产后恢复培训PostpartumRecoveryTrainingCourse案例分析形体评估与恢复

产后恢复培训课程PostpartumRecoveryTrainingCourse案例分析：形体评估与恢复实施CaseStudy:PhysiqueAssessmentandRecoveryImplementation形体的评估

（Assessmentofphysique）形体的恢复实施

（Implementationofphysiquerecovery）目录（Contents）导入(Introduction)案例（CaseStudy）张女士，33岁，自然分娩后8个月，自述产后身体肥胖，产后恢复效果较差。体查：T36.3℃，P85次/分，R22次/分，BP138/85mmHg。请对该产妇进行体型评估。(Pleaseassessthiswoman'sbodytype.)任务（Tasks）(Ms.Zhang,33yearsold,8monthsafternaturaldelivery,self-reportedpostpartumobesityandpoorpostpartumrecovery.Physicalexamination:T36.3℃,P85beats/min,R22resp/min,BP138/85mmHg.)请制定出该产妇的恢复方案。(Pleasedeveloparecoveryplanforthiswoman.)体型评估该产妇体型评估所需数据：胸围

腰围臀围大腿围上臂围体重身高(Requireddatatoassessthiswoman‘sbodytypeare)(chestcircumference)(waistcircumference)

(hip

circumference)

(thighcircumference)

(upperarmcircumference)(weightandheight)(Assessmentofphysique)测胸围(Chestcircumferencemeasurement)(Measuredchestcircumferenceofthepuerpera:100cm)(Takeasittingorstandingpositionwithupperlimbshangingdownnaturallyonbothsides.)常取乳头水平周径为胸围值。测得该产妇胸围：100cm(Thecircumferencewasmeasuredattheendofdeepinspirationandexpirationrespectively,andthedifferencebetweenthetwovaluesreflectsthedegreeofthoracicexpansion.)取坐位或站立位，双上肢在身体两侧自然下垂。在腋窝下缘水平、乳头水平、创突水平，测量周径。(Measurethecircumferenceattheleveloftheloweredgeofthearmpit,thelevelofthenipple,andtheleveloftheprotrusion.)(Thecircumferenceatthenipplelevelisoftentakenasthechestcircumference.)在深吸气末和深呼气末，分别测量周径，两数值差反映胸廓扩张度。01ABCDE体型评估(Assessmentofphysique)测腰围(Waistcircumferencemeasurement)(Measuredwaistcircumferenceofthepuerpera:92cm)(takethestandingpositionwithupperlimbshangingdownnaturallyonbothsides,andfeetapartwithshoulderwidth.)测得该产妇腰围：92cm取站立位，双上肢在身休两侧自然下垂，双脚分开同肩宽。产妇自然呼吸，分别取左右两侧腋中线的肋骨下缘与骼嵴连线中点，在两点水平测量腰腹部周径。(Thepuerperabreathenaturally,takethemidpointofthelinebetweentheloweredgeoftheribsinmidaxillarylineonbothsidesandtheiliaccrestrespectively,andmeasurethecircumferenceofthewaistandabdomenattwopoints.)02体型评估(Assessmentofphysique)测臀围(Hipcircumferencemeasurement)(Measuredhipcircumferenceofthepuerpera:103cm)(takeastandingpositionandrelax,withupperlimbshangingdownnaturallyonbothsides,andfeettogethernaturally.)测得该产妇臀围：103cm取站立位，将部放松，双上肢在身体两侧自然下亚，双脚自然并扰。产妇自然呼吸、在臀部后侧最突出部位或股骨大相隆处测量周径。(Puerperabreathenaturally,andmeasuresthecircumferenceatthemostprominentpartbehindthehiporatthegreaterfemur.)03010203体型评估(Assessmentofphysique)测大腿围（Thighcircumferencemeasurement)取站立位，下肢稍外展，膝关节伸直。04(Takeastandingpositionwithlowerlimbsslightlyabductedandkneestraight.)在储骨上方10cm或15cm处，或6cm、8cm、10cm、12cm处测量或测量最粗壮处大腿周径。(Measureat10cmor15cmabovethestoragebone,orat6cm,8cm,10cm,12cmormeasurethecircumferenceofthethickestpartofthigh.)记录时注明测量点。(Notethemeasuringpointwhenrecording.)测得该产妇大腿围：59cm(Measuredthighcircumferenceofthepuerpera:59cm)体型评估(Assessmentofphysique)01020304测上臂围（Upperarmcircumferencemeasuremen)(Measuredupperarmcircumferenceofthepuerpera:34cm)(takethestandingorsittingposition.)测得该产妇上臂围：34cm取站立位或坐位。产妇自然呼吸，分别在时关节用力屈曲和伸展时，测量肱头肌隆起最高处的上臀围。(Puerperabreathenaturallytheupperarmcircumferencewasmeasuredatthehighestpointofbrachialismusclewhen,thejointwasflexedandextendedwithforcerespectively.)05体型评估(Assessmentofphysique)测体重身高（Weightandheightmeasurement)(heelstogetherandtiptoesseparatedat30°~40°Measureverticallyfromtheheadtotheheel.)(Themeasurementisaffectedbythetimeofday,10:00amisthebesttime.)足尖以30°~40°分开，从头项到足跟垂直测量。受时间影响，测量时间以上午10点为佳。取站立位，产妇挺胸收腹、下肢伸直、赤足，足跟并拢。(Takethestandingposition,thepuerperashouldstandwithherchestupandabdomentight,lowerlimbsstraight,barefoot,.)身高测得该产妇身高：160cm（Height）（Measuredheightofthepuerpera:160cm.）06体型评估(Assessmentofphysique)(Measuredweightofthepuerpera:73kg)(Takethenaturalstandingposition.)测得该产妇体重：73kg取自然站立位。测量前，尽量排空膀胱和直肠，站在体重计上测量，读数减去所着衣物质量，即为体重。(bladderandbowelbeforemeasurement,standonthescaleandmeasuretheweightbysubtractingthemassofclothingworn.)体重（Weight）010203测体重身高（Weightandheightmeasurement)06体型评估(Assessmentofphysique)身高体重胸围腰围臀围大腿围上臂围标准值1605384.859.286.449.429实际值16073100921035934体型评估(Assessmentofphysique)该产妇体型评估所需数据：腰臀比

标准体重体质指数体脂率(Thefollowingdataarerequiredtoassessthematernalbodytype:)(waist-hipratio)(standardweight)(bodymassindex)(bodyfatpercentage)体型评估(Assessmentofphysique)腰臀比（Waist-hipratio)01腰臀比腰围与臀围的比例腰臀比＝腰围（cm)／臀围（cm)(Waist-hipratioistheratioofwaistcircumferencetohipcircumference.)(Waist-hipratio=waistcircumference(cm)/hipcircumference(cm))体型评估（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国标准为＜0.8,WHO标准为＜0.85，本比值反映脂肪分布情况，用于评估中心性肥胖(腹型肥胖)。计算得该产妇腰臀比＝92/103=0.893(Calculatedwaist-hipratioofthepuerpera=92/103=0.893)体型评估(Assessmentofphysique)030201标准体重（kg)＝身高（cm)-100（身高≤165cm)（Standardweight(kg)=height(cm)-100(height≤165cm)标准体重（kg)＝身高（em)-105（身高为166~175cm)（Standardweight(kg)=height(cm)-105(heightof166~175cm）标准体重（kg)＝身高（em)-110（身高为176~185cm)（Standardweight(kg)=height(cm)-110(heightof176~185cm)体型评估(Assessmentofphysique)标准体重(Standardweight)02标准体重—评估(Standardweight—Assessment)02体型评估(Assessmentofphysique)在标准体重10％以内为正常，在10%~19％为超重，超过20％为肥胖。(Within10%ofthestandardweightwasconsiderednormal,between10%and19%wasconsideredoverweight,andover20%wasconsideredobese.)该产妇标准体重(kg)＝160-100=60kg产妇实际体重73kg。(Calculatedstandardweightofthispuerpera(Kg)＝160-100=60kgActualweightofthispuerperais73kg.)(73-60)÷60×100%=21.67%该产妇体重超出标准体重的20％以上，属于肥胖。(Throughcalculation,thispuerpera’sweightexceedsmorethan20%ofthestandardweight,whichbelongstoobesity.)体重指数(BMI)=体重(kg)/身高2(m2)(Bodymassindex(BMI)=weight(kg)/squareofheight(m2))体重指数（Bodymassindex)03体型评估（Assessmentofphysique）

计算得该产妇体重指数=73/1.602=28.5，根据标准值可判定为肥胖。(Calculatedthatthispuerpera’sbodymassindex=73/squareof1.602=28.5,whichcanbedeterminedasobesityaccordingtotheBMIevaluationstandard.)中国标准WHO标准结果评判<18.5<18.5体重过低18.5≤BMI≤24.018.5≤BMI≤25.0体重正常24.0≤BMI<28.025.0≤BMI<30.0超重≥28.0≥30.0肥胖体型评估（Assessmentofphysique）

体重指数（Bodymassindex)03体脂率（Bodyfatpercentage)04体型评估(Assessmentofphysique)计算公式：参数a=腰围(单位：厘米)×0.74(Calculationformula:parametera=waistcircumference(unit:cm)×0.74)身体脂肪总重量(单位:千克)=参数a－参数b(Totalbodyfatweight(unit:kg)=parametera-parameterb)体脂率=(身体脂肪总重量÷体重)×100%(Bodyfatpercentage=(totalbodyfatweight÷bodyweight)×100%)参数b=体重(单位:千克)×0.082+34.89(parameterb=weight(unit:kg)×0.082+34.89)体脂率（Bodyfatpercentage)04计算得该产妇(Throughcalculation,thepuerpera’s）参数a=92×0.74=68.08（Parametera=92×0.74=68.08）参数b=73×0.082+34.89=40.876（Parameterb=73×0.082+34.89=40.876）体型评估（Assessmentofphysique）

体脂率（Bodyfatpercentage)04体型评估（Assessmentofphysique）

身体脂肪总重量=68.08－40.876=27.204(Totalbodyfatweight=68.08-40.876=27.204)1体脂率=27.204÷73×100%=37.27%(Bodyfatpercentage=27.204÷73×100%=37.27%)2根据体脂对照表可判定张女士体型为偏胖。(Accordingtothebodyfatcomparisontable,Ms.Zhang'sbodytypecanbedeterminedasoverweight.)体脂对照表性别年龄偏瘦标准偏胖过胖女18-39岁5-20%21-34%35-39%40-45%40-59岁5-21%22-35%36-40%41-45%50岁5-22%23-36%37-41%42-45%体脂率（Bodyfatpercentage)04体型评估（Assessmentofphysique）

饮食方面

高热量的食物010302饮食原则平衡膳食避免高脂肪(Dietaryprinciples)(balanceddiet)

(avoidhigh-fat)(high-caloriefoods)(Diet)饮食方面体型恢复方案（Physiquerecoveryplan）

饮食方面(Diet)(Physiquerecoveryplan)体型恢复方案你每天获取的食物热量不应低于1800卡路里。如果你还需哺乳，那你需在1800卡路里的基础上再加300到500以上的卡路里。(Youshouldnotconsumelessthan1800caloriesoffoodperday.Ifyouarebreastfeeding,thenyouneedtoadd300to500morecaloriestothe1800calories.)避免节食(Avoiddieting)01确保你的热量均匀地分散在一整天。避免暴饮暴食。可以在两餐之间适当的加一些零食，但是热量一定要低，而且你每天的摄入热量的总数不要超过2500卡路里。(Makesureyourcaloriesaredistributedevenlythroughouttheday.Avoidovereating.It'sokaytosnackinbetweenmeals,butmakesurethecaloriesarelow,andyourtotaldailycalorieintakeshouldnotexceed2500calories.)控制零食(Controlsnacking)02(Physiquerecoveryplan)体型恢复方案饮食方面(Diet)千万不要吃减肥药、减肥茶。减肥药主要是通过人体少吸收营养，又增加排泄量，从而达到减肥的目的。同时，减肥药影响人体正常的代谢，尤其是哺乳期吃减肥药，大部分药物会从乳汁里排泄，这样就等于给婴儿也吃了减肥药，婴儿肝脏解毒功能差，减肥药量大了易使婴儿的肝脏功能降低，容易引起婴儿的肝功能异常。(Donottakedietpillsordiettea.Dietpillsaremainlythroughthebodytoabsorblessnutritionandincreaseexcretiontoachievethepurposeofweightloss.Atthesametime,dietpillsaffectthenormalmetabolismofthebody,especiallyduringlactation,mostofthedrugswillbeexcretedfromthebreastmilk,whichisequivalenttogivingtheinfantdietpills,whohaspoorliverdetoxificationfunction.Dietpillsinlargeamountscaneasilydecreasetheinfant'sliverfunction,andcauseabnormalliverfunctionoftheinfant.)忌吃减肥药（Avoiddietpills）任何的体育锻炼最好包括心血管的锻炼，因为这将会更加帮助加强心脏的功能和燃烧脂肪。而散步将会是最简单，最有效的锻炼方式。(Anyphysicalexercise,andisbesttoincludecardiovascularexercise,becauseitwillstrengthenthefunctionoftheheartandburnfat.Andwalkingisthesimplestandmosteffectivewaytoexercise.)专家说：“散步一小时可以帮助消耗大约500卡的能量”。我们知道，如果消耗3500卡的能量就可以帮助减掉一磅的体重。(Expertssay:"anhourofwalkingcanhelpburnabout500caloriesofenergy".Weknowthatifyouburn3,500caloriesyoucanloseapoundofweight.)(Physiquerecoveryplan)体型恢复方案运动方面—散步(Exercise—Walking)(Itisbestnottoincreasethetimemorethan5minutesatatime,oneatatime.It'sbesttokeepincreasingthelengthofyourwalkswiththefrequencyyou'reusedto.)最好每次增加的时间不要超过5分钟，一次一次的增加。最好以你习惯的频率不断的增加散步的长度。散步也需要循序渐进，要有计划。刚刚开始散步时最好一次散步5到10分钟，然后以后慢慢的增加到每次散步30分钟左右。(Walkingalsoneedstobegradualandplanned.Itisbesttostartwalkingfor5to10minutesatatime,andthenslowlyincreasetoabout30minutesperwalk.)(Physiquerecoveryplan)体型恢复方案运动方面—散步(Exercise—Walking)(Physiquerecoveryplan)体型恢复方案运动方面—多做运动(Exercise—Domoreexercise)呼吸运动仰卧，两臂放在后脑，深呼吸，使内脏牵向上方，而使腹壁下陷，然后将气呼出。(Breathingexercise:lieonyourback,botharmsonthebackofyourhead,breathedeeply,sothattheinternalorgansaredrawnupward,whiletheabdominalwallsinks,andthenexhale.)举腿运动仰卧，两臂伸直，平放在身边，左右腿轮流举高，与身体成一直角。这可加强腹直肌力量。(Legliftingexercise:lieonyourbackwithyourarmsstraightandflatbesideyou.Liftyourleftandrightlegsinturntomakearightangletoyourbody.Thiscanstrengthentherectusabdominis.)体型恢复方案（Physiquerecoveryplan）

运动方面—多做运动(Exercise—Domoreexercise)胸膝运动这个运动可在产后10至14天开始做。跪姿，两膝分开，胸与肩部放在床面，头侧向一边。这样做可以防止子宫后位。(Chestandkneeexercise:thisexercisecanbestarted10to14daysafterdelivery.Kneelingpositionwithkneesapart,chestandshouldersonthebedandheadtothes