【作者】 王建梅；

【导师】 李奕；

【作者基本信息】 天津医科大学 ， 妇产科学， 2008， 硕士

【摘要】 目的:调查未婚重复人工流产青少年的心身行为、生殖健康与避孕状况以及生殖避孕知识知晓程度及途径,为在医疗机构的计划生育科室开展青少年流产后服务及心理咨询提供参考和建议。方法:选取2007.7-2007.11就诊于天津医科大学第二医院和天津市中心妇产科医院计划生育门诊,年龄24岁以下,人工流产1次及以上,妊娠5-10周的未婚女性要求终止妊娠者100例为研究对象,采用精神症状自评量表、焦虑自评量表、抑郁自评量表及自制生殖健康调查表进行匿名问卷调查,由门诊医师对调查对象进行常规妇科检查并采集实验室标本,检测假丝酵母菌、阴道毛滴虫、线索细胞和加特纳杆菌。将审核好的问卷统一编码输机,采用SPSS11.0统计软件进行描述性分析、x~2检验及t检验。结果:研究对象平均年龄21.18±2.46(15-24),首次性生活年龄19.51+2.32岁,首次人工流产年龄20.24±3.11岁,性伴侣数1.32±1.05个,人工流产次数1.96±1.44次,既往人工流产次数最少1次,最多9次,2次及以上占52%。6个月内重复人工流产32例,其中9例人工流产术后未转经再次妊娠,7个月到1年内重复人工流产31例,1年到2年内29例。前次流产后主动寻求避孕措施的占49%,其中在手术前后向医生咨询的占45%,得到医生具体避孕方法指导的占25%;此次妊娠未避孕者占56.0%,避孕失败44%,选用避孕方法依次为:安全期、体外排精、紧急避孕药、避孕套。97%知道避孕套是避孕和防止性传播疾病的有效方法,但67%不知道避孕套的正确使用方法和时间;79%不知道口服避孕药正确服用方法;81%不会正确使用紧急避孕药;92%知道安全期避孕法,但知道确切安全期计算方法的只有11%。多因素Logistic回归结果显示,首次流产年龄≤20岁、性生活频率大于3次/周、性伴侣数2个以上以及前次人工流产选择无痛人工流产是未婚青少年重复多次妊娠的危险因素。90项症状自评量表(SCL-90)结果出现高频率阳性症状,SCL-90因子患病率依次为躯体化(45.0%)、焦虑(33.0%)、抑郁(21.0%)、人际关系敏感(18.0%)、偏执(17.0%)、恐怖(17.0%)、其它(16.0%)、敌对(15.0%)、精神病性(12.0%)、强迫症状(9.0%)。躯体化、焦虑、抑郁、人际关系、恐怖、精神病性和敌对性的因子分值均高于全国常模,有统计学意义(P＜0.05);焦虑自评量表(SAS)、易于自评量表(SDS)的评分与SCL-90中焦虑、抑郁因子相一致:在本研究人群中,研究对象的SAS标准分和SDS标准分高于全国常模,差异具有显著性(P＜0.05)。两次流产间隔≤6月、首次性年龄≤18、性伴侣个数≥2、妊娠次数≥3次和有生殖道感染是影响未婚重复人工流产青少年心身症状和焦虑、抑郁的主要因素。研究对象中有56人检出生殖道感染。在生殖道感染患者中,慢性宫颈炎的患病率最高,为40.0%,其中宫颈糜烂轻度、中度和重度的患病率分别为21.0%、10.0%和9.0%;细菌性阴道病的患病率33.0%,假丝酵母菌性外阴阴道病的患病率25.0%,滴虫性阴道炎的患病率7.0%,其它STD(沙眼衣原体感染、尖锐湿疣、淋病)的患病率6.0%。流产次数大于2次、首次性行为年龄≤18岁、性生活频率多于3次/周、多性伴(特别是同时多性伴)、性生活卫生不良为生殖道感染的危险因素。结论:未婚青少年重复人工流产的主要原因是生殖避孕知识的缺乏和不准确,流产后未落实有效的避孕措施。该人群存在明显的生殖健康问题:心理障碍突出表现在躯体化、焦虑、抑郁、敌对性等方面;生殖道感染在未婚重复流产人群中存在较高比例。首次性生活和首次流产年龄小、生殖避孕知识和性卫生知识缺乏、性生活活跃、流产次数多和流产间隔时间短是重复流产青少年心理健康和生殖道感染的主要危险因素。积极开展围手术期生殖心理健康咨询,指导并督促落实流产后可靠和可持续的避孕措施,完善人流后服务是防范未婚青少年重复流产,保障其身心健康的关键。更多还原

【Abstract】 OBJECTIVE:To study the psychosomatic symptoms,status of reproductive health and contraceptive use among the unmarried adolescents undergoing repeated induced abortion,and to know what they undertstand and how to get the knowledge about reproductive health care and contraceptive methods,and give reference and advice on supplying the good Post Abortion Care and reduce the rate of reapeated abortion of them in the department of family planning in hospital.METHODS:From 2007.7-2007.11,we investigated 100 repeated abortion of unmarried adolescents below 24 years of age in two hospitals in Tianjin,adopting Symptom Checklist 90(SCL-90),Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS)and reproductive health questionnaire.To determine the situation of reproductive tract infections(RTIs)through gynecological examination and laboratory tests.The data was analyzed by SPSS 11.0 statistical software.RESULT:The mean age of study object was 21.18±2.46 years with minimal age as 15 years old.The mean age of first sexual life was 19.51±2.32 years,and the age of first induced abortion was 20.24±3.11 years.The number of sexual partners of studied group was 1.32±1.05.The mean times of induced abortion previously was1.96±1.44,and the maximum was 9 times.There were 32 women seeking repeated abortion within 6 months from the time of induced abortion previously,9 of them had pregnancy once again within 1 month after abortion,31 women had pregnancy once again within 1 year and 29 women within 2 years.49%of them asked for contraceptive measures initiativly after previous abortion,45%searched for information from their doctor and only 25%of them got the advice.The reason for 56%unwanted repeated pregnancy was no contraception.The contraceptive failure mainly because unreliable contraceptive methods use.In this study,The SCL-90 show high frequency positive symptoms,and the SCL-90 factor scores were higher than normal model on average;the scores on some sub-scales,depression,somatization,anxiety,hostility,interpersonal sensitivity and psychoticism,were significantly different between this group and Normal mode (P＜0.05).For the studied population,the average total index scores of SAS and SDS were higher than those of Normal mode(P＜0.05).The prevalence of RTIs in this study was 56%,and there are 37 women among them were suffering from sexually transmitted diseases.Among all the diseases,the chronic cervicitis had the highest prevalence rate of 40.0%,the morbidity rate of ’cervical erosion’ degreeⅠ、ⅡandⅢwas 21.0%、10.0%and 9.0%respectively.The prevalence of BV,VVC and TV among this study was 33.0%,25.0%and 7.0%,the morbidity rate of other RTIs(Chlamydia tracomatis,Condyloma acuminata, Gonorrhea)was 6%.The risk factor of genital duct infected diseases were the number of abortion was more than 2 times,the age of first sexual behavior was less than 18 years,there are more than 2 sexual partners,having sexual intercourse more than 3 times a week,and so on.CONCLUSION:The main reason of repeated induced abortion among unmarried adolescents was the deficiency of the knowledge on reproductive health and contraceptive,They did not use effective contraceptive measures or not use accurately contraceptive measures after abortion.Abnormal mental status and RTIs are the main problems on reproductive health among unmarried repeated abortion adolescents.We should give them the psychological counseling and contraceptive advice,after induced abortion to prevent repeated pregnance among unmarried adolescents.Post Abortion Service must be conducted in the hospital.更多还原