分娩方式对母婴身心健康的影响及机制

发布时间：2018-04-24 01:43

本文选题：分娩方式 + 母婴　；参考：《山东大学》2008年硕士论文

【摘要】： 目的探讨分娩方式对产妇和儿童心理、行为及健康状况的的影响及发生原因,为规范产科医生的职业行为,促进母婴身心健康水平提供科学依据。对象与方法分娩方式对儿童免疫系统的影响:随机选择济宁市第一人民医院、济宁市中区妇幼保健院、济宁市第二人民医院顺产与社会因素剖宫产新生儿各100名,按其分娩方式分为顺产组和社会因素剖宫产组。在每个产妇生产过程中各取脐静脉血6ml,分别采用Sysmex Kx-21血细胞仪测定全血白细胞和单抗桥联酶标法测定T细胞亚群(CD_3、CD_4)。比较两组免疫细胞水平。分娩方式对儿童远期作用的影响:采用整群抽样方式,在济宁、日照两市各随机抽取城区和郊区小学一年级学生共九个班453名学生,根据家长回忆和查阅有关产科记录将以上儿童分为顺产组和剖宫产组。按照预先设计好的“儿童心理、行为调查表”由统一培训好的调查员讲解后,由其父母根据儿童近半年的表现进行填写,将调查结果按照“儿童行为、感觉统合能力发展评定量表”进行评分,比较两组的评分结果。分娩方式对产妇妇科疾病发病率的影响: 于2007年6月对以上济宁、日照两市随机抽取453名小学一年级学生的母亲进行回顾性调查。在调查人员统一讲解有关内容和填写方法的前提下,根据现场调查和产科记录,比较剖宫产组和顺产组两组产妇出现腹部不适、腹腔脏器粘连、子宫肌瘤、子宫内膜异位症、盆腔炎等并发症的发病率。不同分娩方式的产妇激素水平的比较:以济宁市第一人民医院、济宁市中区妇幼保健院、济宁市第二人民医院的200名产妇为研究对象,按其分娩方式分为顺产组和社会剖宫产组。在每个产妇生产过程中各取肘静脉血2ml,采用放射免疫法测定两组产妇的皮质醇和雌二醇含量并进行比较分析。结果剔除项目填写不全者及多胎、家族精神和遗传病史、出生缺陷、颅脑外伤史、急症剖宫产等,共收回有效问卷399份,其中男孩194人,女孩205人(男:女=9:10);年龄分布为6-7岁;顺产221例,剖宫产178例。两组产妇及儿童的一般情况比较:两组产妇的文化程度、家庭经济状况差异没有显著性(P＞0.05)。社会因素剖宫产组新生儿白细胞、中性粒细胞分别为12.3±3.48×10~9/L和0.42±0.094%,顺产组新生儿分别为15.9±3.86×10~9/L和0.53±0.084%,后者明显多于前者,两组之间差异有显著性(P＜0.05)。而社会因素剖宫产组婴儿CD_3、CD_4分别为0.49±0.076%和0.374±0.075%,顺产组婴儿CD_3、CD_4分别为0.48±0.042%和0.362±0.047%,虽然前者高于后者,但两组之间差异并没有显著性(P＞0.05)。此外,在对分娩方式对儿童远期行为的影响时发现:顺产组儿童感觉统合失调征的发病率为26.0%、而社会因素剖宫产组为43.0%,两组之间差异有显著性(P＜0.05);在CBCL调查中,共发现86例行为异常儿童,发病率21.6%,其中剖宫产组儿童47例(47/178),顺产组儿童39例(39/221),两组之间差异有显著性(P＜0.05)。不同分娩方式产妇的妇科疾病发生率比较。结果发现,实行剖宫产的178名产妇出现宫外孕5例、内膜异位症9例、肠粘连17例、抵抗力下降70例、子宫肌瘤23例和盆腔炎31例,明显高于顺产产妇(宫外孕1例、内膜异位症3例、肠粘连4例、抵抗力下降37例、子宫肌瘤8例和盆腔炎16例),两组之间除宫外孕外差异有显著性(P＜0.05)。不同分娩方式产妇的激素水平比较。结果发现,自然分娩组产妇的皮质醇与雌二醇水平[18.032±3.066;1299.18±71.71]明显高于剖宫产组产妇[7.805±1.987;646.0±93.659]水平,两组之间差异有显著性(P＜0.05)。结论结果显示,剖宫产组儿童的非特异性免疫力有所降低,但特异性免疫力降低不明显;剖宫产组儿童感觉统合失调、行为异常发病率高于顺产组儿童。剖宫产产妇产后妇科疾病发病率高于顺产组产妇,雌二醇及皮质醇的分泌低。提示我们,为了提高产妇和儿童的身心健康,医生在诊疗过程中,除非有明确的剖宫产适应征,尽量不要对产妇采取剖宫产的分娩方式。剖宫产后妇女妇科疾病发病率增高可能与体内激素水平的变化有关。
[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.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R719.8;R395

【引证文献】