产后运动指导及高钙饮食对产后骨密度恢复的影响

THE POSTPARTUM EXERCISE GUIDANCE AND HIGH CALCIUM DIET ON BONE MINERAL DENSITY(BMD) IN POSTPARTUM RECOVERY

目的:探讨产后运动指导及高钙饮食对产后骨密度恢复的影响。方法:选择在我院产科单胎足月分娩的健康产妇144例为观察对象,随机将产妇分为A、B、C 3组,每组48例。A组产妇每日口服碳酸钙600mg;牛奶250mL,2次/d;指导运动(产后2个月开始,以4km/h的时速快步走30min/次,5～7次/周);B组产妇每日口服碳酸钙600mg;牛奶250mL,2次/d;由我课题组成员专人负责督导;C组无专人督导其服钙片、牛奶及进行运动指导。所有产妇分别于产后3d内、产后12个月测量骨代谢指标[血碱性磷酸酶(ALP)、尿钙/尿肌酐(Ca/Cr)]和一侧股骨颈及腰椎骨密度。结果:①孕期(产后3d内测定)骨量减少发生率为(100/130)76.9%,A组34例,B组35例,C组31例,3组比较差异无统计学意义(χ2=0.073,P=0.964);产后12个月骨密度恢复正常的人数A组为33.3%(17/45),B组为20%(10/45),C组为12.5%(5/40),3组比较差异有统计学意义(χ2=7.504,P=0.023);②在产后12个月3组左侧股骨颈及腰椎骨密度比较,差异有统计学意义(P<0.05),A组最高;3组的血ALP、尿Ca/Cr比较差异有统计学意义(P<0.05),A组最低。结论:孕期容易发生骨量减少,哺乳期造成骨量进一步丢失。在哺乳期适当的运动辅以高钙饮食可促进骨密度恢复,降低骨转换率。

Objective：To investigate the effect of postpartum exercise guidance and high calcium diet on bone mineral density（BMD） in postpartum recovery. Methods：Chose 144 health parturients full-term delivery of single fetus in our hospital to survey,mothers were randomly divided into groups A, B and C with 48 cases each group. Group A of maternal daily oral calcium carbonate 600 mg; milk 250 mL, twice a day; guidance movement （started 2 months postpartum, to 4 km/hour speed of brisk walking 30 minutes/time,5-7 times/ week）; Group B was daily oral calcium carbonate 600 mg; milk 250 mL, twice a day; by my task force member of staff for supervision. Group C had no hand steering its services calcium, milk and exercise guid ance. All mothers were at 3 days postpartum, 12 months postpartum measurement of bone metabolism （alkaline phosphatase, urinary calcium, urinary creatinine） and the side of the femoral neck and lumbar spine bone mineral density. Results：（1） pregnancy （3 days postpartum measurement） bone loss rate was 76.9% （100/130）,34 cases in group A,35 cases in group B and 31 cases in group C （x^2 =0. 073, P =0. 964） ; BMD in postpartum recovery of 12 months group A 33.3%（17/45） ,group B 20%（10/45） ,group C 12.5%（5/40） was significant（x^2= 7. 504, P =0. 023）;（2） 12 months after giving birth three groups on the left femoral neck and lumbar spine bone mineral density significantly （ P 〈0.05）, group A was the highest;blood ALP, urinary Ca/Cr in three groups were significant （P 〈0.05）, group A was minimum. Conclusion： prone to bone loss during pregnancy, breast-feeding caused a further loss of bone mass. But breast feeding of high calcium diet supplemented with the appropriate exercise can promote the recovery of bone mass, reduce bone turnover rate.