基于生命周期视角的藏医妇科病机转化与预防研究

发布时间：2019-05-27 11:56

【摘要】：研究背景近年来,人们深知女性的身心健康对提高全人类健康水平有着至关重要的作用。对于提高藏区妇女的身心健康,随着女性研究生的不断增多,深入研究藏医妇科学为之已做出了一定的贡献。但是关于某地区常见妇科病的患病率、危险因素、主要和次要因素、高发人群、因素间的交互作用、危险因素与妇科病的关系、妇科病的纵横转归,相应预防策略待需要进一步加强研究。研究目的本研究运用妇女全生命周期保健新视角的思路,首先解析各年龄段的女性饮食与行为保健措施;其次总结各年龄段的主要妇科病的种类及患病率;再次探讨藏医学结合公共卫生学的三级预防策略等作为主要研究目的。第一,通过藏医学的文献研究,明确各重要年龄段的划分标准及生理特征,解析女性特殊时期的饮食与行为保健措施,探讨五大妇科病的分类及各年龄段的纵横转归。第二,通过公共卫生学的文献研究,总结各年龄段高发妇科病的种类、患病率及主要死因,吸收国内外妇幼卫生示范项目的经验及有效实施方案,探讨藏医学结合公共卫生学待需要完成的初步预防工作。第三,通过调查研究,查明泽库县各年龄段常见妇科病的种类及患病率,筛选危险人群及乡镇,提出三级危险因素,探讨主要和次要危险因素,分析危险因素与妇科病的关系,总结目前妇幼卫生项目的经验,结合文献研究内容初步策划待续实施的项目及具体措施,为社区预防工作提供参考。研究方法本研究采取了理论研究与实证分析相结合的方法,综合运用了文献研究、实地考察、问卷调查、访谈、其它相关数据的分析等进行研究。文献研究方面:运用比较、分析、归纳、总结等文献研究方法对藏医学经典书籍、公共卫生学论著、期刊文献、视频、政策文件等相关内容进行剖析。在实地考察方面,考察妇幼卫生项目的示范基地,并请教相关工作人员,为理论与实践相结合提供向导。问卷调查方面:运用横向研究法,选取偶遇非随机抽样,采用自行设计的问卷对参加青海大学泽库县惠民服务活动中的204名藏族牧区育龄妇女进行调查,其内容主要包括一般情况、现病史、孕产史、分娩史等女性特殊时期妇科病的危险因素。访谈方面:访问了当地富有临床经验的十名妇幼卫生工作人员,为问卷调查获得的定量数据分析结果提供进一步的解释。采集其它相关数据方面:对参加青海大学泽库县惠民服务活动中,进行妇科常规检查和全科检查的1128例病人和参与免费宫颈癌筛查项目的1723例妇女的检测结果等原始数据进行回顾性分析。在统计分析方面,对定性资料的录音内容均转录为文字,并结合其它数据进行分析;对定量数据应用Stata14统计软件,采用Fisher检验、卡方检验、方差分析、logistic回归等方法进行分析。研究结果第一,藏医学文献研究的主要结果包括:1.各重要年龄段的特殊时期划分方面,分析影响女性生殖健康的孕期十五个关键周次和五个月份;出生后年、月、日及十九个各年龄段的关键时期。2.各重要年龄段的生理特征方面,探讨各年龄段三大基因与生理变化的交互作用,其中包括孕期每个月的生理发育过程,出生后生理发展期与衰退期的变化。3.各重要年龄段的心理特征方面,解析孕期心智变化过程,出生后结合三时、三因、七大体质的心理变化及外因而引起的女性六个特殊时期的心理变化过程。4.女性特殊时期的饮食保健方面,基于藏医学饮食保健理论并参考中医学关于现代饮食的寒热性理论知识,探讨女性六个特殊时期的饮食保健策略。5.女性特殊时期的行为保健方面,解析女性五个特殊时期的行为取舍,并吸收及阐释国内外孕期不可缺少的十个行为,结合藏医学与现代自然分娩法诠释产时十六个行为的作用机制。6.妇科病的分类方面,总结妇科病的九种分类特点,并依据病因、转移、部位、三因、并发症等,探讨扩充五大妇科病的详细分类法。7.各年龄段妇科病的纵横转归方面,解析常见六大妇科病的发病机制,探讨各年龄段妇科病的六种转归方式。第二,公共卫生学文献研究的主要结果包括:1.总结各年龄段六种妇科病的主要危险因素。2.汇总各年龄段的三十五种主要死亡原因。3.集结各年龄段十二种心理问题的主要因素。4.归纳各年龄段提高妇女健康水平的六十种项目的主要成效及经验。5.吸收三级行为改变理论的八种具体措施。6.探讨藏医学结合公共卫生学,初步实施公共卫生项目的五个基本工作。第三,泽库县实地调查研究的主要结果包括:1.各年龄段常见妇科病的种类及患病率方面,十五岁以下少女的妇科患病率较低,但外阴瘙痒和脓肿相对较多。十七岁以上各年龄段妇女普遍患病率由高到低依次为宫颈糜烂、宫颈肥大、阴道虫病。(p0.05)三十五岁以上的妇女子宫肌瘤患病率较高。(p0.05)四十四岁至五十九岁的妇女疑患宫颈癌前病变的人数较多,(p0.05)其中宫颈病变的患病率为83%,而48%的妇女患有重度宫颈炎,7%的妇女疑患有宫颈癌前病变。2.筛选危险因素的乡镇方面,乡乙的阴道虫病患病率、流产及死胎次数均高于其他乡镇。(p0.05)乡镇甲的子宫肌瘤患病率明显高于其他乡镇。(p0.05)另外,乡镇甲、庚、已、乙的宫颈病变患病率依次加剧。因此,甲和乙是急需预防妇科病的两个主要乡镇。3.内科疾病的分布方面,关节炎和胃炎的患病率最高。尤其是十五岁以下胃炎患病率较高,十五岁以上关节炎患病率较高。(p0.05)4.三级危险因素方面,本研究共发现了七十六个危险因素,其中与个人及家庭相关的有十个主要危险因素,与社区相关的有十三个主要危险因素。尤其是妇女教育程度每增加一年,孕期、产时、产后接受卫生保健服务程度增加3.62个单位。(p0.05)5.妇幼卫生项目实施方面,分析目前实施的八个妇幼卫生项目,并在此基础上探讨藏医学结合公共卫生学的七种待续实施的项目及具体措施,为提高泽库县藏族妇女的健康工作提供参考建议。研究结论首先,文献研究结果显示:1.各年龄段女性生理变化的特点显著,依据生理变化和“得过”进行保健和治疗是重中之重。2.女性的健康需要妇女全生命周期保健新视角进行思考,并需要在可靠的数据引导下实施切实可行的干预措施。3.藏医学拥有现代研究已证明的,临床实践中未开展的,各年龄段的女性保健措施待需要进一步挖掘和开展。其次,田野调查结果显示:1.泽库县藏族妇女的健康状况较差,但各年龄段主要妇科病的种类及危险因素的主次之别较明确,可待提供切实可行的策略从而提高妇女健康水平。2.提高泽库县各年龄段女性健康水平,各级同时需要提供直接与间接的多种干预措施。
[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.
【学位授予单位】：青海大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R29

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