時(shí)期。2.各重要年齡段的生理特征方面,探討各年齡段三大基因與生理變化的交互作用,其中包括孕期每個(gè)月的生理發(fā)育過(guò)程,出生后生理發(fā)展期與衰退期的變化。3.各重要年齡段的心理特征方面,解析孕期心智變化過(guò)程,出生后結(jié)合三時(shí)、三因、七大體質(zhì)的心理變化及外因而引起的女性六個(gè)特殊時(shí)期的心理變化過(guò)程。4.女性特殊時(shí)期的飲食保健方面,基于藏醫(yī)學(xué)飲食保健理論并參考中醫(yī)學(xué)關(guān)于現(xiàn)代飲食的寒熱性理論知識(shí),探討女性六個(gè)特殊時(shí)期的飲食保健策略。5.女性特殊時(shí)期的行為保健方面,解析女性五個(gè)特殊時(shí)期的行為取舍,并吸收及闡釋國(guó)內(nèi)外孕期不可缺少的十個(gè)行為,結(jié)合藏醫(yī)學(xué)與現(xiàn)代自然分娩法詮釋產(chǎn)時(shí)十六個(gè)行為的作用機(jī)制。6.婦科病的分類方面,總結(jié)婦科病的九種分類特點(diǎn),并依據(jù)病因、轉(zhuǎn)移、部位、三因、并發(fā)癥等,探討擴(kuò)充五大婦科病的詳細(xì)分類法。7.各年齡段婦科病的縱橫轉(zhuǎn)歸方面,解析常見六大婦科病的發(fā)病機(jī)制,探討各年齡段婦科病的六種轉(zhuǎn)歸方式。第二,公共衛(wèi)生學(xué)文獻(xiàn)研究的主要結(jié)果包括:1.總結(jié)各年齡段六種婦科病的主要危險(xiǎn)因素。2.匯總各年齡段的三十五種主要死亡原因。3.集結(jié)各年齡段十二種心理問(wèn)題的主要因素。4.歸納各年齡段提高婦女健康水平的六十種項(xiàng)目的主要成效及經(jīng)驗(yàn)。5.吸收三級(jí)行為改變理論的八種具體措施。6.探討藏醫(yī)學(xué)結(jié)合公共衛(wèi)生學(xué),初步實(shí)施公共衛(wèi)生項(xiàng)目的五個(gè)基本工作。第三,澤庫(kù)縣實(shí)地調(diào)查研究的主要結(jié)果包括:1.各年齡段常見婦科病的種類及患病率方面,十五歲以下少女的婦科患病率較低,但外陰瘙癢和膿腫相對(duì)較多。十七歲以上各年齡段婦女普遍患病率由高到低依次為宮頸糜爛、宮頸肥大、陰道蟲病。(p0.05)三十五歲以上的婦女子宮肌瘤患病率較高。(p0.05)四十四歲至五十九歲的婦女疑患宮頸癌前病變的人數(shù)較多,(p0.05)其中宮頸病變的患病率為83%,而48%的婦女患有重度宮頸炎,7%的婦女疑患有宮頸癌前病變。2.篩選危險(xiǎn)因素的鄉(xiāng)鎮(zhèn)方面,鄉(xiāng)乙的陰道蟲病患病率、流產(chǎn)及死胎次數(shù)均高于其他鄉(xiāng)鎮(zhèn)。(p0.05)鄉(xiāng)鎮(zhèn)甲的子宮肌瘤患病率明顯高于其他鄉(xiāng)鎮(zhèn)。(p0.05)另外,鄉(xiāng)鎮(zhèn)甲、庚、已、乙的宮頸病變患病率依次加劇。因此,甲和乙是急需預(yù)防婦科病的兩個(gè)主要鄉(xiāng)鎮(zhèn)。3.內(nèi)科疾病的分布方面,關(guān)節(jié)炎和胃炎的患病率最高。尤其是十五歲以下胃炎患病率較高,十五歲以上關(guān)節(jié)炎患病率較高。(p0.05)4.三級(jí)危險(xiǎn)因素方面,本研究共發(fā)現(xiàn)了七十六個(gè)危險(xiǎn)因素,其中與個(gè)人及家庭相關(guān)的有十個(gè)主要危險(xiǎn)因素,與社區(qū)相關(guān)的有十三個(gè)主要危險(xiǎn)因素。尤其是婦女教育程度每增加一年,孕期、產(chǎn)時(shí)、產(chǎn)后接受衛(wèi)生保健服務(wù)程度增加3.62個(gè)單位。(p0.05)5.婦幼衛(wèi)生項(xiàng)目實(shí)施方面,分析目前實(shí)施的八個(gè)婦幼衛(wèi)生項(xiàng)目,并在此基礎(chǔ)上探討藏醫(yī)學(xué)結(jié)合公共衛(wèi)生學(xué)的七種待續(xù)實(shí)施的項(xiàng)目及具體措施,為提高澤庫(kù)縣藏族婦女的健康工作提供參考建議。研究結(jié)論首先,文獻(xiàn)研究結(jié)果顯示:1.各年齡段女性生理變化的特點(diǎn)顯著,依據(jù)生理變化和“得過(guò)”進(jìn)行保健和治療是重中之重。2.女性的健康需要婦女全生命周期保健新視角進(jìn)行思考,并需要在可靠的數(shù)據(jù)引導(dǎo)下實(shí)施切實(shí)可行的干預(yù)措施。3.藏醫(yī)學(xué)擁有現(xiàn)代研究已證明的,臨床實(shí)踐中未開展的,各年齡段的女性保健措施待需要進(jìn)一步挖掘和開展。其次,田野調(diào)查結(jié)果顯示:1.澤庫(kù)縣藏族婦女的健康狀況較差,但各年齡段主要婦科病的種類及危險(xiǎn)因素的主次之別較明確,可待提供切實(shí)可行的策略從而提高婦女健康水平。2.提高澤庫(kù)縣各年齡段女性健康水平,各級(jí)同時(shí)需要提供直接與間接的多種干預(yù)措施。
[Abstract]:In recent years, it is very important to know that the physical and mental health of women is of great importance to the improvement of the health of all human beings. In order to improve the physical and mental health of women in the Tibetan area, with the increasing number of female graduate students, it has made some contribution to the study of the science of Tibetan medicine. However, the prevalence of common gynecological diseases in a region, the risk factors, the main and minor factors, the high incidence population, the interaction between the factors, the relationship between the risk factors and the gynecological diseases, the aspect of the gynecological diseases, and the corresponding prevention strategies need to be further strengthened. The purpose of this study is to study the women's diet and behavior health-care measures in all ages, and to sum up the types and prevalence of major gynecological diseases in all ages. The purpose of the main research is to study the three-level prevention strategy of the combination of the Tibetan medicine and the public health. First, through the study of the literature of the Tibetan medicine, it is clear that the division standard and the physiological characteristic of each important age group, the diet and the behavior health-care measures in the special period of the female are analyzed, and the classification of the five major gynecological diseases and the aspect ratio of all ages are discussed. Secondly, through the study of the literature of the public health, the type, prevalence and main cause of death of the high-incidence gynopathy in all ages are summarized, and the experience and effective implementation of the domestic and foreign health-care demonstration projects are absorbed, and the preliminary prevention work to be completed in the combination of the Tibetan medicine and the public health science is discussed. Thirdly, through the investigation and study, the types and prevalence of common gynecological diseases in various age groups in the Zuche county were identified, the dangerous people and the towns were selected, the three-level risk factors were put forward, the main and minor risk factors were discussed, and the relationship between the risk factors and the gynecological diseases was analyzed. In this paper, the experience of the current public health project is summarized. Combined with the content of the literature, the project and the concrete measures to be carried out are initially planned, and the reference for the prevention of the community is provided. The research method has taken a combination of the theoretical research and the empirical analysis, and makes a comprehensive use of the literature research, the field visit, the questionnaire, the interview, the analysis of other relevant data and so on. In the aspect of literature research, the author uses the methods of comparison, analysis, induction and summary to analyze the related contents of the classical books, the public health science, the journal literature, the video, the policy documents and so on. In the field of field visits, the demonstration base of the health project of the Republic of China is examined, and the relevant staff are consulted to provide the guide for the combination of theory and practice. in that aspect of the questionnaire survey, the author use the transverse research method to select the non-random sampling, and adopt a self-designed questionnaire to investigate the 204 Tibetan people of childbearing age in the Huimin service activity of the Zuche County, Qinghai University, which mainly include the general situation, the current medical history and the maternity history, The risk factors of gynecological diseases such as the history of labor and the like. Interviews: Ten local health workers with local clinical experience were visited to provide a further explanation of the quantitative data analysis results obtained from the questionnaire. Other relevant data were collected: A retrospective analysis was made on the raw data of 1128 patients who participated in the routine examination and general examination of the gynaecology and the test results of 1723 women participating in the free cervical cancer screening program in the Huimin service activities of the Zuche County, Qinghai University. In the aspect of statistical analysis, the recorded content of the qualitative data is transcribed into the text and analyzed with other data; the Staa14 statistical software is applied to the quantitative data, the Fisher test, the chi-square test, the variance analysis, the logistic regression, and the like are adopted to analyze the quantitative data. The main results of the study are as follows:1. The special period of each important age group is divided into five key weeks and five months, which influence the reproductive health of women. The physiological characteristics of all ages, including the physiological and developmental process of each month during pregnancy, the physiological development period after birth and the change of the decline period, were discussed. The psychological characteristics of each important age group, the course of the mental change during pregnancy, the three times of birth, the psychological change of the seven physical constitutions and the psychological change of the six special periods of the women. On the basis of the theory of Tibetan medicine's diet and health, and with reference to the theory of the cold and heat of the modern diet, the author discusses the diet and health-care strategies of the six special periods of the female. During the special period of women's behavior, the author analyzes the behavior and trade-off of the five special periods of the female, and absorbs and explains the ten behaviors that can't be absent at home and abroad, and combines the mechanism of the role of the Tibetan medicine and the modern natural childbirth method to interpret the sixteen behaviors in the time of birth. In the aspect of the classification of the gynecological diseases, the nine categories of gynecological diseases are summarized, and the detailed classification of the five major gynecological diseases is discussed according to the cause, the metastasis, the location, the third cause, the complication and so on. In the aspect of the aspect and outcome of the gynecological diseases of all ages, the pathogenesis of six gynecological diseases is analyzed, and the six outcomes of the gynecological diseases of all ages are discussed. Secondly, the main results of the study on the literature of public health include:1. The main risk factors of six kinds of gynecological diseases in all ages were summarized. Thirty-five main causes of death in all ages were summarized. The main factors of the 12 kinds of psychological problems in each age group. To sum up the main results and experience of 60 projects to improve the health of women in all ages. Eight specific measures to absorb three-level behavior change theory. The paper discusses the five basic work of Tibetan medicine in combination with the public health science and the preliminary implementation of the public health project. Third, the main results of the field investigation in Zuche County include:1. The prevalence and prevalence of common gynecological diseases in all ages are low, but the incidence of female genital itching and abscess is relatively high. The prevalence of women in all ages over the age of seventeen is from high to low in order of cervical erosion, cervical hypertrophy, and vaginosis. (p0.05) The prevalence of uterine fibroids of women over 35 years of age was higher. (p0.05) The number of pre-cervical lesions in women between the ages of 40 and 59 was much higher (p0.05), in which the prevalence of cervical lesions was 83%, while 48% of women had severe cervicitis and 7% of women were suspected of having pre-cervical lesions. The prevalence of vaginococcosis, the number of abortion and the number of stillbirth are higher than those of other towns. (p0.05) The prevalence of uterine fibroids in villages and towns was significantly higher than in other towns. (p0.05) In addition, the prevalence of cervical lesions in the villages and towns was increased in this order. Therefore, A and B are two major towns that are in urgent need of prevention of gynecological diseases. The prevalence of arthritis and gastritis is the highest in the distribution of internal medical conditions. In particular, the prevalence of gastritis under the age of 15 is high, and the prevalence of arthritis in the age of 15 is higher. (p0.05)4. In that three-level risk factor, there are seven risk factors, among which there are ten major risk factors associated with the individual and the family, and there are thirteen major risk factors associated with the community. In particular, that degree of women's education is increase by 3.62 units per year, during pregnancy, and during the post-natal period. (p0.05)5. In order to improve the health of the Tibetan women in the Zuku county, the paper analyzes the eight main health projects currently being implemented and discusses seven projects and concrete measures to improve the health of the Tibetan women in the Zuche county. The results of the study are as follows:1. The characteristics of the female physiological changes of all ages are significant, and the health care and the treatment are the most important according to the physiological changes and the "have to go through". Women's health needs a new perspective on life-cycle health care for women, and practical interventions need to be implemented with reliable data guidance. The modern study of the Tibetan medicine has proved that the female health-care measures of all ages are to be further excavated and carried out without being carried out in clinical practice. Secondly, the results of field investigation showed:1. The health status of the Tibetan women in the Zuche county is poor, but the primary and secondary of the type and risk factors of the major gynecological diseases in all ages is clear, and the practical strategies can be provided to improve the health level of women. To improve the level of women's health at all ages in the Zuche County, there is a need to provide direct and indirect interventions at all levels.
【學(xué)位授予單位】：青海大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R29

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