80年代末期上海妇女哺乳行为及影响因素分析

对８０年代末上海市卢湾、虹口两区的７８２６对新婚夫妇婚后１５个月内，生育一孩后的哺乳行为及其影响因素的分析表明，至婚后１５个月，已有７１．６％的夫妇生育一孩。这些夫妇产后２周时的哺乳率为７０．７％。人工喂养的主要原因是无母乳或母乳不足（占总数的８２．８％）。Ｌｏｇｉｓｔｉｃ回归分析表明，影响哺乳行为的母亲方面的因素有年龄、受教育程度、企业性质、生育意愿、对配偶的满意情况及某些个性特征。婴儿方面的因素有出生体重、早产及婴儿异常。并对各种不同特征妇女的哺乳率作了分析。     

新婚夫妇对避孕方法可接受性分析

对上海市卢湾、虹口两区的７８２６对新婚夫妇的口服避孕药、宫内节育器（ＩＵＤ）、避孕套及避孕针４种避孕方法的可接受性进行了分析。结果表明，６３．７％的对象诉说不愿使用口服药及５．７％的对象不愿使用避孕针，主要原因怕影响健康及使人发胖。８．７％的对象不愿使用ＩＵＤ，主要因为怕月经过多或不干净及容易失败。６．２％的对象不愿使用避孕套，主要原因怕影响性生活及使用不便。获得这些情况的首要途径皆为听他人议论。单因素及ｌｏｇｉｓｔｉｃ回归分析显示，妇女的年龄、文化程度、职业、家庭经济状况、避孕知识分数、以往避孕史及其某些个性特征等影响其可接受性。提示，加强对新婚夫妇避孕知识的宣教，提高他们对避孕方法副作用的正确认识以及减少避孕药具的副作用，对提高避孕方法的可接受性是必要的。     

Prevalence of term low birth weight andits determinants in Shanghai,China

Objective: To investigate the prevalence of term low birth weight (TLBW) and its risk factors. Methods: A follow-up study with 7, 872 couples was conducted from 1987 to 199o beginning from the time they got marriage licenses in two districts defined in Shanghai. They were interviewed in the third month and again in the fifteenth month and in the fifth to sixth year afterwards individually at home. The total follow up rate reached 98%. Couple's background characteristics as well as the information on their general health. reproductivc history and contraceptive use etc.. were collected dynamically. All of the single live births with term delivery were Included for data analysis in this paper. Adjusted odd ratios and population attributable risk (PAR%) were computed. Results: The prevalence of TLBW in Shanghai single term live births was 2. 0% (134,/6.573), represents 54. 7% (134/245) of the total low birth weights in our sam pie. Significant social and behaviour risk factors relating with TI-BW were wife's dissat- isfaction with marriage; low education level of husband; co-residence with parents during pregnancy; heavy housework done by the wife while being pregnant. Significant biomedical risky factors were menarche age greater than 16 years old; maternal age at delivery greater than 29 years old; maternal body mass index less than 19. 8; wife suf- fered from serious disease prior to conceiving; having pregnancy complication; gestational weight gain less than 20 % of pre-pregnancy weight; having abortion, stillbirth and fetal death history. Conclusion: TL.BW constituted over half of all low birth weights in Shanghai. Special attention should be paid to the determinants mentioned above in TLBW intervention program. Improving couples' economic and living condition and husband 's education at tainment, and caloric supplementation with women while being pregnant would all be particularly effective in reducing the occurrence of TLBW in Shnaghai.     

上海市夫妇婚后15个月时避孕知识状况及影响因素的分析

目的 :了解夫妇各自于婚礼后 1 5个月时避孕知识状况及影响因素。比较影响双方该时点避孕知识得分的因素。方法 :对上海市近 80 0 0对初婚夫妇自办婚礼后进行 2次随访。由拟合多元线性回归模型比较影响因素。结果 :该时点平均避孕知识得分妻子略高于丈夫 ,平均分别为 1 1 .7及 9.9分 ;对避孕措施一无所知分别为 1 .4%及 6.2 % ;对避孕套一无所知分别为 4.8%及 6.3 %。虽 98%的妻子及 81 %的丈夫知晓口服药 ,但能正确讲述其使用方法仅分别为 1 9%及 1 1 % ;分别有 44 %及 3 0 %未能正确掌握使用避孕套。多元回归模型显示 ,该时点夫妇避孕知识主要来自配偶、自我阅读或家庭内环境的改变。不愿服药或对避孕措施持否定态度的妻子其得分明显偏低。而新婚是否曾用避孕措施或多数性行为仅影响丈夫的得分。结论 :妻子产后近期对避孕措施的了解相对较丈夫被动。计划生育人员及社会媒体有必要消除夫妇对口服避孕药认识的误区 ,指导做好知情选择     

上海市婚后六年妻子避孕知识状况及影响因素分析

目的 :了解上海市 80年代末初婚 76 93对夫妇婚后 6年内妻子避孕知识状况。方法 :由描述及拟合多元线性回归模型对影响妻子婚后 6年时避孕知识得分的因素进行分析。结果 :该时 96 .3 %的夫妇已有一孩 ;妻子平均避孕知识得分 ( 1 6 .4分 )虽明显高于新婚 3个月时 ( 5.9分 ) ,但与婚后 1 5个月时比较 ( 1 1 .9分 ) ,无显著差异 ;0 .9%仍对避孕措施一无所知 ;2 0 .5%仍不会正确使用避孕套 ;虽 95%知道口服药 ,仅 3 1 .8%能正确述出使用方法 ,对安全期基本了解的正确性相对较高 ,在 91 .7%的知道该措施的妻子中 ,77.1 %能基本掌握推算排卵期方法。多元回归模型显示 ,该时妻子避孕知识得分主要与其对避孕措施的负性态度、了解生殖健康有关知识的广度或受丈夫的避孕知识的影响有明显关系。不了解避孕套能预防艾滋病、性病或不愿使用某避孕措施的妻子其避孕知识得分明显偏低 ;产后首选非宫内节育器或有多种性生活体位者该时的避孕知识得分也相对较高。结论 :随婚后时间的推移 ,上海市妻子避孕知识增长趋向缓慢。计划生育工作人员及社会媒体有必要结合生殖健康知识的普及 ,继续加强对已生育孩子的夫妇双方避孕知识 ,特别是口服药对妇女健康效应的教育 ,以提高可接受性 ,进一步保障妇女健康、降低人工流产率。     

Research on the incidence and prevalence of congenital abnormalities in Iaşi district and Iaşi city, from 2001 to 2008

Congenital abnormalities (CA) are deviations from the normal embryonic development that appear antenatal and they are characterized by the alteration of the morphology and function of an organ, system of organs or even of the entire body. MATERIAL AND METHOD: The study, on a period of eight years, included 1685 children with CA, from which 58% were males and 50% were from the country-side. RESULTS: It has been observed that 36% of the CA cases were premature births and 64% were normal term births. Also, 21% of the children with CA weighed less than 2700 grams at birth and 79% weighed more than 2700 grams at birth. The birth's APGAR score has been less than 7 in 30% of the cases and higher than 7 in 70% of the cases. 72% of the cases were natural births and 28% were caesarian births. 88% of the CA cases were singular congenital abnormalities and 12% were multiple congenital abnormalities. 24% of the CA were cardiac abnormalities and 21% were skeletal abnormalities. 3% of the subjects of the study have died, of which 69% died from cardiac abnormalities, 22% from hydrocephalus abnormalities, 7% from diaphragmatic hernia and 2% from renal congenital abnormalities.     

上海市两社区初婚已分娩夫妇人工流产后开始选用避孕措施状态及影响因素的分析

对上海市两社区 71 0 1对于 1 987～ 1 988年初婚并于婚后 5～ 6年时已有孩子的夫妇进行 8年的前瞻性队列调查。结果显示 ,其中 9.3 % (6 6 3对 )的夫妇是于人工流产(人流 )术后开始选用避孕措施 (在本次调查的 2 52 7例产后至少有一次人流者中占2 6 .2 % )。在 6 3 3例产后完全暴露于妊娠危险状况的夫妇中 ,1 / 3的妻子因感避孕麻烦而原就准备于人流术后放环避孕。 51 .3 %的夫妇认为产后夫妇性生活少、哺乳期或未转经、月经量少不会受孕等而未于产后及时避孕。近 80 %未及时避孕的妻子于恢复性生活后 1年内受孕。56 .4 %未及时避孕的妻子均于人流术后放置环 ,其中 1 / 2的妻子认为于该时放环最有效。在产后非人流术后开始避孕的妻子中仅 8.1 %首选放环 ,从有效性出发首选放环的仅占 1 / 3。拟合双反应 L ogistic回归模型显示夫妇人口统计学 (妻子婚龄、宗教信仰、夫妇月收入 ) ,生育意愿 (婚后推迟生育时期 ) ,心理学因素 (产后妻子健康状况 ) ,妻子对人流的态度 ,夫妇的避孕知识 (特别丈夫在二访时 ) ,性生活状况等多种因素均显著影响到夫妇产后是否及时避孕。结果显示 :(1 )要加强对夫妇 ,特别是妻子 ,产后一旦恢复性生活及时避孕的教育 ;(2 )对有关人流后放环和人流术本身对妇女健康潜在危险性等开     

中老年女性骨密度相关因素的临床分析

目的　分析中老年女性骨密度的相关因素。方法　从 2 0 0 1年 9月至 2 0 0 2年 8月分层随机抽样 10 90名妇女 ,询问病史、体检 ,按 1∶3的比例随机抽样 330名妇女 ,用双能X线骨密度仪测量其骨密度。结果　随着年龄的增大和绝经年限的延长 ,妇女的骨密度逐渐下降 ,其骨密度值与年龄、绝经年限、初潮年龄、月经周期天数、孕、产次、产后哺乳月数、吸烟、喝酒呈显著负相关 (P <0 . 0 5 ) ,与身高、体重、体重指数呈显著正相关 (P <0. 0 5 )。用逐步回归的方法进行分析 ,年龄、绝经后年限、喝骨头汤量可以进入方程。结论　妇女的骨密度在 4 0岁以上逐渐降低 ,年龄越大、绝经年限越长、孕产次越多、产后哺乳时间越长、有吸烟喝酒习惯者 ,其骨密度较低 ;而体重、体重指数越大 ,其骨密度较高。     

产后抑郁症相关因素调查研究

目的探讨产后抑郁症的相关因素.方法采用分层整群抽样方法,对长沙市4所医院300例产后6周复查的初产妇进行Edinburgh产后抑郁量表与自编问卷调查.结果产后抑郁症的发生率为17.3%;产妇年龄、婚姻状况、教育程度与产后抑郁症无关(均P＞0.05),分娩疼痛承受力、分娩方式、新生儿性别、母婴同室、母乳喂养为产后抑郁症的影响因素(P＜0.05、P＜0.01),且分娩方式是产后抑郁症的危险因素,分娩疼痛承受力与母婴同室是保护因素.结论产后抑郁症发生率较高,其影响因素应引起产科工作人员的重视.     

上海市夫妇产后五年内首选避孕措施失败及停用的研究

对上海市卢湾、虹口两区 80年代末 71 0 1对初婚并已生育孩子的夫妇进行产后避孕状况的定群队列随访研究。结果显示 ,产后 5年内至少又妊娠过 1次的夫妇为40 .5 % ;妊娠过 2或 3次的夫妇分别为 5 .0 %及 0 .8% ;因带环或环移位而受孕的比例由 1次妊娠的 1 7.8%上升到 3次妊娠的 5 3 .1 %。首选避孕措施失败的主要原因 :安全期计算失误 (3 3 .4% )、环问题 (其中带环妊娠 1 7.8%、脱落 1 2 .6% )、未正确用套 (1 7.8% )及体外排精失控 (9.7% ) ,因漏用措施而妊娠者多在避孕套使用者 (65 .2 % )。寿命表法分析显示 ,夫妇产后 1 2个月时总避孕失败率 (2 6.4% )略低于新婚期 (44 .0 % ) ,但产后首选口服药或杀精剂的同期失败率却明显高于新婚期首选该两类的夫妇 ,避孕套及体外排精使用者失败率产后低于新婚期。提示产后妻子避孕实践的认真性不及丈夫。为进一步降低放环后脱落或带环妊娠 ,对放环妇女必须加强指导及做好随访     

严重少精子症患者行卵胞浆内单精子注射治疗单个取卵周期累积活产率分析

目的分析严重少精子症患者行卵胞浆内单精子注射(ICSI)治疗的单个取卵周期累积活产率。方法回顾性分析2014年1月至2019年9月在本院生殖医学科因男方严重少精子症为主要指征接受ICSI治疗的187对不育夫妇的临床资料,其中8对夫妇伴有男方染色体异常,单独列出分析。将最终纳入的179对夫妇的240个取卵周期按照女方年龄分为≤35岁、36～39岁、≥40岁组;按照获卵数不同分为≤5枚、6～10枚、11～15枚、≥16枚组,比较各组的移植胚胎情况及累积临床妊娠率和累积活产率。结果 179对夫妇目前的单个取卵周期累积活产率为50.00%(96/192)。≤35岁组、36～39岁组、≥40岁组的获卵数、可利用胚胎数、累积临床妊娠率及活产率比较均有显著性差异(P<0.05),随着女方年龄的增加,获卵数、可利用胚胎数、累积临床妊娠率及累积活产率均呈下降的趋势。不同获卵数组间比较,随着获卵数的增加,可利用胚胎数显著增加(P<0.05)。获卵数≥6枚的各组与≤5枚组比较,女方年龄、无可利用胚胎率、平均移植胚胎数、平均移植优胚数、累积临床妊娠率、累积活产率均显著升高(P<0.05)。获...     

两种不同黄体酮制剂对冻融胚胎移植周期围产期结局的影响

目的初步探讨两种不同的黄体酮制剂对冻融胚胎移植(FET)周期围产期结局的影响。方法采用回顾性队列研究,选取2013年1月至2017年5月在空军军医大学唐都医院妇产科生殖医学中心采用非激素替代周期方案行FET后获得单胎活产的患者共1 803个周期为研究对象,根据黄体支持药物不同分为单纯肌肉注射黄体酮针剂组(黄体酮针组,1 297个周期)和单纯阴道用黄体酮缓释凝胶组(雪诺同组,506个周期),比较两组出生子代<37孕周的早产率、平均出生孕周和平均出生体重的差异,通过单因素分析及分层分析探讨子代出生孕周及出生体重的影响因素,通过多元回归分析确定不同黄体酮制剂对子代出生孕周及出生体重的影响。结果雪诺同组与黄体酮针组相比,出生子代<37孕周早产率显著降低(5.53%vs.8.64%,P<0.05),平均出生孕周有所延长[(38.80±1.46) vs.(38.57±2.41)周,P<0.05]。单因素分析及分层分析提示,不同的黄体支持方案、不孕夫妇双方高龄及辅助孵化与出生孕周显著关联(P<0.05);顺产分娩方式与出生体重显著关联(P<0.05)。多元回归分析...     

Nitroglycerin to relax the uterus during cesarean delivery for the low birthweight baby

BACKGROUND: The uterus at premature birth being thick and sensitive, we applied nitroglycerin (NTG) to relax the uterus during cesarean delivery for the low birthweight baby. METHODS: Twelve parturients of impending premature birth and nine of severe intoxication were included. General anesthesia was induced with thiamylal, and maintained with 5% inhaled sevoflurane. NTG was injected in an intermittent dose of 500 microg. The relative hardness of the uterus at delivery was evaluated by obstetricians in four ranks of categories. RESULTS: The mean gestation period was 27.4 weeks (24 weeks at the minimum-33 weeks at the maximum) and the mean birthweight was 986 g (561-1518 g). The mean time elapsed from induction of anesthesia to delivery was 8.3 min (2-14 min) while NTG was injected for the mean 1.8 times that reflected a total dose of 900 microg (500-1500 microg). The mean endtidal concentration of sevoflurane at delivery reached 3.8% (3.4-4.3%). The uterus was evaluated as "very soft" in 15 out of 21 cases, and all babies were extracted easily without injury through the lower J-shaped section of the uterus. The mean Apgar score was 2.9 points at 1 minute and 6.3 points at 5 minutes. No adverse effect of NTG on the mothers or babies was noticed. CONCLUSIONS: NTG relaxes the uterus effectively and facilitates cesarean delivery for the low birthweight baby.     

口服佐洛复结合行为疗法治疗早泄

目的 :探讨口服佐洛复结合行为疗法治疗早泄的效果。　方法 :5 2例病人采用治疗前后自身对照研究 ,记录病人用药前后的射精潜伏期和夫妻对性生活的满意程度。　结果 :5 2例病人射精潜伏期延长 (P <0 .0 1) ,对性生活的满意程度提高。　结论 :口服佐洛复结合行为治疗是治疗早泄的一种有效方法     

Childbearing after liver transplantation

Seventeen female patients who underwent orthotopic liver transplantation between June 1973 and June 1987 became pregnant 5 months to 11 years after transplantation. Immunosuppression was maintained with combinations of prednisone, cyclosporine, and azathioprine prior to and during pregnancy. One patient discontinued immunosuppression after knowledge of pregnancy, taking only azathioprine sporadically. Mean age at time of delivery was 26 years. Twelve patients had no alteration in liver function studies; 7 patients demonstrated mild or moderate enzyme elevations prior to delivery, with one case of rejection confirmed by percutaneous liver biopsy. Major problems related to pregnancy were hypertension, anemia, and hyperbilirubinemia. Twenty live births occurred (2 patients had 2 separate pregnancies, one patient had a set of twins); 13 were by cesarean section, 7 by vaginal delivery. Eleven of the 13 cesarean births were premature by gestational age. All vaginal births were term. Toxemia of pregnancy and early rupture of membranes were the principal indications for cesarean section. There were no congenital abnormalities or birth defects and all the children are surviving well. Fifteen of 16 children older than one year all have normal physical and mental development, with one child manifesting immature speech development. Four children are under one year, all with normal milestones thus far. Sixteen of the 17 mothers are alive from 2-18 years after transplantation; the only death was from a lymphoma, almost 4 years after transplantation and 2 1/2 years after delivery. This experience suggests that women undergoing liver transplantation can safely bear children despite an increased risk of premature cesarean births. The effect of chronic immunosuppression of female pediatric patients on their reproductive potential later in adulthood remains to be fully evaluated but the results so far are favorable.     

Current trends in infant feeding

This study examined aspects of newborn feeding in a maternity hospital and also investigated feeding practices during the first 6 months of life. Four hundred and fifty mothers were interviewed while in the maternity hospital. The majority (93%) had booked for their confinement and had attended antenatal clinics regularly. Most had had early contact with the baby at birth and stated that they thought breast-milk was best for the baby. Despite this only 54.6% had given breast-milk as the first feed and only 10% had done so within the first hour. Most mothers (54%) stated that they preferred a timed feeding routine to demand-feeding, while 86% planned to give water between feeds. The majority indicated they would change to formula feeds should they experience problems with breast-feeding. A follow-up visit of 78 mothers 6 months later showed that 50% breast-fed exclusively for 3 - 4 months and 23% for 6 - 7 months. When feeding problems occurred only 27% of the mothers utilised the local authority baby clinic for help. The main reasons given for stopping breast-feeds were insufficient milk, the need for employment and feeding problems. The implications of these findings are discussed.     

Characteristics of male fertility after renal transplantation

We investigated factors such as time span between transplantation and having offspring, the dosage of immunosuppressive agents during fertilisation and the effects of fertilisation on recipient's renal allograft function in 212 male recipients registered at eight Chinese organ transplantation centres. Our results are as follows: the 212 male renal allograft recipients conceived with their wives between 15 and 204 months after transplantation. The wives who became pregnant at 15-24 months after the renal transplantation gave birth to a total of 20 babies with an average weight of 3115 ± 517 g, of which 3 (15.0%) were premature. The wives who became pregnant at 25-204 months after the renal transplantation gave birth to a total of 196 babies with an average weight of 3384 ± 438 g, of which 6 (3.1%) were premature. All recipients had normal renal function during the fertile period. In conclusion, the fertility capacity of male renal allograft recipients was associated with the time after transplantation and the dose of immunosuppressive agents used during fertilisation. It might be helpful to have a fertility capacity evaluation before fertilisation. There were no effects of fertility on renal allograft function.     

眼球居中指导日间门诊眼底检查术早产儿七氟醚吸入麻醉的效果

目的 探讨眼球居中指导日间门诊眼底检查术早产儿七氟醚吸入麻醉的效果.方法 矫正胎龄(末次月经第1天至接受眼底检查时的周数)为44～64周拟行眼底检查术的早产儿,随机分为2组:体动组和眼球居中组.麻醉诱导:面罩吸入6%七氟醚,氧流量3 L/min,保留自主呼吸.麻醉诱导后使用开眼器撑开眼睑行眼底检查.采用up-and-down法确定麻醉维持期间七氟醚吸入浓度.两组初始维持浓度均为3%,相邻浓度差值为0.5%.计算体动组七氟醚抑制体动反应的半数有效浓度及其95%可信区间[EC50(95%CI)]和眼球居中组七氟醚使眼球居中的EC50(95%CI).记录麻醉维持期间体动或眼球居中情况、最低SpO2、呼吸抑制和呛咳的发生情况.结果 体动组共入选早产儿27例,七氟醚抑制体动反应的EC50(95%CI)为2.9%(2.2%～3.6%),眼球居中组共入选早产儿3例,七氟醚使眼球居中的EC50(95%CI)为3.4%(2.6%～4.6%).眼球居中组EC50高于体动组(P＜0.05).两组均顺利完成眼底检查,未见呼吸抑制和呛咳,清醒后1 h早产儿饮水及喂奶时无呛咳和呕吐发生.最低SpO2比较差异无统计学意义(P＞0.05).体动组眼球居中早产儿8例,均无体动;无体动早产儿14例,其中眼球居中早产儿8例.眼球居中组眼球居中早产儿15例,均无体动;无体动早产儿24例,其中眼球居中早产儿15例.结论 早产儿日间门诊眼底检查术中吸入七氟醚麻醉时适宜应用眼球居中作为判断麻醉深度的标准.     

Early postnatal renal growth in premature infants

AIMS: To assess postnatal kidney volume development and to compare the intrauterine and extrauterine kidney growth curves of premature infants. METHODS: One hundred neonates were enrolled in this study, and all infants had their kidney volumes measured by renal ultrasound examination. Group GA consisted of 44 neonates who were evaluated within 48 h after birth, and their gestational ages were used in the analysis. Group CA included 56 premature infants born before 34 weeks of gestation and was evaluated 14-96 days after birth, and their conceptional ages were used in the analysis. Left kidney volume, body weight, body height and age were used in the correlation analysis. RESULTS: There was a better kidney growth rate for Group GA infants than for Group CA infants (P = 0.001). Kidney volumes in Group CA infants were thus apparently larger than those of the Group GA infants before 31 weeks of age, but they were smaller after 31 weeks of age. Group GA infants had a significantly faster growth in body weight (P = 0.001) and body height (P < 0.001). However, a larger kidney volume was noted in Group CA infants with the same body weight (P < 0.001). CONCLUSION: A chart is presented of the postnatal growth of normal kidney volume before 40 weeks conceptional age in premature infants. These data suggest that intrauterine growth may have a regulatory influence on kidney growth, and the reduced kidney volume in premature infants may result from the early extrauterine period.