社区健康服务中心开展产后访视工作的研究

A study and valuation on postpartum visits developed by community health service centers

目的:了解产妇及新生儿主要健康问题,分析产妇参加产前系统管理、接受产后访视和产褥期状况的影响因素,总结社区健康服务中心开展产后访视工作模式的优势和可行性.方法:2001年1月1日～12月31日,深圳市罗湖区共22家社区健康服务中心对休养地在罗湖区的产妇6 110人和新生儿6 135人进行了产后访视,对其健康状况进行统计、汇总,并在4家社区健康中心随机抽取213名产妇进行问卷调查,在Foxpro中建立数据库,采用SAS统计软件进行统计分析.结果:产褥期妇女的主要健康问题是乳汁分泌不足(17.89%),伤口愈合欠佳(6.07%);新生儿的主要异常情况是黄疸症状重或持续时间延长(8.43%),湿疹(4.37%).抽样调查显示:①产妇的丈夫为教师、对访视工作的满意度高者,产妇接受产后访视的次数较多;②产妇为科技人员、丈夫为商业人员和个体者是产妇产褥期健康的危险因素;产妇和丈夫的文化程度高则是产妇参加产前系统管理的保护因素;产妇为阴道产、在产褥期适当运动、每天清洗会阴、定时开窗和产后访视次数多为产褥期健康的保护因素.结论:①产后母乳分泌不足、新生儿黄疸是母婴的主要健康问题,应采取综合措施,提高母乳喂养率;②严格掌握剖宫产指征,遏制不合理剖宫产的增加;③社区健康服务中心开展产后访视具有一定的优势和可行性;④运用社区妇幼保健服务新的管理模式,不断完善产后访视工作.

Objective： To understand the main health problems of the lying - in women and newborns and to analyze the influential factors of lying -in women＇s taking part in systemic management in prenatal period, receiving postpartum visit and health condition in perinatal period. It also to summarize the advantage and feasibility of the model of postpartum visit in health service centers. Methods： Twentytwo community health service centers of Luohu District of Shenzhen developed postpartum visit to 6 110 local women during pregnancy and postpartum period and 6 135 newborns from Jan. 1 st, 2001 to Dec. 31st, 2001. Health status of the women and babies were consistently recorded. Four centers were sampled from the 22 centers , and 213 Women who received postpartum visit, were recruited as samples to investigate according to the rule of random sampling. The statistical database was set up by Foxpro and statistically analyzed by analysis software SAS. Results： The most common postpartum issues were weak or little milk （ 17. 89% ）, and by wound healing below the mark （6. 07% ） while the most common newborns morbidities were severe jaundice （8.43 % ）, and eczema （4. 37% ） . The result of multi -factors logistic regression revealed that： ①The women whose husbands were＇teachers and who had higher degrees of atisfaction in postpartum visits had received more postpartum vistis. ②the safty factor of system management in antepartum stage was that the women and their husbands were more educated; The safety factor of health in postpartum stage was that the women had spentancous delivery, made action adequately, washed vulvae everyday, opened windows regularly and received more postpartum visits in postpartum period while the risk factor was that the women were technologists, their husbands were in service industry and were self - employed abourers. Conclusion： The main health problems in postpartum visits were having weak or little milk in mothers and newborn jaundice in babies. We must take essential positive methods to increase the ratio of breastfeeding. （~）Master die index of uterine - incision delivery and prevent the growth of unreasonable uterine - incision delivery. ③Because postpartum visits developed by the community health service centers have larger scope and higher degree of satisfaction, the new model of visits have advantages and feasibility. ④Improve the postpartum visits continuously by means of using the new management model of community maternal and child health care.