已婚已育女性宫内节育器放置的相关因素探讨及对策

发布时间：2018-09-13 14:14

【摘要】：目的：本研究通过调查已婚已育女性人工流产术后影响其选择放置宫内节育器(IUD)的相关因素以及随访放置IUD的女性在术后1个月、3个月不良反应,分析影响已婚已育女性人工流产术后放置和未放置IUD的因素,并提出相应对策和建议。为更好的完善计划生育服务,转变计划生育服务理念,进而降低女性意外妊娠率、减少重复流产率,降低高危流产风险,提高女性的生殖健康水平提供理论数据。方法：以2014年9月至2015年5月到广西医科大学第一附属医院计划生育门诊行人工流产手术终止妊娠的542例已婚已育女性为研究对象,其中选择术后放置IUD女性209例,选择不放置IUD女性333例。采用自行设计的IUD放置服务调查表进行问卷调查,并对放置IUD的女性在术后1、3个月进行电话随访,调查其术后不良反应情况。问卷资料运用Epidata 3.1软件进行双录入电脑,建立影响已婚已育女性人工流产术后放置IUD相关因素的数据库。所有数据采用SPSS16.0软件包进行相应的统计分析,构成比资料的比较使用卡方检验,对多项选择题应用多重响应变量方法分析,对影响IUD放置的相关因素进行分层分析及非条件Logistic回归模型分析。P0.05为差异有统计学意义。结果：1.人工流产术后选择放置IUD与未放置IUD的女性在年龄、文化程度、职业、原采用避孕方法、关于避孕方法知识获得渠道及关于IUD知识的获得渠道上有差异,具有统计学意义。2.年龄越大,IUD放置比例越高,并随着年龄的增加选择放置IUD的比例显著升高(以30岁为参照组,OR=1.6-7.7)。文化程度越高,IUD放置比例越低。3.已婚已育女性中,孕次越多,IUD放置比例越高(以孕1次为参照组,OR=3.0)。产次越高放置IUD比例越高(以产1次为参照组,OR=4.1)。末次分娩时间距今时间越短放置IUD比例越低(以末次分娩时间距今≥11年为参照组,OR=-2.7-14.2)。4.选择放置IUD女性对放置IUD好处、人工流产术后可立即放置IUD的知晓率高于未放置组(P＜0.05)。两组女性在近3年内是否有生育需求的差异有统计学意义(P＜0.05),无生育需求女性选择放置IUD的比例远高于有生育需求者(OR=-15.2)。IUD费用越高,则女性放置IUD的比例降低(OR=3.2-11.4)。5.多因素非条件Logistic回归分析显示,在控制了其他的影响因素后,影响已婚已育女性人工流产术后是否放置IUD的主要因素为生育需求(OR=24.0)、能承担IUD的费用(OR=3.2-10.8)、产次(OR=-3.5)、年龄(OR=1.1-3.3)及对人工流产术后可立即放置IUD的知晓度(OR=1.7)。6.209例女性选择放置IUD的主要原因为：方便106例(50.7%),安全82例(39.2%),不愿吃药及不愿用避孕套等66例(31.6%),避孕有效率高57例(27.3%)、近三年内无生育需求55例(26.3%)。7.选择放置IUD女性术前担心放置IUD后会出现副反应137例(65.6%),术后1、3个月随访时有异常者分别为79例(37.8%)、50例(23.9%)。术前担心出血模式改变78例(37.3%),术后3个月出现此异常情况为29例(13.9%)；术前担心腰酸腹痛者75例(35.9%),术后3个月出现此情况分别为10例(4.8%)。8.未放置IUD的女性中受个人因素影响241例(72.4%),受家庭因素影响185例(55.6%),担心放置IUD相关风险246例(73.9%),受政策、西方文化、经济因素影响者较少。9.对于未放置的女性,其希望获得IUD的信息为：需哪种IUD更好101例(30.3%),IUD效果78例(23.4%),放置IUD是否疼痛67例(20.1%),IUD是否影响生育62例(18.6%),IUD有何副作用40例(12.0%)；仍需获得的帮助为：医护详细介绍124例(37.5%),相关文字资料119例(36.0%)。结论：1.影响已婚已育人工流产女性IUD放置的最主要因素是生育需求,其次是经济因素、产次、年龄以及对流产术后可立即放置IUD的知晓度。2.已婚已育女性放置IUD的影响因素主要依赖于IUD的优点、个人喜好、家庭避孕责任的承担、政府政策影响、自身疾病等。3.出血模式改变、腰酸腹痛、感染、脱落、带器妊娠是已婚已育女性放置IUD术前担心的主要因素,而这些情况在术后的发生比例却远远低于担心比例。4.对于选择流产术后不放置IUD的已婚已育女性,其不放置IUD的最主要是原因是近3年有生育需求,其次是担心出血模式改变、异物排斥感、担心腰酸腹痛。
[Abstract]:Objective: To investigate the factors influencing the placement of IUD in married women after induced abortion and the adverse reactions of women who received IUD at 1 month and 3 months after operation, and to analyze the factors influencing the placement and non-placement of IUD in married women after induced abortion. Methods: From September 2014 to May 2015, we conducted family planning clinic in the First Affiliated Hospital of Guangxi Medical University. 542 married and fertile women who terminated pregnancy after induced abortion were selected as subjects, 209 women with IUD and 333 women without IUD. Self-designed IUD placement service questionnaire was used to conduct a questionnaire survey, and women with IUD placement were followed up by telephone at 1 and 3 months after operation to investigate the adverse reactions. Conditions. Questionnaire data were entered into the computer by using Epidata 3.1 software to establish a database of factors related to placement of IUD after induced abortion for married and fertile women. All data were analyzed by SPSS16.0 software package. The comparison of the data was made by chi-square test, and multiple response variable method was applied to multiple choice questions. Results: 1. After induced abortion, the women who chose to place IUD and those who did not place IUD were in age, education level, occupation, the way of using contraceptive methods, the channels of obtaining knowledge about contraceptive methods and the IUD. 2. The higher the education level, the lower the IUD placement ratio. 3. The more pregnant the married women, the higher the IUD placement ratio. For the control group, OR = 3.0). The higher the parity, the higher the placement rate of IUD (OR = 4.1). The shorter the time between the last delivery and the present, the lower the placement rate of IUD (OR = 2.7-14.2). 4. The better the placement of IUD, the higher the awareness rate of IUD placement immediately after induced abortion. There was a significant difference between the two groups (P < 0.05). The proportion of women who chose to place IUD without fertility requirement was much higher than that of women who had fertility requirement (OR = - 15.2). The higher the cost of IUD, the lower the proportion of women who placed IUD (OR = 3.2-11.4). 5. Multivariate unconditional logistic regression analysis showed significant difference. After controlling for other factors, the main factors affecting the placement of IUD after induced abortion for married and fertile women were fertility demand (OR = 24.0), ability to bear the cost of IUD (OR = 3.2-10.8), parity (OR = - 3.5), age (OR = 1.1-3.3) and awareness of placement of IUD immediately after induced abortion (OR = 1.7). 6.209 women chose to placement of IUD. The main reasons were convenience 106 cases (50.7%), safety 82 cases (39.2%), reluctance to take medicine and condom 66 cases (31.6%), high contraceptive efficiency 57 cases (27.3%) and lack of fertility demand 55 cases (26.3%) in the past three years. There were 79 cases (37.8%) and 50 cases (23.9%) respectively, 78 cases (37.3%) were worried about the change of bleeding pattern before operation, 29 cases (13.9%) were worried about the abnormality 3 months after operation, 75 cases (35.9%) were worried about low back pain before operation and 10 cases (4.8%) were worried about abdominal pain 3 months after operation. 85 cases (55.6%), 246 cases (73.9%) worried about the risk of IUD placement, less affected by policy, western culture and economic factors. Conclusion: 1. The most important factors affecting the placement of IUD in married women with abortion are reproductive needs, followed by economic factors, parity, age and awareness of placement of IUD immediately after abortion. 2. Married women Influencing factors of IUD placement for women with childbearing mainly depend on the advantages of IUD, personal preferences, family contraceptive responsibilities, government policies, and their own diseases. 4. For married and fertile women who choose not to place IUD after abortion, the main reason for not placing IUD is that they have reproductive needs in the past three years, followed by worrying about changes in bleeding patterns, foreign body rejection and low back pain.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R169.41

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