基于“防微安和”理念的复发性流产社区干预体系探微

丁朝阳; 姚易; 郭芷亦; 张建容; 朱建平; 姜丽娟

doi:10.16766/j.cnki.issn.1674-4152.002862

基于“防微安和”理念的复发性流产社区干预体系探微

doi: 10.16766/j.cnki.issn.1674-4152.002862

1.
云南中医药大学第一临床医学院，云南昆明 650000
2.
云南省中医医院医学伦理委员会，云南昆明 650021

基金项目:

国家自然科学基金地区科学基金项目 82060882

云南省科技厅科技计划项目重大科技专项计划 202102AA100008

云南省科技厅科技计划项目重大科技专项计划 2017ZF011

云南省“万人计划”名医专项云卫人发[2018]1号

详细信息

通讯作者:
姜丽娟，E-mail：jianglijuan825@163.com

中图分类号: R714.21 R197.61
计量
- 文章访问数: 208
- HTML全文浏览量: 49
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2022-07-18
- 网络出版日期: 2023-04-20

Exploring the community intervention of recurrent abortion based on the concept of "preventing disease from the beginning makes the human body peaceful"

1.
First Clinical Medical College, Yunnan University of Traditional Chinese Medicine, Kunming, Yunnan 650000, China

摘要

摘要: 复发性流产是现代妇科常见多发病之一，其不仅是一个医学问题，更是成为一个逐渐影响婚姻生活及家庭和谐的社会问题，对育龄期女性的身心健康造成了严重困扰。复发性流产具有“应期而堕”的特点，明确流产原因，积极调理身体，及早地预防干预能更有效地避免流产再次发生。社区干预旨在以综合干预手段改变人群的行为习惯与生活方式，进而干预疾病发生、发展中的危险因素，充分体现了三级预防的内涵。传统社区干预手段为复发性流产的防治起到了积极作用，但干预项目影响力多局限于试点阶段与试点区域，难以大范围推广应用。针对复发性流产社区干预的系列问题，系统整理了导师姜丽娟教授“防微安和”理念，从“气血和”，分期调养；“志意和”，调畅情志；“寒温和”，重视人群体质；“医患和”，增强疾病观念4个方面具体阐述了在社区实践中如何针对复发性流产患者进行有效干预，并构建了系统的社区干预体系。“防微安和”理念不仅适用于复发性流产，对其他疾病社区干预的开展亦有参考价值，将中医理论同社区干预相结合并发挥中医全科医生的主体地位，才能最大限度地优化干预计划中各项资源的配置，提高干预实践的实效和质量。以中医理论为指导的社区干预将是未来全科医学在基层卫生保健事业中防治疾病、促进健康的有力武器。
- 复发性流产 /
- 社区干预 /
- “防微安和” /
- 预培其损
Abstract: Recurrent abortion is one of the common and frequently occurring diseases in modern gynaecology. It is not only a medical problem but also a social burden that gradually affects marriage life and family harmony, causing serious problems to the physical and mental health of women in childbearing age. Recurrent abortion has the characteristics of "abortion will occur at a specific time". It is more effective to avoid the recurrence of abortion by clarifying the causes of abortion, actively regulating the body and early prevention and intervention. Community intervention aims to change people' s behaviour, habits and lifestyles through comprehensive intervention and then intervene the risk factors in the occurrence and development of diseases. This process fully reflects the connotation of three-level prevention. Traditional community intervention has played a positive role in the prevention and control of recurrent abortion, but the influence of intervention projects is mostly limited to the pilot stage and the pilot area, which is difficult to promote and apply in a large scale. In view of the series of problems of community intervention for recurrent abortion, the writer systematically sorted out Professor Jiang Li-juan' s concept of "prevent disease from the beginning makes the human body peaceful", and specifically elaborated how to carry out effective intervention for patients with recurrent abortion in community practice and built a systematic community intervention system from the "harmony of Qi and blood", phased recuperating; "harmony of will", regulating emotion; "harmony cold and mild", attaching importance to people' s physique; and "doctor-patient harmony", enhancing the concept of disease. This concept is not only applicable to recurrent abortion but also has reference value for the development of community intervention for other diseases. Combining the theory of traditional Chinese medicine with community intervention and giving play to the dominant position of general practitioners of traditional Chinese medicine can optimise the allocation of various resources in the intervention plan to the maximum extent and improve the effectiveness and quality of the intervention practice. Community interventions guided by TCM theory will be a powerful tool for the future of general medicine in primary health care to prevent and treat diseases and promote health.
- Recurrent abortion /
- Community intervention /
- Preventing disease from the beginning makes the human body peaceful /
- Pre-cultivates the loss

HTML全文

参考文献(24)

[1]	国家妇幼健康研究会生殖免疫学专业委员会专家共识编写组. 复发性流产合并血栓前状态诊治中国专家共识[J]. 中华生殖与避孕杂志, 2021, 41(10): 861-875. doi: 10.3760/cma.j.cn101441-20210715-00310 Experts Consensus Group on Reproductive Immunology of Maternal and Child Health Research Association. Chinese experts consensus on the diagnosis and treatment of recurrent spontaneous abortion with prethrombotic state[J]. Chinese Journal of Reproduction and Contraception, 2021, 41(10): 861-875. doi: 10.3760/cma.j.cn101441-20210715-00310
[2]	温海燕, 王靖, 钱敏, 等. miR-155在复发性流产患者绒毛组织中的表达及与TIM3水平的关系[J]. 中华全科医学, 2020, 18(3): 438-441. doi: 10.16766/j.cnki.issn.1674-4152.001267 wEN H Y, WANG J, QIAN M, et al. Expression of miR-155 in villus tissues and its relationship with TIM3 level in patients with recurrent abortion[J]. Chinese Journal of General Practice, 2020, 18(3): 438-441. doi: 10.16766/j.cnki.issn.1674-4152.001267
[3]	于晓松, 路孝琴. 社区预防[M]. 北京: 人民卫生出版社, 2019: 46-47. YU X S, LU X Q. Community prevention[M]. Beijing: People's Medical Publishing House, 2019: 46-47.
[4]	严慧艳, 王敬丽, 陈晟, 等. 冠心病社区综合干预的研究进展分析[J]. 实用心脑肺血管病杂志, 2020, 28(S2): 263-265. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL2020S2107.htm YAN H Y, WANG J L, CHEN C, et al. Analysis of research progress of comprehensive community intervention for coronary heart disease[J]. Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease, 2020, 28(S2): 263-265. https://www.cnki.com.cn/Article/CJFDTOTAL-SYXL2020S2107.htm
[5]	郇建立. 美国斯坦福5城市慢性病社区干预项目的经验和教训[J]. 医学与社会, 2020, 33(3): 25-31. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSH202003007.htm HUAN J L. Analysis of experiences and lessons from the community-based intervention program for chronic diseases in 5 stanford cities in the united states[J]. Medicine and Society, 2020, 33(3): 25-31. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSH202003007.htm
[6]	王艳红. 社区干预试验的理论、设计与实践[J]. 北京医学, 2020, 42(10): 986-991. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX202010018.htm WANG Y H. Theory, design and practice of community intervention trials[J]. Beijing Medical Journal, 2020, 42(10): 986-991. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX202010018.htm
[7]	王东华, 邓杨春. 七损八益本义考[J]. 中华中医药杂志, 2019, 34(9): 4396-4398. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201909133.htm WANG D H, DENG Y C. Original meaning of seven impairments and eight benefits[J]. China Journal of Traditional Chinese Medicine and Pharmacy, 2019, 34(9): 4396-4398. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201909133.htm
[8]	郑勇强, 陈瑞芳. 五脏元真通畅的实质是气血中和: 邓铁涛五脏相关理论在治未病中的应用[J]. 江西中医药, 2020, 51(7): 37-39. https://www.cnki.com.cn/Article/CJFDTOTAL-JXZY202007014.htm ZHENG Y Q, CHEN R F. The true unobstructed essence of the Five Zang Organs is the neutralization of Qi and blood: the application of Deng Tietao's Five Zang Theory in the treatment of disease[J]. Jiangxi Journal of Traditional Chinese Medicine, 2020, 51(7): 37-39. https://www.cnki.com.cn/Article/CJFDTOTAL-JXZY202007014.htm
[9]	谈勇. 中医妇科学[M]. 4版. 北京: 中国中医药出版社, 2019: 168-170. TAN Y. Gynecology of Chinese medicine[M]. 4th ed. Beijing: China Traditional Chinese Medicine Press, 2019: 168-170.
[10]	武桐, 王媛中, 李伟莉, 等. 补肾健脾法治疗复发性流产的meta分析[J]. 中华全科医学, 2022, 20(6): 1056-1061. doi: 10.16766/j.cnki.issn.1674-4152.002523 WU T, WANG Y Z, LI W L, et al. Meta-analysis of tonifying kidney and invigorating spleen in the treatment of recurrent abortion[J]. Chinese Journal of General Practice, 2022, 20(6): 1056-1061. doi: 10.16766/j.cnki.issn.1674-4152.002523
[11]	LA X L, WANG W J, ZHANG M, et al. Definition and multiple factors of recurrent spontaneous abortion[J]. Adv Exp Med Biol, 2021, 1300: 231-257. DOI: 10.1007/978-981-33-4187-6_11.
[12]	林佩萱, 屈艳霞, 华世文, 等. 复发性流产患者心理状况分析[J]. 中国妇幼保健, 2018, 33(12): 2764-2767. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201812044.htm LIN P X, QU Y X, HUA S W, et al. Analysis on psychological status of patients with recurrent spontaneous abortion[J]. Maternal and Child Health Care of China, 2018, 33(12): 2764-2767. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201812044.htm
[13]	陈建明, 牟方祥, 纪亚忠, 等. 复发性流产病因检查专家共识[J]. 中国计划生育和妇产科, 2022, 14(2): 3-9. https://www.cnki.com.cn/Article/CJFDTOTAL-JHFC202202001.htm CHEN J M, MOU F X, JI Y Z, et al. Expert consensus on the etiological examination of recurrent spontaneous abortion[J]. Chinese Journal of Family Planning & Gynecotokology, 2022, 14(2): 3-9. https://www.cnki.com.cn/Article/CJFDTOTAL-JHFC202202001.htm
[14]	张清华, 潘静, 姚丽艳. 复发性流产患者病因构成分析[J]. 中国全科医学, 2020, 23(14): 1760-1764. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202014010.htm ZHANG Q H, PAN J, YAO L Y. Etiological factors of recurrent spontaneous abortion[J]. Chinese General Practice, 2020, 23(14): 1760-1764. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202014010.htm
[15]	黄海雁, 张惠玲, 陈肖娟. 自然流产2次与≥3次的早期复发性流产患者的病因构成比较[J]. 现代医院, 2020, 20(2): 270-272, 276. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYU202002033.htm HUANG H Y, ZHANG H L, CHEN X J. Comparison of the pathological factors between twice and over three times early miscarriages in patients with spontaneous abortion[J]. Modern Hospitals, 2020, 20(2): 270-272, 276. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYU202002033.htm
[16]	张丽梅, 杨燕宁, 张瑞晓, 等. 自然流产两次与三次及以上的早期复发性流产患者病因构成的比较[J]. 中华妇产科杂志, 2018, 53(12): 855-859. ZHANG L M, YANG Y N, ZHANG R X, et al. Comparison of the etiological constitution of two and three or more recurrent miscarriage[J]. Chinese Journal of Obstetrics and Gynecology, 2018, 53(12): 855-859.
[17]	自然流产诊治中国专家共识编写组. 自然流产诊治中国专家共识(2020年版)[J]. 中国实用妇科与产科杂志, 2020, 36(11): 1082-1090. 自然流产诊治中国专家共识编写组. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSF202011013.htm
[18]	代林莉, 田甜, 解丽菲, 等. 姜丽娟基于"宫络学说"改善人流术后子宫内膜血流经验[J]. 辽宁中医杂志, 2021, 48(3): 19-22. https://www.cnki.com.cn/Article/CJFDTOTAL-LNZY202103006.htm DAI L L, TIAN T, JIE L F, et al. JIANG Lijuan's experience on improving endometrial blood flow after abortion based on "uterus collateral theory"[J]. Liaoning Journal of Traditional Chinese Medicine, 2021, 48(3): 19-22. https://www.cnki.com.cn/Article/CJFDTOTAL-LNZY202103006.htm
[19]	王欢. 分析中医食疗药膳对亚健康状态的影响[J]. 医学食疗与健康, 2021, 19(1): 22-24. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSL202101010.htm WANG H. The influence of Chinese medicine diet on sub-health state was analyzed[J]. Medical Diet and Health, 2021, 19(1): 22-24. https://www.cnki.com.cn/Article/CJFDTOTAL-YXSL202101010.htm
[20]	倪诚, 李英帅, 王琦. 中医体质研究40年回顾与展望[J]. 天津中医药, 2019, 36(2): 108-111. https://www.cnki.com.cn/Article/CJFDTOTAL-TJZY201902002.htm NI C, LI Y S, WANG Q. Review and prospect of traditional Chinese medicine constitution research for 40 years[J]. Tianjin Journal of Traditional Chinese Medicine, 2019, 36(2): 108-111. https://www.cnki.com.cn/Article/CJFDTOTAL-TJZY201902002.htm
[21]	伊静. 复发性流产病因与中医体质的相关性研究[D]. 晋中: 山西中医药大学, 2019. YI J. Study on the correlation between the cause of recurrent abortion and constitution of Traditional Chinese medicine[D]. Jinzhong: Shanxi University of Chinese Medicine, 2019.
[22]	陈芊宇, 战丽彬. 《临证指南医案》辨治情志致病的特色[J]. 湖南中医药大学学报, 2020, 40(11): 1346-1349. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZX202011011.htm CHEN Q Y, ZHAN L B. Analysis of the characteristics of syndrome differentiation and treatment of emotional diseases in guide to clinical practice with medical records[J]. Journal of Hunan University of Chinese Medicine, 2020, 40(11): 1346-1349. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZX202011011.htm
[23]	冯晓玲, 常卓, 赵小萱, 等. 不明原因复发性流产患者的D型人格与中医证候分布研究[J]. 中国全科医学, 2018, 21(34): 4227-4231. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX201834017.htm FENG X L, CHANG Z, ZHAO X X, et al. Prevalence of type D personality and distribution of TCM syndromes in unexplained recurrent spontaneous abortion patients[J]. Chinese General Practice, 2018, 21(34): 4227-4231. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX201834017.htm
[24]	ZHU J Y, SIMONS J S, GOLDSTEIN A L. Dynamics of parental criticism and emerging adult emotional functioning: associations with depression[J]. J Fam Psychol, 2022. DOI: 10.1037/fam0001022.