本文選題：中西部 + 孕產(chǎn)婦死亡�。� 參考：《復(fù)旦大學(xué)》2013年碩士論文

【摘要】：一、研究背景與目標(biāo) 孕產(chǎn)婦死亡率是反映一個(gè)國(guó)家或地區(qū)經(jīng)濟(jì)社會(huì)發(fā)展水平的重要指標(biāo),我國(guó)在《聯(lián)合國(guó)千年宣言》中承諾到2015年將孕產(chǎn)婦死亡率降低到22.2/10萬(wàn)。2010年我國(guó)孕產(chǎn)婦死亡率為30.0/10萬(wàn),與國(guó)際承諾的目標(biāo)還存在一定差距。但是不可忽視的是中西部地區(qū)整體的孕產(chǎn)婦死亡率高于全國(guó)平均水平,要實(shí)現(xiàn)千年目標(biāo),中西部是重點(diǎn)。政府也一直很重視中西部地區(qū),采取政策干預(yù)和項(xiàng)目干預(yù)來(lái)改善孕產(chǎn)婦死亡率狀況,中西部孕產(chǎn)婦死亡率在干預(yù)下總體呈現(xiàn)下降趨勢(shì),但是近年來(lái)下降速度趨緩,2010年10多個(gè)省份孕產(chǎn)婦死亡率甚至出現(xiàn)了反彈。這可能是因?yàn)榇胧┽槍?duì)關(guān)鍵因素發(fā)揮針對(duì)性的效力后,對(duì)象因措施的推進(jìn)調(diào)整了自己的行為和發(fā)展方向,原來(lái)影響孕產(chǎn)婦死亡的關(guān)鍵因素發(fā)生變化,因此,若要使孕產(chǎn)婦死亡率保持繼續(xù)下降的趨勢(shì),需重新審視現(xiàn)階段關(guān)鍵影響因素,制定針對(duì)性干預(yù)措施。本研究的目的是在了解中西部孕產(chǎn)婦死亡率和住院分娩的基本情況和變化趨勢(shì)基礎(chǔ)上,分析降低孕產(chǎn)婦死亡率和提高住院分娩率的關(guān)鍵影響因素,制定相應(yīng)的干預(yù)策略,進(jìn)一步降低孕產(chǎn)婦死亡率,為實(shí)現(xiàn)千年發(fā)展目標(biāo)提供依據(jù)。 二、材料與方法 根據(jù)漸進(jìn)主義政策模型和孕產(chǎn)婦死亡生存分析框架,構(gòu)建降低孕產(chǎn)婦死亡率的理論模型。運(yùn)用系統(tǒng)論,矛盾分析法,漸進(jìn)主義理論及利益相關(guān)者理論對(duì)中西部地區(qū)影響因素及干預(yù)策略進(jìn)行分析。主要的資料來(lái)源包括文獻(xiàn)評(píng)閱、現(xiàn)場(chǎng)調(diào)查、專(zhuān)家咨詢(xún)和定性訪(fǎng)談等。通過(guò)文獻(xiàn)歸納分析法對(duì)文獻(xiàn)的外部特征進(jìn)行定性及半定量分析,以明確婦幼保健干預(yù)策略和模式的研究現(xiàn)狀。通過(guò)專(zhuān)家咨詢(xún)及現(xiàn)場(chǎng)調(diào)查法了解中西部地區(qū)、典型調(diào)查地區(qū)的孕產(chǎn)婦死亡現(xiàn)存問(wèn)題、影響因素及需要的支持。調(diào)查收集的資料采用QSR NVivo8、Excel2007建立數(shù)據(jù)庫(kù)和數(shù)據(jù)錄入,用SPSS18.0及QSR NVivo8進(jìn)行統(tǒng)計(jì)分析。 三、主要研究結(jié)果 (一)國(guó)內(nèi)研究多以現(xiàn)狀描述為主 孕產(chǎn)婦死亡是研究熱點(diǎn),目前國(guó)內(nèi)在降低孕產(chǎn)婦死亡率的研究中,多以地區(qū)為單位進(jìn)行描述性分析,以孕產(chǎn)婦死亡卡和醫(yī)院死亡病例為資料結(jié)合孕產(chǎn)婦死亡評(píng)審分析孕產(chǎn)婦死亡的流行病學(xué)特征,并探討孕產(chǎn)婦死亡的原因及策略,卻少見(jiàn)對(duì)這些建議和措施的實(shí)施及實(shí)施效果的評(píng)價(jià)。 (二)中西部地區(qū)部分省份孕產(chǎn)婦死亡率出現(xiàn)反彈 中西部地區(qū)近年來(lái)孕產(chǎn)婦死亡率下降趨緩,部分省份出現(xiàn)反彈。對(duì)典型調(diào)查地區(qū)甘肅省和新疆生產(chǎn)建設(shè)兵團(tuán)進(jìn)行分析,甘肅省孕產(chǎn)婦死亡率降低明顯,但下屬市級(jí)甘南州孕產(chǎn)婦死亡率出現(xiàn)反彈,并且其住院分娩率低于全省平均水平。新疆生產(chǎn)建設(shè)兵團(tuán)住院分娩率較高,但孕產(chǎn)婦死亡率出現(xiàn)反彈。 (三)孕產(chǎn)婦死亡率的影響因素分析 運(yùn)用矛盾分析法分析地區(qū)差異,運(yùn)用利益相關(guān)者法分析不同對(duì)象的訴求,可得出甘肅省和新疆生產(chǎn)建設(shè)兵團(tuán)孕產(chǎn)婦死亡率的關(guān)鍵影響因素。甘肅省婦幼衛(wèi)生狀況的影響因素以社會(huì)因素為主,山高路遠(yuǎn)、經(jīng)濟(jì)條件差和信仰活佛的習(xí)俗使得住院分娩率一直處于低位。住院分娩率不高,交通不便急救轉(zhuǎn)診不暢,產(chǎn)科急救水平差等綜合因素則造成了孕產(chǎn)婦死亡。兵團(tuán)的住院分娩率已經(jīng)達(dá)到較高水平,孕產(chǎn)婦死亡率反彈的主要原因在于流動(dòng)人口和計(jì)劃外生育者孕產(chǎn)婦的死亡。兵團(tuán)人口基數(shù)較少,孕產(chǎn)婦死亡絕對(duì)數(shù)的較小變化引起了孕產(chǎn)婦死亡率的較大變化,導(dǎo)致遠(yuǎn)高于全國(guó)平均水平。 (四)降低孕產(chǎn)婦死亡率的實(shí)施策略研究 利用孕產(chǎn)婦死亡生存分析理論框架,并結(jié)合文獻(xiàn)及實(shí)證中對(duì)干預(yù)措施的收集,本研究針對(duì)孕產(chǎn)婦死亡形成了三大維度九大干預(yù)策略。對(duì)于每個(gè)地區(qū),干預(yù)措施和干預(yù)策略分為兩類(lèi),一類(lèi)是在針對(duì)原有影響因素在原有措施或策略上的繼續(xù)推進(jìn),一類(lèi)是針對(duì)新的關(guān)鍵影響因素采取的新的措施或策略。 干預(yù)模式的制定思路是,基于孕產(chǎn)婦影響因素的研究,利用專(zhuān)家評(píng)分法確定孕產(chǎn)婦死亡的關(guān)鍵影響因素,然后評(píng)價(jià)關(guān)鍵影響因素在孕產(chǎn)婦死亡生存分析框架中所處的模塊,根據(jù)模塊即可對(duì)應(yīng)相應(yīng)的策略,最后,集合這些策略,就形成了適宜當(dāng)?shù)氐母深A(yù)模式。甘肅模式主要是采用策略4、策略6、策略7、策略8,進(jìn)一步提高保健意識(shí)及暢通急救綠色通道。兵團(tuán)模式主要是采用策略3、策略5,提升基層醫(yī)院及市區(qū)綜合醫(yī)院產(chǎn)科綜合救治能力,并抓好流動(dòng)人口和計(jì)劃外生育者的孕產(chǎn)婦管理。將典型調(diào)查地區(qū)干預(yù)模式研究的思路外推到中西部其他區(qū)域,即可形成中西部地區(qū)進(jìn)一步降低孕產(chǎn)婦死亡率的策略。 四、研究主要結(jié)論 (一)降低孕產(chǎn)婦死亡率需要差異化管理,分類(lèi)指導(dǎo)；各地區(qū)選擇策略時(shí)需深入分析關(guān)鍵影響因素,探索最適合當(dāng)?shù)氐母深A(yù)模式。 (二)合理配置人員,并完善人才激勵(lì)機(jī)制。 (三)加強(qiáng)各個(gè)利益相關(guān)者之間的協(xié)調(diào),最大化發(fā)揮社會(huì)效益；全社會(huì)努力,提高孕產(chǎn)婦文化素質(zhì),優(yōu)化保障體系。
[Abstract]:I . Background and Objectives

The maternal mortality rate is an important indicator reflecting the economic and social development level of a country or region . In the United Nations Millennium Declaration , the maternal mortality rate is reduced to 22.2 per 100,000 . In 2010 , the maternal mortality rate in the central and western regions is higher than the national average . In the middle and western regions , the maternal mortality rate is higher than the national average . In the middle and western regions , the key influencing factors of the maternal mortality rate have been improved . The aim of this study is to improve the maternal mortality rate and increase the rate of maternal mortality . The aim of this study is to develop corresponding intervention strategies to further reduce maternal mortality and provide the basis for achieving the Millennium Development Goals .

II . MATERIALS AND METHODS

Based on the progressive policy model and the analysis frame of maternal mortality survival analysis , the paper constructs a theoretical model for reducing maternal mortality . The main sources include literature review , field investigation , expert consultation and qualitative interview . The main sources include literature review , field investigation , expert consultation and qualitative interview . The main sources include literature review , field investigation , expert consultation and qualitative interview .

III . Main research results

( 1 ) The domestic research is mainly described in the current situation

Maternal mortality is a hot spot . At present , in the study of reducing maternal mortality , a descriptive analysis is carried out in many areas . The maternal mortality rate and the hospital death cases are combined with maternal mortality review to analyze the epidemiological characteristics of maternal mortality , and the causes and strategies of maternal mortality are discussed . However , the evaluation of the implementation and implementation of these recommendations and measures is rare .

( II ) Maternal mortality in some provinces of the central and western parts of the country rebounded

In the middle and western regions , the maternal mortality rate has declined in recent years , and some provinces have rebounded . In the typical survey area , Gansu Province and Xinjiang Production and Construction Corps carried out the analysis , the maternal mortality rate in Gansu Province decreased obviously , but the rate of maternal mortality in Gansu Province was lower than the average of the province average . The hospitalization rate of the Xinjiang Production and Construction Corps was higher , but the maternal mortality rate rebounded .

( III ) Analysis on the Influencing Factors of Maternal Mortality

Using the contradiction analysis method to analyze the regional difference , the key influencing factors of maternal mortality in Gansu and Xinjiang Production and Construction Corps were analyzed by means of stakeholder method . The factors affecting maternal and child health in Gansu Province were mainly due to social factors , high mountain road , poor economic conditions and living Buddha ' s customs , which resulted in the death of maternal mortality . The hospitalization delivery rate of the regiment had reached a higher level , and the rate of maternal mortality was mainly due to the death of the floating population and the unplanned fertility . The small change of the absolute number of maternal deaths resulted in a greater change in maternal mortality , which resulted in a much higher level of maternal mortality .

( IV ) Study on the Implementation Strategy of Reducing Maternal Mortality

Based on the theoretical framework of maternal mortality survival analysis and the collection of intervention measures in combination with literature and demonstration , this study has formed a three - dimensional nine - dimensional intervention strategy for maternal deaths .

The development of intervention model is based on the study of maternal influence factors , the key influencing factors of maternal mortality are determined by using expert scoring method , and then the key influencing factors are evaluated in the framework of maternal mortality survival analysis .

IV . Main conclusions of the study

( i ) Reducing maternal mortality requires differentiated management and classification guidance ;
In each region selection strategy , the key influencing factors should be analyzed in depth , and the most suitable intervention mode is explored .

( 2 ) reasonably allocate personnel and improve the talent incentive mechanism .

( 3 ) To strengthen coordination among various stakeholders and maximize social benefits ;
Full - society efforts to improve the cultural quality of pregnant women and optimize the guarantee system .
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R173

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 凌金梅;;我國(guó)孕產(chǎn)婦死亡原因控制成效概況[J];廣西醫(yī)學(xué);2007年09期

2 王臨虹,方利文;我國(guó)孕產(chǎn)婦死亡的常見(jiàn)原因及其影響因素[J];實(shí)用婦產(chǎn)科雜志;2004年04期

3 賈麗華;;云南省施甸縣孕產(chǎn)婦住院分娩率及其影響因素分析[J];中國(guó)婦幼衛(wèi)生雜志;2010年06期

4 劉奇葆;提高認(rèn)識(shí) 突破難點(diǎn) 為實(shí)現(xiàn)婦女兒童綱要目標(biāo)而奮斗[J];中國(guó)婦幼保健;2000年03期

5 王愛(ài)婷;于春梅;于維霞;劉yN;;濰坊市7年122例孕產(chǎn)婦死亡原因及相關(guān)因素分析[J];中國(guó)婦幼保健;2008年01期

6 毛惠;楊景芳;康江;周燕;洪世海;張永志;趙金萍;趙紅;;孕產(chǎn)婦死亡原因與干預(yù)措施[J];中國(guó)婦幼保健;2008年02期

7 王臨虹,郭素芳,張小松;孕產(chǎn)婦死亡率下降趨勢(shì)及其相關(guān)因素分析[J];中華圍產(chǎn)醫(yī)學(xué)雜志;2004年01期

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