我国麻醉住院医师产假后母乳喂养的职业相关影响因素分析  

Occupational Factors Associated with Breastfeeding Continuation after Maternity Leave Among Female Anesthesia Residents in China

作　　者：徐宵寒 张娇[1] 虞雪融[1] 李旭[1] 黄宇光[1] XU Xiaohan;ZHANG Jiao;YU Xuerong;LI Xu;HUANG Yuguang(Department of Anesthesiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医院麻醉科,北京100730

出　　处：《协和医学杂志》2023年第4期820-825,共6页Medical Journal of Peking Union Medical College Hospital

基　　金：北京市自然科学基金(7194313)。

摘　　要：目的分析我国麻醉住院医师产假后母乳喂养的职业相关影响因素。方法本研究基于一项由中华医学会麻醉学分会发起的“女性麻醉医师母乳喂养及工作/家庭平衡状况”全国性调研,纳入全国2015年1月1日后生育过的女性麻醉专业住院医师。通过匿名在线填写问卷的方式收集麻醉住院医师基本信息、母乳喂养时长和哺乳期工作情况。以赤池信息标准最小原则筛选纳入变量,将事件定义为“终止母乳喂养”,将可能影响母乳喂养的职业相关因素作为解释变量,将可能影响母乳喂养的个人影响因素亦作为解释变量纳入模型,以调整其潜在的混杂效应,采用Schoenfeld残差图评估各解释变量是否满足等比例风险假设,对于不满足者,则在模型中加入该变量的时间依存协变量,采用分步Cox回归分析影响母乳喂养持续时间的职业因素。结果本研究共纳入436名麻醉住院医师,所在地区包括除宁夏回族自治区和黑龙江省以外的29个省份;372名(85.3%,372/436)已终止母乳喂养,其中268名(72.0%,268/372)由于工作原因提前结束母乳喂养;419名(96.1%,419/436)工作后母乳显著减少,133名(30.5%,133/436)在工作中无机会吸奶;中位母乳喂养时长为10(8,12)个月;住院医师年资越高,母乳喂养终止时间越早(HR=1.09,95%CI:1.03~1.15,P=0.004);产假时间长(HR=0.85,95%CI:0.78~0.93,P<0.001)、三级医院(HR=0.56,95%CI:0.43~0.73,P<0.001)、工作中吸奶机会多(HR=0.02,95%CI:0~0.08,P<0.001)和哺乳期工作量减少(HR=0.47,95%CI:0.26~0.86,P=0.014)可能与母乳喂养时间延长相关。结论应适当延长我国麻醉住院医师产假、调整轮转计划、提供专用哺乳室、保障工作中的吸奶时间等,以保证麻醉住院医师的母婴健康。Objective To analyze the current status and occupational factors associated with breastfeed⁃ing continuation after maternity leave among female anesthesia residents in China.Methods Our study was based on a nationwide survey“Breastfeeding and Work/Family Balance Among Female Anesthesiologists”conducted by Chinese Society of Anesthesiology,which was targeted to female anesthesia residents giving birth since January 1,2015.An anonymous online questionnaire was developed to collect basic information,breast⁃feeding practices and workload.The inclusion variables were screened using the akaike information criterion(AIC),with the event defined as“termination of breastfeeding”.Occupational factors that may affect breast⁃feeding were included as explanatory variables and non⁃occupational related factors that may affect breastfeeding were also included in the model to adjust for potential confounding effects.Schoenfeld were used to assess whether the variables were satisfied for each explanatory variable,and for those that were not,the time⁃depend⁃ent covariate for that variable was added to the model,occupational factors affecting breastfeeding duration were analyzed using stepwise Cox regression.Results A total of 436 anesthesia residents from 29 provinces were in⁃cluded.According to the survey,372(85.3%,372/436)terminated breastfeeding,of which 268(72.0%,268/372)ended breastfeeding early due to work,419(96.1%,419/436)significantly reduced breast milk after work,and 133(30.5%,133/436)had no opportunity to breastfeed at work.Their median breastfeeding duration was 10(8,12)months.Longer work experience at childbirth was associated with a higher risk of dis⁃continuing breastfeeding(HR=1.09,95%CI:1.03-1.15,P=0.004).The following occupational factors were associated with a longer breastfeeding duration:prolonged maternity leave(HR=0.85,95%CI:0.78-0.93,P<0.001),tertiary hospital(HR=0.56,95%CI:0.43-0.73,P<0.001),more opportunities for breast pumping during worktime(HR=0.02,95%CI:0-0.08,P<0.001)and reduce

关 键 词：母乳喂养 麻醉住院医师 职业因素 母婴健康 

分 类 号：R614[医药卫生—麻醉学]