移动医疗用于孕产妇健康管理的效果研究

景联红　肖文霞　肖玲

【摘要】 目的：探討移动医疗对于孕产妇健康管理的效果，为推行移动医疗提供理论依据。方法：采用前瞻性研究方法，选取2017年10月1日-12月31日在笔者所在医院门诊建档的230例孕妇为研究对象。将研究对象随机分为两组，每组115例。对照组采用常规规律产检+笔者所在医院正常安排的孕妇学校课程;观察组采用常规规律产检+笔者所在医院正常安排的孕妇学校课程+微信群结合幸运妈咪APP进行移动医疗干预。观察并比较两组孕妇孕期体重增长、新生儿出生体重及孕晚期血红蛋白水平，妊娠期高血压疾病、妊娠期糖尿病及贫血发生率，剖宫产率及产后出血率。结果：（1）观察组孕期体重增长明显少于对照组，差异有统计学意义（P<0.05）;两组新生儿出生体重比较，差异无统计学意义（P>0.05）;观察组孕晚期血红蛋白水平明显高于对照组，差异有统计学意义（P<0.01）。（2）两组妊娠期高血压疾病发生率比较，差异无统计学意义（P>0.05）;观察组妊娠期糖尿病及贫血的发生率均明显低于对照组，差异有统计学意义（P<0.05）。（3）两组剖宫产率及产后出血率比较，差异均无统计学意义（P>0.05）。结论：移动医疗是一种健康教育方式，能减少孕期体重增长，降低妊娠期糖尿病和贫血的发生率，对于新生儿体重、分娩方式及产后出血无明显影响。

【关键词】 移动医疗; 健康管理; 效果

doi：10.14033/j.cnki.cfmr.2019.25.068 文献标识码 B 文章编号 1674-6805（2019）25-0-03

Effect of Mobile Health on Maternal Health Management/JING Lianhong，XIAO Wenxia，XIAO Ling.//Chinese and Foreign Medical Research，2019，17（25）：-162

【Abstract】 Objective：To explore the effect of mobile health on maternal health management and to provide theory evidence for the implementation of mobile health.Method：A total of 230 pregnant women who were documented in the outpatient department of our hospital from October 1st to December 31st 2017 were selected as the research object by prospective study.They were randomly divided into two groups，with 115 cases in each group.The control group was treated by routine regular obstetric examination and normal school courses for pregnant women arranged by our hospital.The observation group was treated by routine regular obstetric examination，and normal school courses for pregnant women arranged by our hospital，and wechat group with lucky mummy APP for mobile health.The pregnancy weight gain，neonatal birth weight，hemoglobin level in the third trimester，incidence of hypertensive disorder of pregnancy and gestational diabetes mellitus and anemia，cesarean section rate and postpartum hemorrhage rate were observed and compared between the two groups.Result：（1）The pregnancy weight gain in the observation group was significantly less than that in the control group，the difference was statistically significant（P<0.05）.There was no significant difference in neonatal birth weight between two groups（P>0.05）.The level of hemoglobin in the third trimester of observation group was significantly higher than that of the control group，the difference was statistically significant（P<0.01）.（2）The incidence of hypertensive disorder of pregnancy between the two groups was not statistically significant（P>0.05）.The incidence of gestational diabetes mellitus and anemia of the observation group were significantly lower than those of control group，the differences were statistically significant（P<0.05）.（3）There were no significant differences in cesarean section rate and postpartum hemorrhage rate between the two groups（P>0.05）.Conclusion：Mobile health is a kind of health education，which can reduce pregnancy weight gain，and reduce the incidence of gestational diabetes mellitus and anemia.It has no effect on neonatal birth weight，mode of delivery and postpartum hemorrhage.

本研究显示：与对照组相比，观察组孕妇的血红蛋白水平明显高于对照组（P<0.05）。说明通过移动医疗干预，结合孕妇常规的保健检查结果，对孕妇进行生活方式指导并提出建议，使孕妇有意识补充铁剂，有利于防止孕期贫血。两组新生儿出生体重比较，差异无统计学意义（P>0.05）。孕期体重增长与新生儿出生体重具有一定相关性，本研究显示观察组孕妇体重增长少于对照组，但新生儿体重比较，差异无统计学意义（P>0.05），推测与样本较少有关，有待于进一步扩大样本深入研究。此外，观察组妊娠期糖尿病及贫血发生率均明显低于对照组，差异有统计学意义（P<0.05）;而两组妊娠期高血压疾病发生率比较，差异无统计学意义（P>0.05）。由于移动医疗干预主要通过健康教育对孕妇进行生活方式的干预和指导，妊娠期糖尿病和贫血与孕妇饮食、运动等生活方式关系密切，因此，通过生活方式干预可降低妊娠期糖尿病和贫血的发生。而妊娠期高血压疾病的发病因素较为复杂，并非单独由于不良生活方式引起，因此移动医疗干预对于其发病影响不大，并且该病发病率约7%[10]，本研究样本较少，应进一步扩大样本研究移动医疗对于妊娠期高血压疾病的意义。而两组剖宫产率及产后出血率比较，差异均无统计学意义（P>0.05）。分析原因可能为分娩方式及产后出血涉及诸多因素，社会因素、分娩镇痛、胎儿大小、骨盆大小、产程进展及产后子宫收缩等因素，移动医疗通过医患互动宣教分娩方式、生活方式干预等，可增加患者的生育知识，可增加依从性，但是并不能代替医院的医疗操作，因此对于剖宫产率和产后出血率影响不明显。

综上所述，移动医疗是现代化的健康教育手段，可通过智能手机增加医患互动，增加患者生育健康知識，增加患者的依从性，并可对患者进行生活方式干预，控制孕期体重增长，减少贫血及妊娠期糖尿病的发生;并且移动医疗方便可行，费用低，很受广大孕妇喜爱。因此，移动医疗有望成为一种新的健康教育和管理模式。但是，移动医疗是一种健康教育方式，不能代替真正的医疗操作和检查，对于产后出血及分娩方式的影响并不明显，因此移动医疗可作为一种常规医疗的补充和宣教。关于移动医疗对于孕期健康管理的作用仍有待进一步探讨和研究。

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（收稿日期：2019-04-08） （本文编辑：桑茹南）