分娩方式与儿童感觉统合失调的回顾性队列分析

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摘要目的采用回顾性队列研究设计,评价分娩方式与儿童感觉统合失调的关联。方法依托北京大学生育健康研究所围生保健监测系统,随机抽取1993—1994年出生儿童2 402名,于2000年12月—2001年7月采用“感觉统合能力发展量表”,从前庭平衡、触觉防御、本体感平衡和学习能力四个维度评价儿童感觉统合功能。分娩方式源自围生监测系统,以阴道助产和剖宫产为暴露组,以阴道自然分娩为非暴露组。采用多因素Logistic回归分析估计阴道助产和剖宫产与感觉统合各维度失调关联程度。结果前庭平衡、触觉防御、本体感平衡和学习能力四个维度感觉统合失调率依次为14.8%、11.9%、9.1%和14.1%。调整母亲年龄、文化程度等混杂因素后,与阴道自然分娩儿童相比,阴道助产儿童四个维度失调OR范围1.21～1.44,剖宫产儿童四个维度OR范围1.01～1.27,可信区间均包含1.00。按性别分层分析发现,阴道助产和剖宫产男童四个维度失调OR范围分别1.00～1.42和0.98～1.00,且部分OR可信区间下限均包含1.00;阴道助产和剖宫产女童四个维度失调OR范围分别1.20～2.32和1.04～1.71,且部分OR可信区间下限大于1.00。结论阴道助产和剖宫产对男童感觉统合失调发生风险无影响,但有增加女童感觉统合失调发生风险的可能。

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关键词 ：阴道助产, 剖宫产, 感觉统合失调, 队列研究

Abstract：Objective To assess the association between mode of delivery and sensory integration dysfunction (SID) of children.Methods A total of 2 402 children born in 1993-1994 were randomly selected from a perinatal healthcare surveillance system. The sensory integration function of children was evaluated using the Chinese Children Sensory Integration Capacity Development Rating Scale during Dec. 2000 to Jul. 2001. The scale included four dimensions of sensory integration function: vestibular, tactile defensiveness, proprioception, learning ability. Birth records (including mode of delivery, maternal age, etc.) were obtained from the surveillance system. According to mode of delivery, the children were divided into spontaneous vaginal delivery group (SVD), assisted vaginal delivery group (AVD) and cesarean delivery group (CS). Multivariable logistic regression was used to estimate adjusted odds ratio (OR) and 95% confidence intervals (95% CIs) of SID.Results The prevalence rates of vestibular disorder, tactile overly defensive, proprioceptive disorder and learning ability insufficient were 14.8%, 11.9%, 9.1% and 14.1%, respectively. Compared with SVD, the adjusted ORs of the four dimensions of SID for children born by AVD were 1.21-1.44, and 1.01-1.27 for children born by CS, and all of the 95% CIs of ORs included the null. In subgroups stratified by gender, the corresponding adjusted ORs of boys born by AVD and CS were 1.00-1.42 and 0.98-1.00, and all of 95% CIs of ORs included the null. The adjusted ORs of girls born by AVD and CS were 1.20-2.32 and 1.04-1.71, and parts of 95% CIs of ORs included the null.Conclusion AVD and CS are not significantly associated with SID among boys, while they may be associated with the risk of SID among girls.

Key words： Assisted vaginal delivery Cesarean delivery Sensory integration dysfunction Cohort study

收稿日期: 2015-05-20

通讯作者: 刘建蒙(liujm@pku.edu.cn)

引用本文:

李碧, 李宏田, 周玉博, 叶荣伟, 任爱国, 刘建蒙. 分娩方式与儿童感觉统合失调的回顾性队列分析[J]. 中国生育健康杂志, 2016, 27(1): 1-5.
LI Bi, LI Hongtian, ZHOU Yubo, YE Rongwei, REN Aiguo, LIU Jianmeng. Institute of Reproductive and Child Health/ Ministry of Health Key Laboratory of Reproductive Health, Peking University; School of Public Health Peaking University, Beijing 100191, China. The association between mode of delivery and sensory integration dysfunction of children: A retrospective cohort study in China. Chinese Journal of Reproductive Health, 2016, 27(1): 1-5.

链接本文:

http://cjrh.bjmu.edu.cn/CN/ 或 http://cjrh.bjmu.edu.cn/CN/Y2016/V27/I1/1

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