產(chǎn)后恢復(fù)培訓(xùn)PostpartumRecoveryTrainingCourse案例分析形體評(píng)估與恢復(fù)

產(chǎn)后恢復(fù)培訓(xùn)課程PostpartumRecoveryTrainingCourse案例分析：形體評(píng)估與恢復(fù)實(shí)施CaseStudy:PhysiqueAssessmentandRecoveryImplementation形體的評(píng)估

（Assessmentofphysique）形體的恢復(fù)實(shí)施

（Implementationofphysiquerecovery）目錄（Contents）導(dǎo)入(Introduction)案例（CaseStudy）張女士，33歲，自然分娩后8個(gè)月，自述產(chǎn)后身體肥胖，產(chǎn)后恢復(fù)效果較差。體查：T36.3℃，P85次/分，R22次/分，BP138/85mmHg。請(qǐng)對(duì)該產(chǎn)婦進(jìn)行體型評(píng)估。(Pleaseassessthiswoman'sbodytype.)任務(wù)（Tasks）(Ms.Zhang,33yearsold,8monthsafternaturaldelivery,self-reportedpostpartumobesityandpoorpostpartumrecovery.Physicalexamination:T36.3℃,P85beats/min,R22resp/min,BP138/85mmHg.)請(qǐng)制定出該產(chǎn)婦的恢復(fù)方案。(Pleasedeveloparecoveryplanforthiswoman.)體型評(píng)估該產(chǎn)婦體型評(píng)估所需數(shù)據(jù)：胸圍

腰圍臀圍大腿圍上臂圍體重身高(Requireddatatoassessthiswoman‘sbodytypeare)(chestcircumference)(waistcircumference)

(hip

circumference)

(thighcircumference)

(upperarmcircumference)(weightandheight)(Assessmentofphysique)測(cè)胸圍(Chestcircumferencemeasurement)(Measuredchestcircumferenceofthepuerpera:100cm)(Takeasittingorstandingpositionwithupperlimbshangingdownnaturallyonbothsides.)常取乳頭水平周徑為胸圍值。測(cè)得該產(chǎn)婦胸圍：100cm(Thecircumferencewasmeasuredattheendofdeepinspirationandexpirationrespectively,andthedifferencebetweenthetwovaluesreflectsthedegreeofthoracicexpansion.)取坐位或站立位，雙上肢在身體兩側(cè)自然下垂。在腋窩下緣水平、乳頭水平、創(chuàng)突水平，測(cè)量周徑。(Measurethecircumferenceattheleveloftheloweredgeofthearmpit,thelevelofthenipple,andtheleveloftheprotrusion.)(Thecircumferenceatthenipplelevelisoftentakenasthechestcircumference.)在深吸氣末和深呼氣末，分別測(cè)量周徑，兩數(shù)值差反映胸廓擴(kuò)張度。01ABCDE體型評(píng)估(Assessmentofphysique)測(cè)腰圍(Waistcircumferencemeasurement)(Measuredwaistcircumferenceofthepuerpera:92cm)(takethestandingpositionwithupperlimbshangingdownnaturallyonbothsides,andfeetapartwithshoulderwidth.)測(cè)得該產(chǎn)婦腰圍：92cm取站立位，雙上肢在身休兩側(cè)自然下垂，雙腳分開(kāi)同肩寬。產(chǎn)婦自然呼吸，分別取左右兩側(cè)腋中線的肋骨下緣與骼嵴連線中點(diǎn)，在兩點(diǎn)水平測(cè)量腰腹部周徑。(Thepuerperabreathenaturally,takethemidpointofthelinebetweentheloweredgeoftheribsinmidaxillarylineonbothsidesandtheiliaccrestrespectively,andmeasurethecircumferenceofthewaistandabdomenattwopoints.)02體型評(píng)估(Assessmentofphysique)測(cè)臀圍(Hipcircumferencemeasurement)(Measuredhipcircumferenceofthepuerpera:103cm)(takeastandingpositionandrelax,withupperlimbshangingdownnaturallyonbothsides,andfeettogethernaturally.)測(cè)得該產(chǎn)婦臀圍：103cm取站立位，將部放松，雙上肢在身體兩側(cè)自然下亞，雙腳自然并擾。產(chǎn)婦自然呼吸、在臀部后側(cè)最突出部位或股骨大相隆處測(cè)量周徑。(Puerperabreathenaturally,andmeasuresthecircumferenceatthemostprominentpartbehindthehiporatthegreaterfemur.)03010203體型評(píng)估(Assessmentofphysique)測(cè)大腿圍（Thighcircumferencemeasurement)取站立位，下肢稍外展，膝關(guān)節(jié)伸直。04(Takeastandingpositionwithlowerlimbsslightlyabductedandkneestraight.)在儲(chǔ)骨上方10cm或15cm處，或6cm、8cm、10cm、12cm處測(cè)量或測(cè)量最粗壯處大腿周徑。(Measureat10cmor15cmabovethestoragebone,orat6cm,8cm,10cm,12cmormeasurethecircumferenceofthethickestpartofthigh.)記錄時(shí)注明測(cè)量點(diǎn)。(Notethemeasuringpointwhenrecording.)測(cè)得該產(chǎn)婦大腿圍：59cm(Measuredthighcircumferenceofthepuerpera:59cm)體型評(píng)估(Assessmentofphysique)01020304測(cè)上臂圍（Upperarmcircumferencemeasuremen)(Measuredupperarmcircumferenceofthepuerpera:34cm)(takethestandingorsittingposition.)測(cè)得該產(chǎn)婦上臂圍：34cm取站立位或坐位。產(chǎn)婦自然呼吸，分別在時(shí)關(guān)節(jié)用力屈曲和伸展時(shí)，測(cè)量肱頭肌隆起最高處的上臀圍。(Puerperabreathenaturallytheupperarmcircumferencewasmeasuredatthehighestpointofbrachialismusclewhen,thejointwasflexedandextendedwithforcerespectively.)05體型評(píng)估(Assessmentofphysique)測(cè)體重身高（Weightandheightmeasurement)(heelstogetherandtiptoesseparatedat30°~40°Measureverticallyfromtheheadtotheheel.)(Themeasurementisaffectedbythetimeofday,10:00amisthebesttime.)足尖以30°~40°分開(kāi)，從頭項(xiàng)到足跟垂直測(cè)量。受時(shí)間影響，測(cè)量時(shí)間以上午10點(diǎn)為佳。取站立位，產(chǎn)婦挺胸收腹、下肢伸直、赤足，足跟并攏。(Takethestandingposition,thepuerperashouldstandwithherchestupandabdomentight,lowerlimbsstraight,barefoot,.)身高測(cè)得該產(chǎn)婦身高：160cm（Height）（Measuredheightofthepuerpera:160cm.）06體型評(píng)估(Assessmentofphysique)(Measuredweightofthepuerpera:73kg)(Takethenaturalstandingposition.)測(cè)得該產(chǎn)婦體重：73kg取自然站立位。測(cè)量前，盡量排空膀胱和直腸，站在體重計(jì)上測(cè)量，讀數(shù)減去所著衣物質(zhì)量，即為體重。(bladderandbowelbeforemeasurement,standonthescaleandmeasuretheweightbysubtractingthemassofclothingworn.)體重（Weight）010203測(cè)體重身高（Weightandheightmeasurement)06體型評(píng)估(Assessmentofphysique)身高體重胸圍腰圍臀圍大腿圍上臂圍標(biāo)準(zhǔn)值1605384.859.286.449.429實(shí)際值16073100921035934體型評(píng)估(Assessmentofphysique)該產(chǎn)婦體型評(píng)估所需數(shù)據(jù)：腰臀比

標(biāo)準(zhǔn)體重體質(zhì)指數(shù)體脂率(Thefollowingdataarerequiredtoassessthematernalbodytype:)(waist-hipratio)(standardweight)(bodymassindex)(bodyfatpercentage)體型評(píng)估(Assessmentofphysique)腰臀比（Waist-hipratio)01腰臀比腰圍與臀圍的比例腰臀比＝腰圍（cm)／臀圍（cm)(Waist-hipratioistheratioofwaistcircumferencetohipcircumference.)(Waist-hipratio=waistcircumference(cm)/hipcircumference(cm))體型評(píng)估（Assessmentofphysique）

腰臀比（Waist-hipratio)01(TheChinesestandardforwaist-hipratioofnormaladultwomenis<0.8,andtheWHOstandardis<0.85.Thisratioreflectsthefatdistributionandisusedtoassesscentralobesity(abdominalobesity).正常成年女性腰臀比的中國(guó)標(biāo)準(zhǔn)為＜0.8,WHO標(biāo)準(zhǔn)為＜0.85，本比值反映脂肪分布情況，用于評(píng)估中心性肥胖(腹型肥胖)。計(jì)算得該產(chǎn)婦腰臀比＝92/103=0.893(Calculatedwaist-hipratioofthepuerpera=92/103=0.893)體型評(píng)估(Assessmentofphysique)030201標(biāo)準(zhǔn)體重（kg)＝身高（cm)-100（身高≤165cm)（Standardweight(kg)=height(cm)-100(height≤165cm)標(biāo)準(zhǔn)體重（kg)＝身高（em)-105（身高為166~175cm)（Standardweight(kg)=height(cm)-105(heightof166~175cm）標(biāo)準(zhǔn)體重（kg)＝身高（em)-110（身高為176~185cm)（Standardweight(kg)=height(cm)-110(heightof176~185cm)體型評(píng)估(Assessmentofphysique)標(biāo)準(zhǔn)體重(Standardweight)02標(biāo)準(zhǔn)體重—評(píng)估(Standardweight—Assessment)02體型評(píng)估(Assessmentofphysique)在標(biāo)準(zhǔn)體重10％以內(nèi)為正常，在10%~19％為超重，超過(guò)20％為肥胖。(Within10%ofthestandardweightwasconsiderednormal,between10%and19%wasconsideredoverweight,andover20%wasconsideredobese.)該產(chǎn)婦標(biāo)準(zhǔn)體重(kg)＝160-100=60kg產(chǎn)婦實(shí)際體重73kg。(Calculatedstandardweightofthispuerpera(Kg)＝160-100=60kgActualweightofthispuerperais73kg.)(73-60)÷60×100%=21.67%該產(chǎn)婦體重超出標(biāo)準(zhǔn)體重的20％以上，屬于肥胖。(Throughcalculation,thispuerpera’sweightexceedsmorethan20%ofthestandardweight,whichbelongstoobesity.)體重指數(shù)(BMI)=體重(kg)/身高2(m2)(Bodymassindex(BMI)=weight(kg)/squareofheight(m2))體重指數(shù)（Bodymassindex)03體型評(píng)估（Assessmentofphysique）

計(jì)算得該產(chǎn)婦體重指數(shù)=73/1.602=28.5，根據(jù)標(biāo)準(zhǔn)值可判定為肥胖。(Calculatedthatthispuerpera’sbodymassindex=73/squareof1.602=28.5,whichcanbedeterminedasobesityaccordingtotheBMIevaluationstandard.)中國(guó)標(biāo)準(zhǔn)WHO標(biāo)準(zhǔn)結(jié)果評(píng)判<18.5<18.5體重過(guò)低18.5≤BMI≤24.018.5≤BMI≤25.0體重正常24.0≤BMI<28.025.0≤BMI<30.0超重≥28.0≥30.0肥胖體型評(píng)估（Assessmentofphysique）

體重指數(shù)（Bodymassindex)03體脂率（Bodyfatpercentage)04體型評(píng)估(Assessmentofphysique)計(jì)算公式：參數(shù)a=腰圍(單位：厘米)×0.74(Calculationformula:parametera=waistcircumference(unit:cm)×0.74)身體脂肪總重量(單位:千克)=參數(shù)a－參數(shù)b(Totalbodyfatweight(unit:kg)=parametera-parameterb)體脂率=(身體脂肪總重量÷體重)×100%(Bodyfatpercentage=(totalbodyfatweight÷bodyweight)×100%)參數(shù)b=體重(單位:千克)×0.082+34.89(parameterb=weight(unit:kg)×0.082+34.89)體脂率（Bodyfatpercentage)04計(jì)算得該產(chǎn)婦(Throughcalculation,thepuerpera’s）參數(shù)a=92×0.74=68.08（Parametera=92×0.74=68.08）參數(shù)b=73×0.082+34.89=40.876（Parameterb=73×0.082+34.89=40.876）體型評(píng)估（Assessmentofphysique）

體脂率（Bodyfatpercentage)04體型評(píng)估（Assessmentofphysique）

身體脂肪總重量=68.08－40.876=27.204(Totalbodyfatweight=68.08-40.876=27.204)1體脂率=27.204÷73×100%=37.27%(Bodyfatpercentage=27.204÷73×100%=37.27%)2根據(jù)體脂對(duì)照表可判定張女士體型為偏胖。(Accordingtothebodyfatcomparisontable,Ms.Zhang'sbodytypecanbedeterminedasoverweight.)體脂對(duì)照表性別年齡偏瘦標(biāo)準(zhǔn)偏胖過(guò)胖女18-39歲5-20%21-34%35-39%40-45%40-59歲5-21%22-35%36-40%41-45%50歲5-22%23-36%37-41%42-45%體脂率（Bodyfatpercentage)04體型評(píng)估（Assessmentofphysique）

飲食方面

高熱量的食物010302飲食原則平衡膳食避免高脂肪(Dietaryprinciples)(balanceddiet)

(avoidhigh-fat)(high-caloriefoods)(Diet)飲食方面體型恢復(fù)方案（Physiquerecoveryplan）

飲食方面(Diet)(Physiquerecoveryplan)體型恢復(fù)方案你每天獲取的食物熱量不應(yīng)低于1800卡路里。如果你還需哺乳，那你需在1800卡路里的基礎(chǔ)上再加300到500以上的卡路里。(Youshouldnotconsumelessthan1800caloriesoffoodperday.Ifyouarebreastfeeding,thenyouneedtoadd300to500morecaloriestothe1800calories.)避免節(jié)食(Avoiddieting)01確保你的熱量均勻地分散在一整天。避免暴飲暴食?？梢栽趦刹椭g適當(dāng)?shù)募右恍┝闶?，但是熱量一定要低，而且你每天的攝入熱量的總數(shù)不要超過(guò)2500卡路里。(Makesureyourcaloriesaredistributedevenlythroughouttheday.Avoidovereating.It'sokaytosnackinbetweenmeals,butmakesurethecaloriesarelow,andyourtotaldailycalorieintakeshouldnotexceed2500calories.)控制零食(Controlsnacking)02(Physiquerecoveryplan)體型恢復(fù)方案飲食方面(Diet)千萬(wàn)不要吃減肥藥、減肥茶。減肥藥主要是通過(guò)人體少吸收營(yíng)養(yǎng)，又增加排泄量，從而達(dá)到減肥的目的。同時(shí)，減肥藥影響人體正常的代謝，尤其是哺乳期吃減肥藥，大部分藥物會(huì)從乳汁里排泄，這樣就等于給嬰兒也吃了減肥藥，嬰兒肝臟解毒功能差，減肥藥量大了易使嬰兒的肝臟功能降低，容易引起嬰兒的肝功能異常。(Donottakedietpillsordiettea.Dietpillsaremainlythroughthebodytoabsorblessnutritionandincreaseexcretiontoachievethepurposeofweightloss.Atthesametime,dietpillsaffectthenormalmetabolismofthebody,especiallyduringlactation,mostofthedrugswillbeexcretedfromthebreastmilk,whichisequivalenttogivingtheinfantdietpills,whohaspoorliverdetoxificationfunction.Dietpillsinlargeamountscaneasilydecreasetheinfant'sliverfunction,andcauseabnormalliverfunctionoftheinfant.)忌吃減肥藥（Avoiddietpills）任何的體育鍛煉最好包括心血管的鍛煉，因?yàn)檫@將會(huì)更加幫助加強(qiáng)心臟的功能和燃燒脂肪。而散步將會(huì)是最簡(jiǎn)單，最有效的鍛煉方式。(Anyphysicalexercise,andisbesttoincludecardiovascularexercise,becauseitwillstrengthenthefunctionoftheheartandburnfat.Andwalkingisthesimplestandmosteffectivewaytoexercise.)專(zhuān)家說(shuō)：“散步一小時(shí)可以幫助消耗大約500卡的能量”。我們知道，如果消耗3500卡的能量就可以幫助減掉一磅的體重。(Expertssay:"anhourofwalkingcanhelpburnabout500caloriesofenergy".Weknowthatifyouburn3,500caloriesyoucanloseapoundofweight.)(Physiquerecoveryplan)體型恢復(fù)方案運(yùn)動(dòng)方面—散步(Exercise—Walking)(Itisbestnottoincreasethetimemorethan5minutesatatime,oneatatime.It'sbesttokeepincreasingthelengthofyourwalkswiththefrequencyyou'reusedto.)最好每次增加的時(shí)間不要超過(guò)5分鐘，一次一次的增加。最好以你習(xí)慣的頻率不斷的增加散步的長(zhǎng)度。散步也需要循序漸進(jìn)，要有計(jì)劃。剛剛開(kāi)始散步時(shí)最好一次散步5到10分鐘，然后以后慢慢的增加到每次散步30分鐘左右。(Walkingalsoneedstobegradualandplanned.Itisbesttostartwalkingfor5to10minutesatatime,andthenslowlyincreasetoabout30minutesperwalk.)(Physiquerecoveryplan)體型恢復(fù)方案運(yùn)動(dòng)方面—散步(Exercise—Walking)(Physiquerecoveryplan)體型恢復(fù)方案運(yùn)動(dòng)方面—多做運(yùn)動(dòng)(Exercise—Domoreexercise)呼吸運(yùn)動(dòng)仰臥，兩臂放在后腦，深呼吸，使內(nèi)臟牽向上方，而使腹壁下陷，然后將氣呼出。(Breathingexercise:lieonyourback,botharmsonthebackofyourhead,breathedeeply,sothattheinternalorgansaredrawnupward,whiletheabdominalwallsinks,andthenexhale.)舉腿運(yùn)動(dòng)仰臥，兩臂伸直，平放在身邊，左右腿輪流舉高，與身體成一直角。這可加強(qiáng)腹直肌力量。(Legliftingexercise:lieonyourbackwithyourarmsstraightandflatbesideyou.Liftyourleftandrightlegsinturntomakearightangletoyourbody.Thiscanstrengthentherectusabdominis.)體型恢復(fù)方案（Physiquerecoveryplan）

運(yùn)動(dòng)方面—多做運(yùn)動(dòng)(Exercise—Domoreexercise)胸膝運(yùn)動(dòng)這個(gè)運(yùn)動(dòng)可在產(chǎn)后10至14天開(kāi)始做。跪姿，兩膝分開(kāi)，胸與肩部放在床面，頭側(cè)向一邊。這樣做可以防止子宮后位。(Chestandkneeexercise:thisexercisecanbestarted10to14daysafterdelivery.Kneelingpositionwithkneesapart,chestandshouldersonthebedandheadtothes