产后运动指导及高钙饮食对产后骨密度恢复的影响

摘要

Objective:To investigate the effect of postpartum exercise guidance and high calcium diet on bone mineral density(BMD) in postpartum recovery. Methods:Chose 144 health parturients full-term delivery of single fetus in our hospital to survey,mothers were randomly divided into groups A, B and C with 48 cases each group. Group A of maternal daily oral calcium carbonate 600 mg; milk 250 mL, twice a day; guidance movement (started 2 months postpartum, to 4 km/hour speed of brisk walking 30 minutes/time,5-7 times/ week); Group B was daily oral calcium carbonate 600 mg; milk 250 mL, twice a day; by my task force member of staff for supervision. Group C had no hand steering its services calcium, milk and exercise guidance. All mothers were at 3 days postpartum, 12 months postpartum measurement of bone metabolism (alkaline phosphatase, urinary calcium, urinary creatinine) and the side of the femoral neck and lumbar spine bone mineral density. Results:① pregnancy (3 days postpartum measurement) bone loss rate was 76. 9% (100/130),34 cases in group A,35 cases in group B and 31 cases in group C (x2 =0.073, P =0. 964); BMD in postpartum recovery of 12 months group A 33. 3%(17/45),group B 20%(10/45) .group C 12. 5%(5/40) was significant(x2 =7. 504, P =0. 023); ②12 months after giving birth three groups on the left femoral neck and lumbar spine bone mineral density significantly ( P ＜0. 05),group A was the highest ;blood ALP, urinary Ca/Cr in three groups were significant ( P ＜0. 05), group A was minimum. Conclusion: prone to bone loss during pregnancy, breast-feeding caused a further loss of bone mass. But breast-feeding of high calcium diet supplemented with the appropriate exercise can promote the recovery of bone mass, reduce bone turnover rate.%目的:探讨产后运动指导及高钙饮食对产后骨密度恢复的影响.方法:选择在我院产科单胎足月分娩的健康产妇144例为观察对象,随机将产妇分为A、B、C3组,每组48例.A组产妇每日口服碳酸钙600 mg；牛奶250 mL,2次/d;指导运动(产后2个月开始,以4 km/h的时速快步走30 min/次,5～7次/周)；B组产妇每日口服碳酸钙600 mg；牛奶250 mL,2次/d;由我课题组成员专人负责督导；C组无专人督导其服钙片、牛奶及进行运动指导.所有产妇分别于产后3d内、产后12个月测量骨代谢指标[血碱性磷酸酶(ALP)、尿钙/尿肌酐(Ca/Cr)]和一侧股骨颈及腰椎骨密度.结果:①孕期(产后3d内测定)骨量减少发生率为(100/130)76.9%,A组34例,B组35例,C组31例,3组比较差异无统计学意义(x2 =0.073,P=0.964);产后12个月骨密度恢复正常的人数A组为33.3%(17/45),B组为20%(10/45),C组为12.5%(5/40),3组比较差异有统计学意义(X2=7.504,P=0.023)；②在产后12个月3组左侧股骨颈及腰椎骨密度比较,差异有统计学意义(P＜0.05),A组最高；3组的血ALP、尿Ca/Cr比较差异有统计学意义(P＜0.05),A组最低.结论:孕期容易发生骨量减少,哺乳期造成骨量进一步丢失.在哺乳期适当的运动辅以高钙饮食可促进骨密度恢复,降低骨转换率.