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中华健康管理学杂志
中华医学会杂志社
中华健康管理学杂志

中华医学会杂志社

白书忠

双月刊

1674-0815

zhjkgl@cma.org.cn

010-85158816

100710

北京市东城区东四西大街42号

中华健康管理学杂志/Journal Chinese Journal of Health ManagementCSCDCSTPCD北大核心
查看更多>>2007年10月创刊，中国科协主管，中华医学会主办。本刊是我国健康管理学领域唯一的一本学术期刊。2009年6月进入中国科技论文统计源期刊（中国科技核心期刊）。主要栏目：述评、专家论坛、标准与规范、论著、短篇论著、综述、学术争鸣、健康体检、健康评估与控制、慢性疾病管理、社区卫生、中医健康管理、继续教育园地、国内学术动态、国外健康管理动态、新技术研发与应用、经验与信息交流、健康管理服务导航、健康管理师、模式探讨、健康科普理论与实践、心理健康管理、个案报道、讲座、功能医学、妇幼健康管理、健康视点等。
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    5G+“三早”糖尿病健康管理中国专家共识（2024）

    郭清刘绍辉宋国营
    161-173页
    查看更多>>摘要：糖尿病高风险人群的筛查和生活方式干预是糖尿病防控的关键。生活方式干预需要长期坚持和持续行为改变，否则将影响服务对象的依从性和干预效果。持续葡萄糖监测（CGM）能提供血糖实时变化的可视化数据，被视为激励健康行为和生活方式的有效教育工具，基于第五代移动通信技术（5G）的糖尿病健康管理能有效控制血糖，提高糖尿病高风险人群的自我管理能力。本共识提出构建5G+“三早”（早筛查、早评估、早干预）糖尿病健康管理模式，包括依托数字化健康管理系统，整合医院、社区卫生服务中心、家庭、个体智能监测终端形成“医院-社区-家庭/个人”健康信息多端数据共享云平台；应用5G智能可穿戴设备实施连续、动态、实时的健康指标居家监测和糖尿病风险预警；对糖尿病高风险人群实施早筛查和风险评估，将基于CGM的24 h平均血糖作为一种可供参考的糖尿病风险评估指标；在遵循糖尿病健康教育、饮食、运动、心理和药物干预的综合性干预原则基础上实施分层管理，根据CGM技术提供的连续、动态、实时的血糖监测结果制定个体化的饮食和运动干预方案，联合智能应用程序实施个体化的精准健康管理，建立糖尿病的“三早”健康管理服务模式。

    糖尿病高风险人群早筛查早评估早干预生活方式干预第五代移动通信技术持续葡萄糖监测

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    泌尿系统疾病筛查临床路径

    杨悦古再丽努尔·赛来阿吉木丁小强毛永辉...
    174-177页
    查看更多>>摘要：泌尿系统由肾脏、输尿管、膀胱、前列腺（男性）等组成，常见疾病包括感染、结石、肿瘤，以及各种原因引起的免疫性肾炎等。泌尿系统疾病患病率高、医疗费用高、知晓率低、治疗率低，给家庭、社会带来沉重负担。本研究参考多项国内外研究及指南共识，提供了针对不同人群的泌尿系统健康体检方案，希望能通过提高百姓和基层全科医生泌尿系统健康体检意识，实现疾病的早发现、早诊断、早治疗，为全民健康保驾护航。

    泌尿系统疾病筛查临床路径

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    高密度脂蛋白胆固醇与糖尿病患病风险之间的非线性关系：基于中国成年人队列研究的二次分析

    杜洁牛晶李红艳隋永杰...
    178-184页
    查看更多>>摘要：目的 探讨中国成年人高密度脂蛋白胆固醇（HDL-C）与糖尿病患病风险的相关性。 方法 本研究是一项多中心、回顾性队列研究的二次分析，数据来源于DATADRYAD数据库的中国健康体检筛查项目。2010—2016年对分布在中国的32个地点和11个城市211 833例≥20岁的中国成年人进行健康筛查，基线时无糖尿病。基线HDL-C水平为目标自变量，随访时发生糖尿病为因变量。Cox比例风险回归分析评估HDL-C水平与糖尿病患病风险之间的独立相关性。应用广义相加模型及平滑曲线拟合方法探讨非线性关系。进行亚组分析，评估不同亚组相关性的一致，进一步验证结果的可靠性。 结果 调整年龄、性别、体重指数等潜在混杂因素后，HDL-C水平与糖尿病发生呈正相关（HR=1.43，95%CI：1.08~1.90，P=0.012）。HDL-C水平与糖尿病患病风险呈非线性关系，其拐点为1.81 mmol/L。拐点左右两侧的HR值（95%CI）分别为0.94（0.56~1.55）和2.54（1.93~3.30）。当HDL-C>1.81 mmol/L时，HDL-C与糖尿病发生呈正相关，HDL-C每增加1.00 mmol/L，糖尿病患病风险增加1.54倍（P<0.001）；而当HDL-C<1.81 mmol/L时，HDL-C水平每增加1.00 mmol/L，糖尿病患病风险下降6%（P=0.798）。亚组分析表明，在年龄全亚组、男性、体重指数24.5~52.7 kg/m2亚组、收缩压全亚组、舒张压69~77和78~164 mmHg（1 mmHg=0.133 kPa）亚组、血总胆固醇0.02~4.26、5.00~17.84 mmol/L亚组、甘油三酯全亚组、低密度脂蛋白胆固醇0~2.42和2.99~12.60 mmol/L亚组、丙氨酸氨基转移酶23.4~1 508.4 U/L亚组、天冬氨酸氨基转移酶0~19.7和24.8~1 026.2 U/L亚组、尿素氮全亚组、肌酐61.5~76.9和77.0~1 116.6 μmol/L亚组、从不吸烟、经常饮酒、无糖尿病家族史中，HDL-C与中国成年人糖尿病患病风险的效应值均显示了良好的稳定性（均HR>1.00）。 结论 高水平HDL-C与中国成年人糖尿病患病风险增加相关，当HDL-C>1.81 mmol/L时，HDL-C与糖尿病患病风险呈正相关。 Objective To investigate the association between high-density lipoprotein cholesterol (HDL-C) and the risk of diabetes mellitus (DM) in Chinese adults. Methods This study was a secondary analysis of a multicenter, retrospective cohort study using data from the Chinese health screening program in the DATADRYAD database. Between 2010 and 2016, 211833 Chinese adults aged 20 years or older were screened for diabetes at baseline in 32 sites and 11 cities across the country. Baseline HDL-C level was the target independent variable and the risk of DM at follow-up was the dependent variable. Cox proportional hazards regression analysis assessed the independent association between HDL-C levels and the risk of developing DM. In this paper, the generalized Additive Model (GAM) and the smoothing curve fitting method were used to study the nonlinear relationships. In addition, subgroup analyses were conducted to assess the consistency of the correlations among different subgroup and to further validate the reliability of the results. Results After adjusting for potential confounding factors such as age, sex and body mass index, HDL-C level was positively correlated with the development of diabetes (HR=1.43, 95%CI: 1.08-1.90, P=0.012). The level of HDL-C showed a non-linear relationship with the risk of DM, and the inflection point was 1.81 mmol/L. The HR (95%CI) of the left and right sides of the inflection point were 0.94 (0.56-1.55) and 2.54 (1.93-3.30), respectively. When HDL-C>1.81 mmol/L, HDL-C was positively correlated with the occurrence of DM. Each 1.00 mmol/L increase in HDL-C increased the risk of diabetes mellitus by 1.54 times (P<0.001) when HDL-C<1.81 mmol/L, the risk of diabetes decreased by 6% for every 1.00 mmol/L increase in HDL-C (P=0.798). Subgroup analysis showed that, in the age, male, BMI 24.5-52.7 kg/m2 subgroups, all the systolic blood pressure subgroups, diastolic blood pressure 69-77 and 78-164 mmHg (1 mmHg=0.133 kPa) subgroups, total cholesterol 0.02-4.26 and 5.00-17.84 mmol/L subgroups, all the triglyceride subgroups, low-density lipoprotein 0-2.42 and 2.99-12.60 mmol/L subgroups, alanine aminotransferase 23.4-1 508.4 U/L subgroups, aspartate transaminase 0-19.7 and 24.8-1 026.2 U/L subgroups, all the urea nitrogen subgroups, creatinine 61.5-76.9, 77.0-1 116.6 μmol/L subgroups, never smoking subgroup, subgroup with frequent alcohol consumption or family history of diabetes mellitus, the effect values of HDL-C and the risk of diabetes mellitus in Chinese adults showed good stability (all HR>1.00). Conclusions High levels of HDL-C are associated with an increased risk of DM in Chinese adults. When HDL-C is greater than 1.81 mmol/L, HDL-C is positively correlated with DM.

    高密度脂蛋白胆固醇糖尿病成年人患病风险队列研究非线性

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    健康体检人群瘦型非酒精性脂肪性肝病人体成分和影响因素分析

    赵微周虓华郭雯张群...
    185-190页
    查看更多>>摘要：目的 分析健康体检人群瘦型非酒精性脂肪性肝病人体成分和影响因素。 方法 本研究为横断面研究，选取2020年1月至2021年12月江苏省人民医院健康管理中心体检人群中肝脏瞬时弹性成像和人体成分检测结果完整可靠、体重指数（BMI）<24 kg/m2且符合纳入标准的体检者共1 342例，收集研究对象的人体成分分析、血生化指标及肝脏检查等结果进行分析。符合正态分布的计量资料采用独立样本t检验，不符合则用秩和检验，计数资料采用χ2检验进行统计学检验，采用二元logistic回归对健康体检人群瘦型非酒精性脂肪性肝病人体成分的影响因素进行分析。 结果 研究对象中，非酒精性脂肪性肝病检出率为13.3%，男性检出率为23.3%（125/537），高于女性的6.6%（53/805）。男女性瘦型非酒精性脂肪性肝病人群空腹血糖（5.15、5.08 mmol/L）、糖化血红蛋白（5.5%、5.6%）、甘油三酯（1.70、1.64 mmol/L）、低密度脂蛋白胆固醇（3.37、3.27 mmol/L）、丙氨酸转氨酶（27.0、21.9 U/L）、天冬氨酸转氨酶（24.1、24.0 U/L）、γ谷氨酰转肽酶（31.4、21.1 U/L）、尿酸（391、296 μmol/L）、体脂率（23.9%、33.7%）、腰臀比（0.90、0.89）以及内脏脂肪面积（70.3、97.0 cm2）均高于非脂肪肝人群（均P<0.05），而高密度脂蛋白胆固醇（1.25、1.32 mmol/L）低于非脂肪肝人群。BMI、糖化血红蛋白、甘油三酯、尿酸、腰臀比是男性瘦型非酒精性脂肪性肝病的危险因素，BMI、糖化血红蛋白、甘油三酯、尿酸、体脂率是女性瘦型非酒精性脂肪性肝病的危险因素（均P<0.05）。 结论 BMI、糖化血红蛋白、甘油三酯、尿酸、体脂率、腰臀比与瘦型非酒精性脂肪性肝病的发生相关。 Objective To analyze the body composition and influencing factors of lean non-alcoholic fatty liver disease in population receiving health examination. Methods This is a cross-sectional study. Between January 2020 and December 2021, 1 342 individuals who had complete and reliable results of liver transient elastography and body composition testing, with a body mass index (BMI)<24 kg/m2 and who met the inclusion criteria, were selected from the physical examination population at the Health Management Center of Jiangsu Provincial People′s Hospital. The results of body composition analysis, blood biochemical indexes and liver examination were collected from the subjects for analysis. Method of inter-group comparison: quantitative data that conform to normal distribution were tested using independent sample t-test, while non-conforming data were tested using rank sum test count data were tested using chi-square test. The binary logistic regression analysis was used to analyze the influencing factors of body composition in lean non-alcoholic fatty liver disease in health examinees. Results The detection rate of non-alcoholic fatty liver disease was 13.3% in all participants, and it was significantly higher in men than that in women (23.3% (125/537) vs 6.6% (53/805)). The fasting blood glucose (5.15, 5.08 mmol/L), hemoglobin A1c (HbA1c)(5.5%, 5.6%), triglyceride (TG)(1.70, 1.64 mmol/L), low density lipoprotein cholesterol (LDL-C)(3.37, 3.27 mmol/L), alanine aminotransferase (ALT)(27.0, 21.9 U/L), aspartate aminotransferase (AST)(24.1, 24.0 U/L), gamma-glutamyltransferase (31.4, 21.1 U/L), uric acid (UA)(391, 296 μmol/L), body fat percentage (23.9%, 33.7%), waist-to-hip ratio(0.90, 0.89) and visceral fat area (70.3, 97.0 cm2) in men and women with lean nonalcoholic fatty liver disease were all higher than those in the population without fatty liver, while the density lipoprotein cholesterol (1.25, 1.32 mmol/L) was lower. Logistic regression analysis showed that BMI, HbA1c, TG, UA and waist-to-hip ratio were risk factors for lean nonalcoholic fatty liver disease in men, while BMI, HbA1c, TG, UA and body fat percentage were risk factors for lean nonalcoholic fatty liver disease in women (all P<0.05). Conclusion BMI, HbA1c, TG, UA, body fat percentage and waist-to-hip ratio are associated with the development of lean nonalcoholic fatty liver disease.

    脂肪肝人体成分血清学检测

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    2021年天津市医疗机构健康管理（体检）服务能力现况调查

    王司宇宋崑高鹰刘莉...
    191-198页
    查看更多>>摘要：目的 调查分析2021年天津市医疗机构健康管理（体检）服务能力现况。 方法 本研究为横断面研究，采用普查法通过问卷调查获取天津市86家医疗机构2021年健康管理（体检）服务能力情况，问卷内容包括机构基本情况、人力资源及设备、体检项目开展、年体检量、信息化程度及质量控制指标完成情况等，共发放问卷86份，收回有效问卷86份（100%）。采用Mann-Whitney U检验、χ2检验比较公立与社会办医机构健康管理（体检）各项指标差异，分析天津市医疗机构健康管理（体检）服务能力现况。 结果 纳入分析的86家医疗机构中，公立性质53家（61.6%），社会办医性质33家（38.4%）。在基本情况方面，公立机构所属综合医院、医疗机构级别为三级的比例以及健康管理（体检）业务开展时间均显著高于社会办医机构［62.3%比30.3%、62.3%比0、11（7，5）年比7（5，10）年］，独立设置比例、体检区域总面积均显著低于社会办医机构［33.3%比98.1%、1 011（600，1 000）m2比2 000（1 395，2 782）m2］（均P<0.05）；在从业人员方面，2021年天津市健康管理（体检）从业人员共2 964人，年龄43（35，56）岁，公立机构男性、兼职、护理、中级职称、主检医师、健康管理师比例以及从事健康管理时间均显著高于社会办医机构［20.6%比17.5%、20.7%比8.1%、33.8%比23.4%、40.7%比27.3%、7.1%比3.9%、13.8%比4.7%、6（3，11）年比5（3，8）年］（均P<0.05）；在业务开展方面，公立机构中医治未病管理、心理健康管理、高血压风险管理、健康管理签约服务、肺结节管理、健康管理干预方案、健康风险评估、健康教育项目开展率均显著高于社会办医机构（24.5%比0、28.3%比0、35.8%比15.2%、39.6%比15.2%、41.5%比12.1%、50.9%比18.2%、66.0%比36.4%、83.0%比42.4%），年健康体检人次、团体及个人体检人次均显著低于社会办医机构［18 625（11 844，27 998）人次比38 384（10 832，46 927）人次、14 818（8 803，23 915）人次比28 663（4 982，41 927）人次、2 179（1 221，3 588）人次比5 784（1 461，12 156）人次］（均P<0.05）。在6项健康体检质量控制指标中，两种类型机构的腰臀围测量完成率均较低（均<40%）。 结论 相比公立机构，天津市社会办医机构健康管理（体检）人才梯队建设和服务开展水平仍有待提升。 Objective To investigate and analyze the current status of health management (physical examination) service capabilities of medical institutions in Tianjin in 2021. Methods It was a cross-sectional study. Using the census method, a questionnaire survey was conducted to obtain the health management (physical examination) service capabilities of 86 medical institutions in Tianjin in 2021. The questionnaire covered the basic information of the institution, human resources and equipment, physical examination items carried out, the annual number of people receiving physical examination, the degree of informatization, and the completion of quality control indicators. In this survey, a total of 86 questionnaires were distributed and 86 valid questionnaires were collected (100%). Mann-Whitney U test and χ2 test were used to compare the differences of health management (physical examination) indicators between public and private medical institutions, and to analyze the current health management (physical examination) service capabilities of medical institutions in Tianjin. Results Among the 86 medical institutions included in the analysis, 53 (61.6%) were public institutions and 33 (38.4%) were private medical institutions. In terms of basic information, the proportion of comprehensive hospitals and level-3 medical institutions belonging to public institutions, as well as the time of health management (physical examination) business development, were significantly higher than those of private medical institutions [62.3% vs 30.3%, 62.3% vs 0, 11 (7, 5) years vs 7 (5, 10) years], and the proportion of independent setup of the physical examination center and the business area of health management (physical examination) were significantly lower than those of private institutions[33.3% vs 98.1%, 1 011 (600, 1 000) m2 vs 2 000 (1 395, 2 782) m2] (all P<0.05). In terms of practitioners, there were 2 964 health management (physical examination) practitioners in Tianjin in 2021, aged 43 (35, 56) years. The proportion of male practitioners, part-time practitioners, nurses, practitioners with intermediate professional title, chief inspection physician, health management specialist in public institutions and the time engaged in health management work of employees were all significantly higher than those in private medical institutions [20.6% vs 17.5%, 20.7% vs 8.1%, 33.8% vs 23.4%, 40.7% vs 27.3%, 7.1% vs 3.9%, 13.8% vs 4.7%, 6 (3, 11) years vs 5 (3, 8) years] (allP<0.05). In terms of business development, the implementation rates of preventive medical management, mental health management, hypertension risk management, health management contract service, pulmonary nodule management, health management intervention plan, health risk assessment, and health education programs in public institutions were significantly higher than those in private medical institutions (24.5% vs 0, 28.3% vs 0, 35.8% vs 15.2%, 39.6% vs 15.2%, 41.5% vs 12.1%, 50.9% vs 18.2%, 66.0% vs 36.4%, 83.0% vs 42.4%), and the annual health physical examination person-times, group and individual physical examination person-times in public institutions were significantly lower than those in private institutions [18 625 (11 844, 27 998) to 38 384 (10 832, 46 927), 14 818 (8 803, 23 915) to 28 663 (4 982, 41 927), 2 179 (1 221, 3 588) to 5 784 (1 461, 12 156)] (allP<0.05). Among the six quality control indicators of health examination, the completion rates of waist-hip circumference measurement in both types of institutions were low (<40%). Conclusion Compared with public institutions, the talent echelon construction and service capability of health management (physical examination) in private medical institutions in Tianjin still needs to be improved.

    健康管理体格检查质量控制现况调查

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    医务工作者体成分现况及各指标对营养状况的评估效果

    黄月周忠彬陈延丽吴瑛...
    199-203页
    查看更多>>摘要：目的 分析医务工作者体成分现况及各指标对营养状况的评估效果。 方法 本研究为横断面研究，于2021年5月21日至6月22日招募北京某医院313例医务工作者为研究对象进行体成分测量，采用方差分析比较其体脂肪总量、去脂体重、体脂率、骨骼肌、蛋白质、水分、矿物质、基础代谢率指标的年龄、性别分布差异，分别用蛋白质含量、体脂率和体重指数评价医务工作者的营养状况，并分析其评估效果。 结果 纳入分析的313例医务工作者中，女性221例，男性92例；女性体脂肪总量、去脂体重、骨骼肌及基础代谢率均与年龄呈正相关（F=19.823、6.745、6.561、6.707）（均P<0.001）；男性各年龄组体成分指标差异均无统计学意义（均P>0.05）。女性医务工作者体脂肪总量显著高于男性（17.58 kg比17.08 kg），总水分、蛋白质、矿物质、去脂体重、骨骼肌及基础代谢率均显著低于男性［30.40 kg比41.78 kg、8.07 kg比11.26 kg、2.96 kg比3.88 kg、41.43 kg比56.92 kg、22.37 kg比31.98 kg、1 264.86 kcal（1 kcal=4.184 kJ）比1 599.39 kcal］（均P<0.05）。医务工作者蛋白质含量正常190例（60.7%），蛋白质含量缺乏103例（32.9%），蛋白质含量超标20例（6.3%）；体脂率正常110例（35.1%），体脂率超标193例（61.6%），体脂率不足10例（3.2%）；体重指数正常198例（63.2%），其中体脂率正常145例（73.2%），体脂率超标53例（26.7%），蛋白质含量正常108例（54.5%），蛋白质含量不足89例（44.9%），蛋白质含量超标1例（0.5%）；体重指数超标103例（32.9%），其中体脂率正常20例（19.4%），属于肌肉/骨骼强壮型，蛋白质含量正常83例（80.6%），属于肌肉良好型；体重指数不足12例（3.8%），其中体脂率正常6例（50.0%）。 结论 医务工作者体成分分布存在明显性别差异，女性体脂肪总量、去脂体重、骨骼肌及基础代谢率与年龄相关，仅根据体重指数进行个体营养状况评价会低估肥胖率，蛋白质/肌肉含量低于或高于正常者均不宜用体重指数评价。 Objective To analyze the current status of physical composition in medical workers and the evaluation effects of each indicator on nutritional status. Methods It was a cross-sectional study. A total of 313 medical workers from one hospital in Beijing were recruited from May 21st to June 22nd in 2021 for body composition measurement. Variance analysis was used to compare the age and gender distribution differences in total body fat, fat-free body weight, body fat percentage, skeletal muscle, protein, water, mineral, and basal metabolic rate indicators among the medical workers. Protein content, body fat percentage, and body mass index (BMI) were used to evaluate the nutritional status of medical workers, and the evaluation effects were analyzed too. Results Of the 313 medical workers included in this study, there were 221 females and 92 males. In females, total body fat, fat-free body weight, skeletal muscle mass, and basal metabolic rate were all positively correlated with age (F=19.823, 6.745, 6.561, 6.707) (all P<0.001). There was no significant differences in body composition indicators among male participants of different age groups (all P>0.05). The total body fat in female medical workers was significantly higher than that in males (17.58 kg vs 17.08 kg). Total water, protein, minerals, fat-free body weight, skeletal muscle mass, and basal metabolic rate were all significantly lower in female medical workers when compared with those in males [30.40 kg vs 41.78 kg, 8.07 kg vs 11.26 kg, 2.96 kg vs 3.88 kg, 41.43 kg vs 56.92 kg, 22.37 kg vs 31.98 kg, 1 264.86 kcal (1 kcal=4.184 kJ) vs 1 599.39 kcal] (allP<0.05). Among the medical workers, 190 cases (60.7%) had normal protein levels, 103 cases (32.9%) had protein deficiencies, and 20 cases (6.3%) had protein levels exceeding the standard. Additionally, 110 cases (35.1%) had normal body fat ratios, 193 cases (61.6%) had excessive body fat ratios, and 10 cases (3.2%) had insufficient body fat ratios. Concerning body mass index (BMI), 198 cases (63.2%) had normal BMI. Among them, 145 cases (73.2%) had normal body fat ratios, 53 cases (26.7%) had excessive body fat ratios, 108 cases (54.5%) had normal protein levels, 89 cases (44.9%) had insufficient protein levels, and 1 case (0.5%) had excessive protein levels. Furthermore, 103 cases (32.9%) had excessive BMI, with 20 cases (19.4%) having normal body fat ratios indicating the muscle/bone strength type, and 83 cases (80.6%) having normal protein levels indicating the muscular type. Lastly, 12 cases (3.8%) had insufficient BMI, including 6 cases (50.0%) with normal body fat ratios. Conclusion There are significant gender differences in body composition distribution among healthcare workers. In females, total body fat, lean body mass, skeletal muscle, and basal metabolic rate are all correlated with age. Evaluating individual nutrition status based solely on BMI would underestimate the obesity rate. Individuals with low or high protein/muscle content should not be assessed using BMI.

    医务工作者体成分营养状况评估蛋白质肥胖

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    青少年妊娠对母婴结局的影响

    陈茜陈翠香董芳香关艳娜...
    204-209页
    查看更多>>摘要：目的 分析青少年妊娠对母婴结局的影响。 方法 本研究为回顾性队列研究，收集2019年1月1日至2020年12月31日在济宁医学院附属医院分娩的5 765例产妇资料，根据妊娠年龄<20岁、20~24岁和25~34岁将产妇分为青少年组（280例）、适龄1组（1 733例）和适龄2组（3 752例），登录院内电子病例系统进行资料收集。采用方差分析、χ 2检验比较3组产妇一般资料、妊娠特点及结局，采用二元logistics回归分析青少年妊娠对母婴结局的影响。 结果 青少年组初中及以下学历、居住地为农村、无固定收入、未婚、无引流产史的产妇比例均显著高于适龄1组及适龄2组（82.50%比17.37%、14.37%，59.29%比42.70%、43.36%，80.71%比15.52%、14.71%，75.71%比12.23%、9.97%，82.50%比71.84%、71.91%）（均P<0.05）；3组产妇在月经初潮年龄、孕前体重指数、妊娠期增重方面差异均无统计学意义（均P>0.05）。青少年组早产、低出生体重儿、转入新生儿重症监护病房（NICU）比例均显著高于适龄1组及适龄2组（5.36%比1.10%、1.57%，5.00%比0.23%、0.05%，21.79%比6.12%、15.17%），妊娠合并贫血发生率显著高于适龄1组（15.36%比9.75%），产后出血发生率显著高于适龄2组（10.71%比6.08%），经阴试产失败转剖宫产、羊水污染、会阴侧切发生率均显著低于适龄2组（8.57%比15.22%、10.71%比18.10%，33.95%比40.01%）（均P<0.05）。产妇经阴试产失败转剖宫产的发生风险与妊娠年龄呈负相关（青少年组，OR=0.252，95%CI：0.123~0.515；适龄1组，OR=0.673，95%CI：0.567~0.799）（均P<0.05）；低出生体重儿（青少年组，OR=7.440，95%CI：3.426~16.156；适龄1组，OR=0.103，95%CI：0.032~0.330）、转入NICU（青少年组，OR=1.661，95%CI：1.120~2.463；适龄1组，OR=0.360，95%CI：0.290~0.448）的发生风险在不同妊娠年龄区间呈“U”型分布，青少年组高于适龄2组（均P<0.05）；会阴侧切（青少年组，OR=0.002，95%CI：0~0.016；适龄1组，OR=1.308，95%CI：1.151~1.485）的发生风险在不同妊娠年龄区间呈倒“U”型分布，青少年组低于适龄2组（均P<0.05）。 结论 青少年妊娠与经阴试产失败转剖宫产、会阴侧切风险降低相关，但可能增加低出生体重儿及转入NICU的风险。 Objective To analyze the impact of adolescent pregnancy on maternal and infant outcomes. Methods A retrospective cohort study was conducted on 5 765 parturbirths in Jining Medical College Hospital from January 1, 2019 to December 31, 2020. The parturbirths were divided into adolescent group (maternal age<20 years, 280 cases), age group 1 (maternal age 20-24 years, 1 733 cases) and age groups 2 (maternal age 25-34 years, 3 752 cases). All information was collected through the hospital′s electronic case system. General data, pregnancy characteristics and outcomes were compared among the three groups by analysis of variance (ANOVA),χ 2 tests and binary logistics regression analysis was used to analyze the impact of adolescent pregnancy on maternal and infant outcomes. Results In the adolescent group, the proportion of women with an education of junior high school or below, rural residence, no fixed income, unmarried, and no history of induced abortion were all significantly higher than those in age group 1 and age group 2 (82.50% vs 17.37%, 14.37% 59.29% vs 42.70%, 43.36% 80.71% vs 15.52%, 14.71% 75.71% vs 12.23%, 9.97% 82.50% vs 71.84%, 71.91%) (all P<0.05) there was no significant differences in age at menarche, body mass index before pregnancy, and weight gain during pregnancy among the three groups (allP>0.05). The proportion of preterm birth, low birth weight infants and transferring to neonatal intensive care unit (NICU) in the adolescent group were all significantly higher than those in age group 1 and age group 2 (5.36% vs 1.10%, 1.57% 5.00% vs 0.23%, 0.05% 21.79% vs 6.12%, 15.17%) the incidence of anemia in pregnancy in the adolescent group was significantly higher than that in age group 1 (15.36% vs 9.75%), and the incidence of postpartum hemorrhage was significantly higher than that in the age group 2 (10.71% vs 6.08%). The incidence of failed vaginal trials leading to cesarean section, amniotic fluid contamination, and episiotomy was significantly lower in the adolescent group than those in age group 2 (8.57% vs 15.22%, 10.71% vs 18.10%, 33.95% vs 40.01%) (allP<0.05). The incidence of failed vaginal trials leading to cesarean section was inversely associated with gestational age (adolescent group,OR=0.252, 95%CI: 0.123-0.515 age group 1, OR=0.673, 95%CI: 0.567-0.799) (both P<0.05) the risks of low birth weight infants (adolescent group,OR=7.440, 95%CI: 3.426-16.156 age group 1, OR=0.103, 95%CI: 0.032-0.330) and transferring to the NICU (adolescent group, OR=1.661, 95%CI: 1.120-2.463 age group 1, OR=0.360, 95%CI: 0.290-0.448) showed a U-shaped distribution in different pregnancy age groups, they were both higher in the adolescent group than those in the age group 2 (both P<0.05) the risk of episiotomy (adolescent group,OR=0.002, 95%CI: 0-0.016 age group 1, OR=1.308, 95%CI: 1.151-1.485) showed an inverted U-shape distribution across the different pregnancy age groups, it was lower in the adolescent group than that in age group 2 (both P<0.05). Conclusion Adolescent pregnancy is associated with a lower risk of conversion to cesarean section and episiotomy due to failed vaginal delivery, but may increase the risk of low birth weight infants and transferring to NICU.

    青少年妊娠母婴结局

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    人文关怀护理联合森田疗法对血液透析患者焦虑状态的影响

    何雯雯贾婉宁杨柳蔡志敏...
    210-213页
    查看更多>>摘要：目的 探讨人文关怀护理联合森田疗法对血液透析患者焦虑状态的影响。 方法 本研究为自身对照研究，选取2020年8月至2022年8月在中日友好医院接受维持性血液透析治疗并存在焦虑状态的终末期肾脏疾病患者54例，对所有患者进行为期1个月的人文关怀护理联合森田疗法；比较患者干预治疗前后的焦虑自评量表（SAS）评分；定量资料的比较采用配对t检验，定性资料的比较采用χ2检验，不同因素与是否焦虑的相关关系采用Spearman相关分析进行统计。 结果 患者中男性26例，女性28例，年龄（61.8±16.3）（29~88）岁，患者干预后的SAS评分（44.0±11.1）分低于干预前（51.9±8.5）分（t=5.395，P<0.001）；患者是否焦虑与其年龄（r=0.305）、就业状况（r=0.270）以及婚姻状况（r=0.397）相关（均P<0.05），患者对干预治疗措施及护理前后的满意度分别为45.6%和87.7%（χ2=5.720，P<0.05）。 结论 人文关怀护理联合森田疗法治疗后，可以使焦虑状态患者心理明显改善，有利于血液透析治疗的顺利完成，提高患者的生活质量。 Objective To explore the effect of humanistic care combined with Morita therapy on anxiety state of hemodialysis patients. Methods A self-controlled study was conducted on 54 patients with end-stage renal disease and anxiety who received maintenance hemodialysis in China-Japan Friendship Hospital from August 2020 to August 2022. All patients were treated with humanistic care nursing and Morita therapy for one month. The Self Rating Anxiety Scale (SAS) scores of the patients before and after the intervention were compaired. The comparison of quantitative data was conducted by paired t-test, and the comparison of qualitative data was conducted by χ2 test. The correlation between different factors and anxiety was analyzed by Spearman correlation analysis. Results Among the 54 patients, there were 26 males and 28 females, aged (61.8±16.3) years (ranging from 29 to 88 years). The SAS score after the intervention (44.0±11.1) was lower than that before the intervention (51.9±8.5) (t=5.395, P<0.001). The anxiety of patients was related to their age (r=0.305), employment status (r=0.270) and marital status (r=0.397) (all P<0.05). The satisfaction of patients with care measures and nursing before and after the intervention was 45.6% and 87.7%, respectively (χ2=5.720, P<0.05). Conclusion After receiving combined humanistic care nursing and Morita therapy, patients in a state of anxiety could experience significant psychological improvement, which is conducive to the successful completion of hemodialysis treatment and enhances the quality of life for patients.

    血液透析人文关怀森田疗法焦虑

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    1 096例健康体检者幽门螺杆菌感染状况及其影响因素

    汪俊虎朱盼盼刘芳芳陈小华...
    214-216页
    查看更多>>摘要：探讨1 096例健康体检者幽门螺杆菌感染状况及其影响因素。本研究选取了2021年6至12月在安庆市立医院健康管理中心接受13C尿素酶呼气试验（13C-UBT）检查的体检人员共1 096例作为研究对象。根据13C-UBT的结果，体检者被科学地分为Hp感染阳性组和HP感染阴性组。使用独立样本χ2检验和t检验分析两组间的一般资料及理化检查指标与Hp感染之间的相关性。幽门螺杆菌的总感染率为44.71%。Hp感染阳性组男性（55.92%比49.17%）、吸烟（59.18%比14.19%）、饮酒（65.31%比23.60%）、低学历（81.63%比44.39%）、超重或肥胖（51.02%比32.51%）的研究对象占比高于Hp感染阴性组，空腹血糖［（5.86±1.37）比（5.45±1.38）mmol/L］、总胆固醇［（5.13±1.01）比（4.62±0.84）mmol/L］、甘油三酯［（2.93±1.86）比（1.73±1.34）mmol/L］、低密度脂蛋白胆固醇［（2.70±0.83）比（2.46±0.74）mmol/L］水平均高于Hp感染阴性组，差异均有统计学意义。在安庆市立医院成年体检人群中，男性、肥胖、低教育水平、吸烟、饮酒以及血液生化指标异常是幽门螺杆菌感染的关联因素。

    幽门螺杆菌感染体格检查风险因素

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    健康服务与管理专业人才培养体系的构建与实践

    杨芳张玉杰常明荆春燕...
    217-221页
    查看更多>>摘要：“健康中国”战略要求加快健康管理人力资源建设，对我国健康管理人才培养提出更高的要求。本文从政策层面、需求层面、产业发展层面全面梳理健康服务与管理专业人才培养背景，并明晰我国健康服务与管理专业本科人才培养现状，指出人才培养所存在的专业教学质量标准、专业课程体系、师资队伍等诸多方面问题。在此基础上，以浙江中医药大学健康服务与管理专业为例，全面探究健康服务与管理专业“学科交叉、产教融合、四轮驱动”的本科人才培养体系，并总结相应应用成效，为相关高等院校健康服务与管理专业设置的调整、人才培养体系的构建等方面提供参考。

    健康管理健康服务人才培养学科建设

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