目的 探讨女性医务人员月经改变的影响因素及与心理状态的相关性。方法 对深圳市3家医院女性医护人员进行随机抽样得到869份问卷调查样本，均为知情自愿参与本项调查研究。统计女性医务人员出现女性月经改变的比率和月经改变的基本特征，并采用单因素和多因素分析的方法分析影响月经改变因素。并以抑郁症筛查量表（PHQ-9）评估女性医护人员的心理状态，分析女性医务人员月经改变与心理状态评分间相关性。结果 869名女性医护人员中有293例发生月经改变，改变率为33.72%，其中月经周期改变94例、经期时间改变86例、月经量改变68例、痛经改变45例。将869例女性医护人员分为月经正常组和月经改变组，经单因素分析，两组间的年龄、职业、值夜班频率、既往病史、新冠感染等比较差异无统计学意义（P＞0.05）。月经改变组的护士占58.36%高于月经正常的24.48%，月经改变组的新冠一线抗疫人员占64.51%高于月经正常的27.08%，月经改变组合并妇科疾病史的占比20.82%（61例）高于月经正常组的占比11.98%（69例）。而月经改变组的护士、新冠一线抗疫人员、合并妇科疾病史、新冠感染的比较差异有统计学意义（P＜0.05）。多因素分析显示，职业为护士、合并妇科疾病史、新冠一线抗疫人员的P值分别为0.001、0.004、＜0.001，故而职业为护士、合并妇科疾病史、新冠一线抗疫人员是女性医务人员月经改变的危险因素。月经改变组PHQ-9评分为9.10±2.57，月经正常组PHQ-9评分为5.98±1.06，月经改变组PHQ-9评分高于月经正常组（P＜0.001）。两组受试者PHQ-9评分比较差异具有统计学意义，月经改变组PHQ-9评分中0～4分受试者为26.3%，月经正常组为47.2%，月经改变组PHQ-9评分中0～4分者比例小于月经正常组，差异具有统计学意义（P＜0.05）。结论 女性医务人员中职业为护士、合并妇科疾病史、新冠一线抗疫人员是月经改变的主要危险因素，且月经改变与心理状态有密切的相关性，需引起医疗机构的关注。
Objective To analyze the influencing factors of menstruation changes of female medical staff and the correlation with their psychological status．Methods The female medical staff in three hospitals of Shenzhen were randomly sampled to get 869 questionnaires，with informed and willing to participate in this research．The rate of female menstruation changes and the basic characteristics of menstruation changes in female medical staff were calculated，and the influencing factors of menstruation changes were analyzed by single factor and multi factor analysis．And the psychological status of female medical staff was using the Depression Screening Scale （PHQ-9），and the correlation between menstrual changes and psychological status scores of female medical staff were analyzed．Results Among 869 female medical staff，293 had hemorrhagic menstrual disease，with a change rate of 33.72%．Among them，94 had changes in menstrual cycle，86 had changes in menstrual period days，68 had changes in menstrual volume，and 45 had changes in dysmenorrhea．These 869 female medical staff were divided into normal menstruation group and menstrual change group．Through single factor analysis，there was no statistical difference between the two groups in terms of age，careers，night shift frequency，previous medical history，COVID-19 infection （P＞0.05）．The percentage of nurses in the menstrual change group was 58.36%，higher than that of 24.48% in the normal menstruation group．The percentage of frontline medical staff combating COVID-19 in the menstrual change group was 64.51%，higher than that of 27.08% in the normal menstruation group．And the percentage of menstrual change group with a history of combined gynecological diseases was 20.82% （61 cases），higher than that of the normal menstruation group was 11.98% （69 cases）．And the difference was statistically significant when comparing the ratio of nurses，the frontline medical staff combating COVID-19，the history of gynecological diseases，and COVID-19 infection in the menstrual change group （P＜0.05）．Multivariate analysis showed that the occupation of nurses，frontline medical staffs combating COVID-19，and history of gynecological diseases were the risk factors for menstrual changes．The PHQ-9 score of the menstrual change group was higher than that of the normal menstrual group，and the difference was statistically significant．Conclusions The main risk factors for menstrual changes are nurses，frontline anti-epidemic staff，and women with gynecological disease history．Menstrual changes are closely related to mental status，attention from healthcare organizations．
目的 探讨剖宫产后再次分娩阴道试产失败的影响因素。方法 选取2021年5月—2024年5月在枣庄市妇幼保健院分娩的138例有剖宫产手术史的足月妊娠产妇进行回顾性分析。所有产妇依照其阴道试产结果将成功阴道分娩的35例产妇分为成功组，将阴道试产失败中转剖宫产的103例产妇分为失败组。对比两组产妇的妊娠结局、孕期情况及围产期情况，最后采用多因素Logistic回归分析法分析剖宫产后再次分娩阴道试产失败的影响因素。结果 两组产妇子宫破裂、胎儿窘迫、产褥感染及产后出血等妊娠不良结局总发生率对比差异无统计学意义（11.43% vs 6.80%，χ 2 =0.760，P=0.382 ＞0.05）；通过对比两组产妇孕期情况发现，失败组与成功组孕妇年龄、孕次、身高、孕前体质量、妊娠期合并症、分娩前体质量指数（BMI）比较差异无统计学意义（P＞0.05），失败组与成功组孕妇孕期体质量增长［（4.56±2.56）kg vs（12.45±3.24）kg］、分娩孕周［（39.46±1.25）周 vs（37.95±1.37）周］、阴道分娩史（8.57% vs 26.21%）、妊娠间隔时间［（2.74±0.35）年 vs（3.37±0.57）年］及瘢痕厚度［（4.51±0.56）mm vs（5.42±0.38）mm］，对比差异有统计学意义（t=3.497，P＜0.001；t=5.755，P＜0.001；χ 2 =4.780，P=0.029；t=6.148，P＜0.001；t=10.764，P＜0.001）；通过对比两组产妇围产期情况发现，失败组与成功组新生儿性别、是否镇痛比例比较差异无统计学意义（P＞0.05），失败组与成功组孕妇产前新生儿估重［（3352.31±153.67）g vs（3046.25±141.68）g］、是否引产［60.00% vs 52.43%］、胎膜早破［11.43% vs 35.92%］、入院时是否临产［857% vs 27.18%］，对比差异有统计学意义（t=10.805，P＜0.001；χ 2 =7.330，P=0.007；χ 2 =7.500，P=0.006；χ 2 =5.200，P=0.023）；以阴道试产情况作为因变量（失败=1，成功=0）纳入Logistic回归模型，结果显示，分娩孕周过晚、产前新生儿估重过高、引产及入院时未临产为剖宫产后再次分娩阴道试产失败的影响因素（P＜0.05）。结论 分娩孕周过高、产前新生儿估重过高、引产及入院时未临产为剖宫产后再次分娩阴道试产失败的独立影响因素，需针对分娩孕周、产前新生儿估重过高的剖宫产后再次分娩阴道试产产妇给予高度关注并采取相应措施进行干预，同时自然临产能够降低阴道试产失败风险，但针对具有引产指征的产妇，依然需要及时引产。
Objective To explore the influencing factors of vaginal trial delivery failure after cesarean section．Methods A retrospective analysis was conducted on 138 full-term pregnant women with a history of cesarean section who gave birth in our hospital from May 2021 to May 2024．All women were divided into two groups according to the results of their vaginal trial delivery．Based on their vaginal trial results，35 parturients who successfully delivered were divided into the successful group，and 103 parturients who failed vaginal trial delivery and transitioned to cesarean section were divided into the failed group．The pregnancy outcomes of postpartum women and the pregnancy and perinatal conditions were compared between the two groups，and multivariate Logistic regression analysis was used to analyze the independent influencing factors of vaginal trial delivery failure after cesarean section．Results There was no significant difference in the total incidence of adverse pregnancy outcomes such as uterine rupture，fetal distress，postpartum infection，and postpartum hemorrhage between the two groups of parturients （P＞0.05）．By comparing the pregnancy status of two groups of pregnant women，it was found that there was no difference （P＞0.05）．The average weight gain during pregnancy of failure and successful group，gestational age，cases with vaginal delivery history，intervalbetween pregnancy and scar thickness，the contrast difference was significant （all P＜0.05） ．By comparing the perinatal situation of the two groups，there was no difference in the sex of fetus and analgesia receiving of parturients between the failed group and the successful group （P＞0.05），while there is difference in weight estimation，whether induced labour，premature rupture of fetal membrane，whether admitted to hospital （all P＜0.05）．Vaginal trial delivery was set as the dependent variable （failure=1，success=0） and it was incorporated into the Logistic regression model．The results showed that high gestational age during delivery，high estimated weight of fetus before delivery，induction of labor，and non-labor upon admission were independent influencing factors for vaginal trial delivery failure after cesarean section （P＜0.05）．Conclusions Excessive gestational age，high estimated weight of fetus before delivery，induced labor，and non-labor upon admission were independent influencing factors for the failure of vaginal trial delivery after cesarean section．It is necessary to pay high attention and take corresponding measures to intervene in women who have undergone vaginal trial delivery after cesarean section due to excessive gestational age and high estimated weight of fetus before delivery．At the same time，spontaneous labour can reduce the risk of vaginal trial delivery failure．However，for women with indications for induced labor，timely induction is still necessary．
目的 探讨阴道分娩后尿失禁患者疾病应对方式的影响因素。方法 选取2022年1月—2023年1月医院收治的阴道分娩后尿失禁患者78例，评估所有患者的应对方式，根据结果分为积极应对组与消极应对组，设计基线资料调查表，详细统计两组患者的基线资料并比较，重点分析阴道分娩后尿失禁患者疾病应对方式的影响因素。结果 经评估，78例阴道分娩后尿失禁患者疾病消极应对有40例，占比51.28%；积极应对组与消极应对组患者的产次（χ 2 =4.110，P=0.043）、文化水平（Z=2.094，P=0.036）、家庭关怀度（Z=2.069，P=0.040）与自我效能（Z=2.249，P=0.025）比较差异有统计学意义，组间年龄（t=0.096，P=0.924）、孕次（t=1.257，P=0.212）、体质指数（BMI）（t=0.125，P=0.901）、工作（χ 2 =0.778，P=0.378）、家庭月人均收入（χ 2 =0.044，P=0.834）、漏尿（χ 2 =0.040，P=0.842）比较差异无统计学意义；经回归分析发现，家庭关怀度低（OR=1.799，P=0.041）、自我效能低（OR=1.942，P=0.026）、经产妇（OR=2.554，P=0.045）及文化水平低（OR=1.837，P=0.038）均是阴道分娩后尿失禁患者疾病应对方式的影响因素。结论 阴道分娩后尿失禁患者疾病消极应对风险高，可能与产次、文化水平、家庭关怀度及自我效能有关。
Objective To explore the influencing factors of disease coping strategies in patients with urinary incontinence after vaginal delivery．Methods A total of 78 patients with urinary incontinence after vaginal delivery admitted to the hospital from January 2022 to January 2023 were selected．The coping strategies of all patients were evaluated，and they were divided into a positive coping group and a negative coping group based on the results．A baseline data questionnaire was designed，and the baseline data of the two groups of patients were compared in detail．The focus was on analyzing the factors influencing the disease coping strategies of patients with urinary incontinence after vaginal delivery．Results After evaluation，40 out of 78 patients with urinary incontinence after vaginal delivery had negative coping strategies，accounting for 51.28%．The parity of patients in the positive and negative coping groups（χ 2 =4.110，P=0.043），educational level（Z=2.094，P=0.036），family care（Z=2.069，P=0.040），and self-efficacy（Z=2.249，P=0.025）among the groups were different．Age between groups（t=0.096，P=0.924），gestational age（t=1.257，P=0.212），body mass index（t=0.125，P=0.901），and work experience（χ 2 =0.778，P=0.378），monthly per capita income of households（χ 2 =0.044，P=0.834），urinary leakage（χ 2 =0.040，P=0.842）had no statistically significant difference in comparison．Through regression analysis，it was found that low family care（OR=1.799，P=0.041），low self-efficacy（OR=1.942，P=0.026），postpartum women（OR=2.554，P=0.045），and low educational level（OR=1.837，P=0.038）were all influencing factors on the disease coping strategies of patients with urinary incontinence after vaginal delivery．Conclusions Patients with urinary incontinence after vaginal delivery have a higher risk of negative coping with the disease，which may be related to parity，educational level，family care and self-efficacy．
