个性化干预对剖宫产产妇母乳喂养行为的影响

丁婷婷; 罗碧如

栏目: 临床医学

个性化干预对剖宫产产妇母乳喂养行为的影响

丁婷婷¹,
罗碧如^2, ,

1.
出生缺陷与相关妇儿疾病教育部重点实验室(四川大学) (成都 610041)
2.
四川大学华西第二医院护理部 (成都 610041)

详细信息

通讯作者:
罗碧如，E-mail: biruluo@126.com

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出版历程
- 收稿日期: 2018-11-18
- 修回日期: 2019-04-16
- 网络出版日期: 2021-03-16
- 发布日期: 2019-07-19

Effect of Individualized Intervention on Postpartum Breast-feeding Behavior after Cesarean Section

DING Ting-ting¹,
LUO Bi-ru^2, ,

1.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, China
2.
Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu 610041, China

More Information

Corresponding author:
LUO Bi-ru, E-mail: biruluo@126.com

摘要

摘要:
目的探讨个性化干预对剖宫产妇女产后母乳喂养率、母乳喂养行为和母乳喂养满意度的影响。
方法前瞻性纳入2018年7月1日~8月30日在四川大学华西第二医院住院行剖宫产分娩的孕妇，采用随机数字表法将研究对象分为干预组(n=171)和对照组(n=170)，干预组实施产前与产后相结合的个性化干预，对照组实施常规护理。记录两组对象基本临床资料、出院时及产后42 d母乳喂养情况并比较两组间差异。
结果两组研究对象年龄、民族、麻醉类型、术前进食时间等临床资料差异均无统计学意义(P>0.05)。产后42 d失访17例，此时干预组163例，对照组161例。干预组在出院时、产后42 d的纯母乳喂养率、母乳喂养满意度、计划母乳喂养时长均高于对照组，且差异有统计学意义(P < 0.05)。对照组出院时及产后42 d的乳房胀痛发生率及程度、乳头皲裂发生率、24 h配方奶添加次数、奶瓶使用率、喂养问题发生率均高于干预组，且差异有统计学意义(P < 0.05)。两组对象出院时，母乳喂养知识得分均高于入院时，但干预组得分高于对照组(P < 0.001)。
结论产前与产后相结合的个性化干预可提高剖宫产妇母乳喂养知识水平和母乳喂养满意度，改善母乳喂养行为，进而提高纯母乳喂养率。
- 剖宫产 /
- 母乳喂养 /
- 个性化干预
Abstract:
Objective To investigate the effects of individualized intervention on postpartum breast-feeding behavior and satisfaction after cesarean section (CS).
Methods 341 pregnant women who had cesarean section in West China Second Hospital of Sichuan University from 1st July to 30th August in 2018 were randomly divided into intervention group (171 cases) and control group (170 cases). The participants in experimental group received individualized intervention through the combination of prenatal and postnatal. The participants in control group received routine nursing care. The basic clinical data and breastfeeding information at discharge and day 42 postpartum were compared between the two groups.
Results There were no significant differences in age, ethnicity, anesthesia type, preoperative feeding time between the two groups (P>0.05). At the time of discharge and day 42 postpartum, the rate of exclusive breastfeeding, breastfeeding satisfaction and planned breastfeeding duration in the intervention group were higher than those in the control group (P < 0.05). The incidence and degree of breast distending pain, the incidence of cracked nipples, the times of adding formula milk in 24 h, the rate of using feeding bottle and the incidence of feeding problems were all higher in the control group than those in the intervention group (P < 0.05). The knowledge scores of breastfeeding in both groups were higher at discharge than at admission, and the score was higher in the intervention group than that in the control group at the time of discharge.
Conclusion The combination of prenatal and postnatal individualized intervention can significantly improve the knowledge, behavior and satisfaction of breastfeeding.
- Cesarean section /
- Breastfeeding /
- Individualized intervention

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母乳是婴儿生长发育的最佳营养来源^[1]。2002年，世界卫生组织(WHO)更新的母乳喂养指南中提出，“所有婴儿在出生后前六个月应纯母乳喂养，母乳喂养最好持续两年或以上”^[2]。然而，因术后切口疼痛，哺乳体位受限，泌乳Ⅱ期延迟等影响，剖宫产产妇的母乳喂养意愿、纯母乳喂养率及母乳喂养持续时间等均低于自然分娩者^[3-6]，因此本研究拟设计个性化干预措施，提高剖宫产产妇母乳喂养率，促进母婴健康，现报道如下。

1. 对象与方法

1.1 对象与分组

本研究为前瞻性随机对照临床研究，纳入2018年7月1日~8月30日在四川大学华西第二医院产科住院并行剖宫产术的孕妇，并通过随机数字表方法分为干预组与对照组。本研究通过四川大学华西第二医院伦理委员会审查，所有纳入患者均签署研究知情同意书。

纳入标准：①年龄≥18岁，语言交流正常；②分娩方式为剖宫产；③自愿参加本研究并签署知情同意书。排除标准：①新生儿死亡的产妇；②有医学指征不能母乳喂养者(如患艾滋病、活动性肺结核的孕妇等)；③患有心理及精神疾病难以配合研究者；④病情危重，不能参与调查者。剔除标准：①中途退出者；②转入其他医院者；③问卷填写空缺≥20%；④病情变化，转为危重，不能配合试验者。

1.2 干预措施

对照组由医护人员进行母乳喂养常规指导, 其主要内容包括：入院时观看母乳喂养视频并发放健康教育手册；剖宫术后回病房，指导产妇及家属母乳喂养；产后第2天，指导母乳喂养、饮食、运动；出院时，进行出院宣教并发放母乳喂养手册。

干预组除对照组措施外，还采取以下干预措施。①入院时：根据自制的剖宫产产妇母乳喂养影响因素调查问卷及母乳喂养知识量表对孕妇进行调查，根据结果制定个性化干预措施，进行一对一、面对面干预；建立孕妇微信群，及时解答孕妇问题。②剖宫术后：在产妇回病房后立即访视，并做针对性、个性化母乳喂养指导，包括早期皮肤接触及早吸吮、母乳喂养姿势和技巧、母乳喂养常见问题及处理、母乳喂养效果观察和评估、早开奶、勤吸吮、坚持按需哺乳、夜间哺乳好处等；并给予产后饮食、运动等指导。③出院时：运用母乳喂养评估量表对产妇进行调查，根据调查结果，分析到该时点仍存在的母乳喂养问题，进行个性化指导；运用母乳喂养知识量表进行母乳喂养相关知识测试，确保产妇基本掌握母乳喂养相关知识。④出院后：利用微信平台每月定期推送母乳喂养相关资料；解答产妇在家中遇到的母乳喂养问题及困难，必要时建议其到院看母乳喂养门诊。

产妇出院时及产后42 d分别对对照组及干预组产妇进行电话随访，询问母乳喂养具体情况。

1.3 测量指标

记录两组研究对象资料。①一般资料:民族、年龄、孕期增重、孕次、产次、分娩孕周、文化程度、职业、家庭人均月收入、目前居住状况、烟酒史、妊娠合并/并发症、生育情况、此次妊娠胎儿数、母乳喂养经历、孕期母乳喂养指导。②基本临床资料:麻醉类型、术前禁食时间、术中液体用量、术中出血量、术后住院时间、产妇睡眠时间、产妇食欲、乳头扁平及凹陷发生率、新生儿性别、出生体质量、婴儿身长。③母乳喂养情况：母乳喂养知识得分(通过“母乳喂养知识量表”测定)、喂养方式、初乳出现时间、乳房是否胀痛、每天哺乳次数、是否夜间哺乳、乳头皲裂发生率、住院期间是否加奶、母乳喂养满意度(通过“母乳喂养评估量表”测定)、计划母乳喂养时间。

1.4 统计学方法

定性资料采用例数和百分率对资料进行统计描述，卡方检验、Fisher确切概率法进行统计比较；定量资料采用x±s进行统计描述，采用t检验、秩和检验进行统计比较。α=0.05。

2. 结果

2.1 基本资料

本研究共纳入346例研究对象，干预组与对照组各173例。出院时干预组回收有效问卷171例，有效率98.8%；对照组回收有效问卷170例，有效率98.3%。产后42 d，干预组163例接受随访，对照组161例接受随访。失访的17例产妇中，5例中途退出，12例联系电话无效。两组研究对象在年龄、民族、孕期增重、分娩孕周等基线资料差异均无统计学意义(P>0.05), 见表 1。

表 1 入院时两组研究对象基本情况比较

Table 1. Comparison of basic information between the two groups at admission

Variable	Intervention group (n=171)	Control group (n=170)	Statistic	P
Nationality/case (%)			-	0.72^*
Ethnic Han	168 (98.2)	166 (97.6)
Minority	3 (1.8)	4 (2.4)
Age/yr.	33.5±4.3	32.6±4.3	1.87	0.06
Body mass gain during the gestation period/kg	13.8±4.3	13.1±4.5	1.58	0.12
Gravidity/times	2.9±3.1	2.5±1.4	1.63	0.11
Parity/times	1.6±0.6	1.5±0.6	0.81	0.42
Gestational weeks/week	38.8±1.1	38.5±3.1	0.002^#	0.99
Education level/case (%)			1.19	0.75
Junior high school	8 (4.7)	7 (4.1)
Senior high school	12 (7.0)	8 (4.7)
Junior college	38 (22.2)	35 (20.6)
Bachelor degree or above	113 (66.1)	120 (70.6)
Occupation/case (%)			4.71	0.45
Professionals	23 (13.5)	19 (11.2)
Agencies and Institutions	52 (30.4)	42 (24.7)
Clerk	44 (25.7)	57 (33.5)
Liberal professions	33 (19.3)	31 (18.2)
Others	19 (11.1)	21 (12.4)
Monthly household income per capita /case (%)			2.58	0.63
< 3 000	5 (2.9)	5 (2.9)
3 001-5 000	32 (18.7)	27 (15.9)
5 001-10 000	62 (36.3)	66 (38.8)
> 10 000	72 (42.1)	72 (42.4)
Current residence status/case (%)			1.81	0.61
Live with husband	94 (55.0)	102 (60.0)
Living with husband and parents	40 (23.4)	37 (21.8)
Live with husband and parents in-laws	36 (21.1)	31 (18.2)
Others	1 (0.6)	0 (0.0)
The history of alcohol and tobacco/case (%)			-	0.77^*
Yes	5 (2.9)	7 (4.1)
No	166 (97.1)	163 (95.9)
Pregnancy complications/case (%)			1.31	0.25
Yes	139 (81.3)	146 (85.9)
No	32 (18.7)	24 (14.1)
Fertility status/case (%)			2.14	0.14
Primipara	81 (47.4)	94 (55.3)
Pluripara	90 (52.6)	76 (44.7)
Number of fetuses/case (%)			0.03	0.85
Single birth	157 (91.8)	157 (92.4)
Polyembryony	14 (8.2)	13 (7.6)
Breastfeeding experience/case (%)			1.95	0.16
Yes	84 (49.1)	73 (42.9)
No	87 (50.9)	97 (57.1)
Guidance on breastfeeding during pregnancy/case (%)			0.52	0.47
Yes	119 (69.6)	124 (72.9)
No	52 (30.4)	46 (27.1)
* Fisher’s exact probability method；# Mann-Whitney U test

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2.2 出院时比较

2.2.1 临床资料

表 2显示，两组研究对象在麻醉类型，术前禁食时间，乳头状态，食欲，新生儿性别、身长、体质量等方面差异均无统计学意义(P>0.05)。

表 2 出院时两组研究对象临床资料比较

Table 2. Comparison of clinical data between the two groups at discharge

Variable	Intervention group (n=171)	Control group (n=170)	Statistic	P
Anesthesia type/case (%)			4.75	0.09
Combined spinal-epidural anesthesia	139 (81.3)	136 (80.0)
General anesthesia	28 (16.4)	22 (12.9)
Persistent epidural anesthesia	4 (2.3)	12 (7.1)
Preoperative fasting time/h	12.2±3.0	11.6±3.4	1.81	0.07
Intraoperative fluid dosage/mL	1 305.0±572.8	1 254.9±500.9	0.87	0.39
Peroperative bleeding/mL	429.3±266.9	463.6±426.6	-0.90	0.37
Sleep time of puerpera /case (%)			4.51	0.11
< 6 h	55 (32.1)	71 (41.8)
6-8 h	100 (58.5)	80 (47.0)
> 8 h	16 (9.4)	19 (11.2)
Appetite of puerpera /case (%)			2.01	0.37
Poor	12 (7.1)	14 (8.2)
General	89 (52.0)	99 (58.2)
Good	70 (40.9)	57 (33.6)
Crater nipple/case (%)			1.02	0.31
Yes	18 (10.5)	23 (13.5)
No	153 (89.5)	147 (86.5)
Flat nipple/case (%)			2.96	0.09
Yes	19 (11.1)	30 (17.6)
No	152 (88.9)	140 (82.4)
Neonatal sex/case (%)			0.24	0.63
Male	93 (54.4)	88 (51.8)
Female	78 (45.6)	82 (48.2)
Birth body mass/g	3 273.0±514.3	3 220.0±444.6	1.03	0.31
Body length of neonate/cm	49.8±2.1	49.3±2.3	1.88	0.28

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2.2.2 母乳喂养情况

由表 3可知，入院时，两组孕妇母乳喂养知识得分差异无统计学意义(P>0.05)，具有可比性；对干预组实施干预后，出院时得分高于对照组(P < 0.001)。如表 4显示，出院时干预组纯母乳喂养率高于对照组，24 h哺乳次数、母乳喂养评估得分、计划母乳喂养时间均高于对照组，差异有统计学意义(P < 0.05)；且乳房胀痛发生率及程度、乳头皲裂发生率，干预组低于对照组，差异有统计学意义(P < 0.05)。两组研究对象出院时在初乳出现时间、是否夜间哺乳、是否加奶差异无统计学意义(P>0.05)。

表 3 干预前后两组孕产妇关于母乳喂养知识得分比较

Table 3. Comparison of knowledge scores of breastfeeding between the two groups before and after intervention

Time	Intervention group (n=171)	Control group (n=170)	Statistic	P
Before intervention (at admission)	102.3±11.1	100.3±11.5	1.66	0.10
After intervention (at discharge)	118.7±7.6	103.2±11.8	-12.1^#	< 0.001
# Mann-Whitney U test

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表 4 出院时两组对象母乳喂养行为比较

Table 4. Comparison of breast-feeding behaviors between the two groups at discharge

Variable	Intervention group (n=171)	Control group (n=170)	Statistic	P
Feeding pattern/case (%)			29.40	< 0.001
Exclusive breastfeeding	118 (69.0)	68 (40.0)
Mixed feeding	53 (31.0)	101 (59.4)
Artificial feeding	0 (0.0)	1 (0.6)
Colostrum secretory time/case (%)			2.80	0.42
Day of childbirth	79 (46.2)	68 (40.0)
First day after delivery	58 (33.9)	58 (34.1)
Second day after delivery	32 (18.7)	39 (22.9)
Third day after delivery	2 (1.2)	5 (2.9)
Breast distending pain /case (%)			32.24	< 0.001
No	90 (52.6)	41 (24.1)
Mild	54 (31.6)	74 (43.5)
Moderate	24 (14.0)	43 (25.3)
Severe	3 (1.8)	12 (7.1)
Feeding frequency per day/case (%)			42.11	< 0.001
< 4	1 (0.6)	8 (4.7)
4-7	58 (33.9)	109 (64.1)
≥8	112 (65.5)	53 (31.2)
Night feeding/case (%)			0.15	0.70
Yes	168 (98.2)	166 (97.6)
No	3 (1.8)	4 (2.4)
Cracked nipple/case (%)			8.26	0.004
Yes	39 (22.8)	63 (37.1)
No	132 (77.2)	109 (62.9)
Adding formula milk /case (%)			0.06	0.81
Yes	160 (94.1)	161 (94.7)
No	11 (5.9)	9 (5.3)
Breastfeeding evaluation scores	120.8±11.0	114.9±12.3	-4.32	< 0.001
Planned breastfeeding duration /month	12.0±5.1	10.7±5.8	3.56^#	< 0.001
# Mann-Whitney U test

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2.3 产后42 d母乳喂养情况

由表 5可知，产后42 d时，干预组纯母乳喂养率高于对照组，婴儿体质量、母乳喂养评估得分、计划母乳喂养时间均高于对照组，差异有统计学意义(P < 0.05)；且干预组乳头皲裂发生率、24 h配方奶添加次数、奶瓶使用率、喂养问题发生率低于对照组，差异有统计学意义(P < 0.05)。两组研究对象产后42 d时产妇睡眠、食欲、婴儿身长、婴儿每日排尿/排便次数、是否按需哺乳、24 h哺乳次数、是否夜间哺乳等方面差异无统计学意义(P>0.05)。

表 5 产后42 d两组对象母乳喂养行为比较

Table 5. Comparison of breast-feeding behaviors between the two groups at postpartum 42 d

Variable	Intervention group (n=163)	Control group (n=161)	Statistic	P
Sleep time of puerpera/case (%)			2.72	0.26
< 6 h	42 (25.8)	32 (19.9)
6-8 h	96 (58.9)	109 (67.7)
> 8 h	25 (15.3)	20 (12.4)
Appetite of puerpera/case (%)			5.44	0.07
Poor	3 (1.8)	11 (6.8)
General	91 (55.8)	79 (49.1)
Good	69 (42.3)	71 (44.1)
The birth body mass/kg	49 133.1±603.6	4 729.9±577.5	2.79	0.01
Body length of neonate/cm	56.2±2.2	55.9±2.2	1.35	0.18
Urinary frequency of infant per day	9.2±3.2	9.1±2.2	-0.84 ^#	0.40
Defecation frequency of infant per day	3.5±2.2	3.7±2.1	-0.81	0.42
Feeding pattern/case (%)			7.86 ^*	0.02
Exclusive breastfeeding	99 (60.7)	73 (45.3)
Mixed feeding	61 (37.4)	85 (52.8)
Artificial feeding	3 (1.8)	3 (1.9)
Times of adding formula milk per day	1.5±2.1	2.3±2.9	-2.48 ^#	0.01
Using feeding bottle/case (%)			6.05	0.01
Yes	103 (63.2)	122 (75.8)
No	60 (36.8)	39 (30.6)
Feeding type/case (%)			0.68	0.41
On-time feeding	12 (7.4)	16 (9.9)
On-demand feeding	151 (92.6)	145 (90.1)
Feeding frequency per day/case (%)			3.61	0.16
< 4	9 (5.5)	4 (2.5)
4-7	75 (46.0)	65 (40.4)
≥8	79 (48.5)	92 (57.1)
Night feeding/case (%)			1.00	0.32
Yes	153 (93.9)	155 (96.3)
No	10 (6.1)	6 (3.7)
Cracked nipple/case (%)			5.99	0.01
Yes	61 (37.4)	82 (50.9)
No	102 (62.6)	79 (49.1)
Breast distending pain /case (%)			6.65	0.08
No	25 (15.3)	41 (25.5)
Mild	81 (49.7)	67 (41.6)
Moderate	48 (29.4)	40 (24.8)
Severe	9 (5.5)	13 (8.1)
Breastfeeding evaluation scores	121.6±12.3	116.8±10.9	3.65	< 0.001
Planned breastfeeding duration/month	10.4±4.9	9.1±4.5	2.32	0.02
Feeding problems/case (%)			11.62	0.001
Yes	91 (55.8)	119 (73.9)
No	72 (44.2)	42 (26.1)
* Fisher’s exact probability method；# Mann-Whitney U test

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3. 讨论

研究显示，产前母乳喂养教育或产后哺乳支持，作为医院的单一干预措施，都显著提高了产后6月的纯母乳喂养率^[8]。本研究将产前健康教育与产后技术指导相结合，入院即进行母乳喂养干预并持续至产后42 d，给予产妇传达正确母乳喂养知识、传授母乳喂养技能及动态个性化的产后喂养支持，发现干预组在出院时、产后42 d纯母乳喂养率高于对照组，且差异有统计学意义，说明个性化干预可有效提高剖宫产妇产后纯母乳喂养率，与MCFADDEN等^[8]研究结论一致。

美国妇产科学会(ACOG)建议婴儿在出生后应早开奶、按需哺乳、坚持夜间哺乳、24 h哺乳次数不低于8次^[9]。基于以上指南，本研究对实验组对象进行了针对性的健康教育与喂养技能指导，干预组乳房胀痛及乳头皲裂发生率、24 h配方奶添加次数、奶瓶使用率、喂养问题发生率均低于对照组，且24 h哺乳次数及计划哺乳时长均高于对照组，可认为干预组对象各阶段母乳喂养行为优于对照组，说明个性化干预能促进产妇掌握母乳喂养技能，增强母乳喂养信心，进而改善母乳喂养行为。

SHI等^[10]对15篇干预性研究综述证实，有效的健康教育干预措施可提升母乳喂养知识水平进而改善母乳喂养行为。国内学者肖红等^[11]研究结果也证实了孕期健康教育能有效提高孕妇母乳喂养知识水平，改变孕妇母乳喂养态度，树立正确母乳喂养观，从而改善其母乳喂养行为。由此可知，母乳喂养知识水平是影响产妇母乳喂养行为的重要因素。因此，本研究在两组对象入院时即进行母乳喂养知识评估，根据评估结果对干预组产妇进行一对一、面对面的健康指导，结果显示，两组对象在出院时母乳喂养知识得分均高于入院时，且与接受常规宣教的对照组相比，接受个性化健康教育的干预组得分更高，说明个性化干预对剖宫产妇母乳喂养知识知晓情况有较大的改善。与此同时，本研究分别在两组对象出院时及产后42 d运用母乳喂养评估量表进行评估，结果显示干预组在两个阶段的得分均高于对照组，说明个性化干预能有效提高干预组产妇母乳喂养满意度，进而改善母乳喂养行为，提高纯母乳喂养率。

因此，实施产前与产后相结合的个性化干预可显著提高剖宫产妇母乳喂养知识水平，提高母乳喂养满意度，改善母乳喂养行为，进而提高纯母乳喂养率。

本研究存在一些不足，由于研究时间有限，故只在一家医院进行了42 d的随访。建议可在不同地区、不同级别的多家医院进行多中心、大样本的研究，延长随访时间，观察干预效果随时间变化的趋势，找出干预方法在各时间点的优缺点，进一步优化干预方式，促进剖宫产产妇母乳喂养行为和持续时间。

表 1 入院时两组研究对象基本情况比较

Table 1 Comparison of basic information between the two groups at admission

Variable	Intervention group (n=171)	Control group (n=170)	Statistic	P
Nationality/case (%)			-	0.72^*
Ethnic Han	168 (98.2)	166 (97.6)
Minority	3 (1.8)	4 (2.4)
Age/yr.	33.5±4.3	32.6±4.3	1.87	0.06
Body mass gain during the gestation period/kg	13.8±4.3	13.1±4.5	1.58	0.12
Gravidity/times	2.9±3.1	2.5±1.4	1.63	0.11
Parity/times	1.6±0.6	1.5±0.6	0.81	0.42
Gestational weeks/week	38.8±1.1	38.5±3.1	0.002^#	0.99
Education level/case (%)			1.19	0.75
Junior high school	8 (4.7)	7 (4.1)
Senior high school	12 (7.0)	8 (4.7)
Junior college	38 (22.2)	35 (20.6)
Bachelor degree or above	113 (66.1)	120 (70.6)
Occupation/case (%)			4.71	0.45
Professionals	23 (13.5)	19 (11.2)
Agencies and Institutions	52 (30.4)	42 (24.7)
Clerk	44 (25.7)	57 (33.5)
Liberal professions	33 (19.3)	31 (18.2)
Others	19 (11.1)	21 (12.4)
Monthly household income per capita /case (%)			2.58	0.63
< 3 000	5 (2.9)	5 (2.9)
3 001-5 000	32 (18.7)	27 (15.9)
5 001-10 000	62 (36.3)	66 (38.8)
> 10 000	72 (42.1)	72 (42.4)
Current residence status/case (%)			1.81	0.61
Live with husband	94 (55.0)	102 (60.0)
Living with husband and parents	40 (23.4)	37 (21.8)
Live with husband and parents in-laws	36 (21.1)	31 (18.2)
Others	1 (0.6)	0 (0.0)
The history of alcohol and tobacco/case (%)			-	0.77^*
Yes	5 (2.9)	7 (4.1)
No	166 (97.1)	163 (95.9)
Pregnancy complications/case (%)			1.31	0.25
Yes	139 (81.3)	146 (85.9)
No	32 (18.7)	24 (14.1)
Fertility status/case (%)			2.14	0.14
Primipara	81 (47.4)	94 (55.3)
Pluripara	90 (52.6)	76 (44.7)
Number of fetuses/case (%)			0.03	0.85
Single birth	157 (91.8)	157 (92.4)
Polyembryony	14 (8.2)	13 (7.6)
Breastfeeding experience/case (%)			1.95	0.16
Yes	84 (49.1)	73 (42.9)
No	87 (50.9)	97 (57.1)
Guidance on breastfeeding during pregnancy/case (%)			0.52	0.47
Yes	119 (69.6)	124 (72.9)
No	52 (30.4)	46 (27.1)
* Fisher’s exact probability method；# Mann-Whitney U test

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表 2 出院时两组研究对象临床资料比较

Table 2 Comparison of clinical data between the two groups at discharge

Variable	Intervention group (n=171)	Control group (n=170)	Statistic	P
Anesthesia type/case (%)			4.75	0.09
Combined spinal-epidural anesthesia	139 (81.3)	136 (80.0)
General anesthesia	28 (16.4)	22 (12.9)
Persistent epidural anesthesia	4 (2.3)	12 (7.1)
Preoperative fasting time/h	12.2±3.0	11.6±3.4	1.81	0.07
Intraoperative fluid dosage/mL	1 305.0±572.8	1 254.9±500.9	0.87	0.39
Peroperative bleeding/mL	429.3±266.9	463.6±426.6	-0.90	0.37
Sleep time of puerpera /case (%)			4.51	0.11
< 6 h	55 (32.1)	71 (41.8)
6-8 h	100 (58.5)	80 (47.0)
> 8 h	16 (9.4)	19 (11.2)
Appetite of puerpera /case (%)			2.01	0.37
Poor	12 (7.1)	14 (8.2)
General	89 (52.0)	99 (58.2)
Good	70 (40.9)	57 (33.6)
Crater nipple/case (%)			1.02	0.31
Yes	18 (10.5)	23 (13.5)
No	153 (89.5)	147 (86.5)
Flat nipple/case (%)			2.96	0.09
Yes	19 (11.1)	30 (17.6)
No	152 (88.9)	140 (82.4)
Neonatal sex/case (%)			0.24	0.63
Male	93 (54.4)	88 (51.8)
Female	78 (45.6)	82 (48.2)
Birth body mass/g	3 273.0±514.3	3 220.0±444.6	1.03	0.31
Body length of neonate/cm	49.8±2.1	49.3±2.3	1.88	0.28

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表 3 干预前后两组孕产妇关于母乳喂养知识得分比较

Table 3 Comparison of knowledge scores of breastfeeding between the two groups before and after intervention

Time	Intervention group (n=171)	Control group (n=170)	Statistic	P
Before intervention (at admission)	102.3±11.1	100.3±11.5	1.66	0.10
After intervention (at discharge)	118.7±7.6	103.2±11.8	-12.1^#	< 0.001
# Mann-Whitney U test

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表 4 出院时两组对象母乳喂养行为比较

Table 4 Comparison of breast-feeding behaviors between the two groups at discharge

Variable	Intervention group (n=171)	Control group (n=170)	Statistic	P
Feeding pattern/case (%)			29.40	< 0.001
Exclusive breastfeeding	118 (69.0)	68 (40.0)
Mixed feeding	53 (31.0)	101 (59.4)
Artificial feeding	0 (0.0)	1 (0.6)
Colostrum secretory time/case (%)			2.80	0.42
Day of childbirth	79 (46.2)	68 (40.0)
First day after delivery	58 (33.9)	58 (34.1)
Second day after delivery	32 (18.7)	39 (22.9)
Third day after delivery	2 (1.2)	5 (2.9)
Breast distending pain /case (%)			32.24	< 0.001
No	90 (52.6)	41 (24.1)
Mild	54 (31.6)	74 (43.5)
Moderate	24 (14.0)	43 (25.3)
Severe	3 (1.8)	12 (7.1)
Feeding frequency per day/case (%)			42.11	< 0.001
< 4	1 (0.6)	8 (4.7)
4-7	58 (33.9)	109 (64.1)
≥8	112 (65.5)	53 (31.2)
Night feeding/case (%)			0.15	0.70
Yes	168 (98.2)	166 (97.6)
No	3 (1.8)	4 (2.4)
Cracked nipple/case (%)			8.26	0.004
Yes	39 (22.8)	63 (37.1)
No	132 (77.2)	109 (62.9)
Adding formula milk /case (%)			0.06	0.81
Yes	160 (94.1)	161 (94.7)
No	11 (5.9)	9 (5.3)
Breastfeeding evaluation scores	120.8±11.0	114.9±12.3	-4.32	< 0.001
Planned breastfeeding duration /month	12.0±5.1	10.7±5.8	3.56^#	< 0.001
# Mann-Whitney U test

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表 5 产后42 d两组对象母乳喂养行为比较

Table 5 Comparison of breast-feeding behaviors between the two groups at postpartum 42 d

Variable	Intervention group (n=163)	Control group (n=161)	Statistic	P
Sleep time of puerpera/case (%)			2.72	0.26
< 6 h	42 (25.8)	32 (19.9)
6-8 h	96 (58.9)	109 (67.7)
> 8 h	25 (15.3)	20 (12.4)
Appetite of puerpera/case (%)			5.44	0.07
Poor	3 (1.8)	11 (6.8)
General	91 (55.8)	79 (49.1)
Good	69 (42.3)	71 (44.1)
The birth body mass/kg	49 133.1±603.6	4 729.9±577.5	2.79	0.01
Body length of neonate/cm	56.2±2.2	55.9±2.2	1.35	0.18
Urinary frequency of infant per day	9.2±3.2	9.1±2.2	-0.84 ^#	0.40
Defecation frequency of infant per day	3.5±2.2	3.7±2.1	-0.81	0.42
Feeding pattern/case (%)			7.86 ^*	0.02
Exclusive breastfeeding	99 (60.7)	73 (45.3)
Mixed feeding	61 (37.4)	85 (52.8)
Artificial feeding	3 (1.8)	3 (1.9)
Times of adding formula milk per day	1.5±2.1	2.3±2.9	-2.48 ^#	0.01
Using feeding bottle/case (%)			6.05	0.01
Yes	103 (63.2)	122 (75.8)
No	60 (36.8)	39 (30.6)
Feeding type/case (%)			0.68	0.41
On-time feeding	12 (7.4)	16 (9.9)
On-demand feeding	151 (92.6)	145 (90.1)
Feeding frequency per day/case (%)			3.61	0.16
< 4	9 (5.5)	4 (2.5)
4-7	75 (46.0)	65 (40.4)
≥8	79 (48.5)	92 (57.1)
Night feeding/case (%)			1.00	0.32
Yes	153 (93.9)	155 (96.3)
No	10 (6.1)	6 (3.7)
Cracked nipple/case (%)			5.99	0.01
Yes	61 (37.4)	82 (50.9)
No	102 (62.6)	79 (49.1)
Breast distending pain /case (%)			6.65	0.08
No	25 (15.3)	41 (25.5)
Mild	81 (49.7)	67 (41.6)
Moderate	48 (29.4)	40 (24.8)
Severe	9 (5.5)	13 (8.1)
Breastfeeding evaluation scores	121.6±12.3	116.8±10.9	3.65	< 0.001
Planned breastfeeding duration/month	10.4±4.9	9.1±4.5	2.32	0.02
Feeding problems/case (%)			11.62	0.001
Yes	91 (55.8)	119 (73.9)
No	72 (44.2)	42 (26.1)
* Fisher’s exact probability method；# Mann-Whitney U test

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参考文献(11)

[1]	曾娟, 褚静, 高燕, 等.剖宫产产妇产后母乳喂养率调查与持续性支持干预研究.河北医药, 2017, 39(2):318-320. http://d.old.wanfangdata.com.cn/Periodical/hbyy201702048
[2]	SOBTI J, MATHUR GP, GUPTA A. WHO's proposed global strategy for infant and young child feeding: a viewpoint. J Indian Med Assoc, 2002, 100(8):502-504. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_PM12675182
[3]	HOBBS AJ, MANNION CA, MCDONALD SW, et al. The impact of caesarean section on breastfeeding initiation, duration and difficulties in the first four months postpartum. BMC Pregnancy Childbirth, 2016, 16: 90[2019-04-19]. https://doi.org/10.1186/s12884-016-0876-1
[4]	张秋君, 史云菊. 612例产妇母乳喂养率影响因素分析.中国妇幼保健, 2013, 28(30):5095-5096. DOI: 10.7620/zgfybj.j.issn.1001-4411.2013.30.67
[5]	邓丽.阴道分娩与剖宫产对产妇母乳喂养情况比较.川北医学院学报, 2013, 28(1):71-73. DOI: 10.3969/j.issn.1005-3697.2013.01.019
[6]	PRIOR E, SANTHAKUMARAN S, GALE C, et al. Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. Am J Clin Nutr, 2012, 95(5):1113-1135. DOI: 10.3945/ajcn.111.030254
[7]	SU LL, CHONG YS, CHAN YH, et al. Antenatal education and postnatal support strategies for improving rates of exclusive breast feeding: randomised controlled trial. BMJ, 2007, 335(7620): 596[2019-4-19]. https://doi.org/10.1136/bmj.39279.656343.55.
[8]	MCFADDEN A, GAVINE A, RENFREW MJ, et al. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev, 2017, 2: D1141[2019-04-19]. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001141.pub5/full.
[9]	ACOG Committee Opinion No. 361: Breastfeeding: maternal and infant aspects. Obstet Gynecol, 2007, 109(2 Pt 1):479-480. http://d.old.wanfangdata.com.cn/Periodical/zgjjyx200906007
[10]	SHI L, ZHANG J. Recent evidence of the effectiveness of educational interventions for improving complementary feeding practices in developing countries. J Trop Pediatr, 2011, 57(2):91-98. DOI: 10.1093/tropej/fmq053
[11]	肖红, 龚良晨, 罗美华, 等.健康教育对提高初产妇母乳喂养相关知识认知行为的评价.中国妇幼保健, 2011, 26(24):3778-3779. http://d.old.wanfangdata.com.cn/Periodical/zgfybj201124039

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1. 对象与方法
1.1 对象与分组
1.2 干预措施
1.3 测量指标
1.4 统计学方法
2. 结果
2.1 基本资料
2.2 出院时比较
2.2.1 临床资料
2.2.2 母乳喂养情况
2.3 产后42 d母乳喂养情况
3. 讨论

个性化干预对剖宫产产妇母乳喂养行为的影响

通讯作者:
罗碧如，E-mail: biruluo@126.com

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