| Object:To evaluate Postpartum Hidrosis objectively by the application of sweating rate test, and provide a basis for early differential diagnosis of Postpartum Hidrosis and puerperium sweating.Method:①Method:Cross-sectional study in descriptive epidemiology, applied to describe the clinical features or progress of a disease in a certain range.②Subjects:62 puerperal cases were observed, which were from Obstetrics and Gynecology of Shandong Police General Hospital, Tangshan Worker’s Hospital and Tangshan Child Health Hospital. ③Information collection:The subjects’ information was collected by Information Forms, including Name, Gender, Age, Maternal conditions and other basic information, as well as sweating symptom and sweating related symptoms (such as tired, weak, etc.), tongue features, pulse features and other Postpartum Hidrosis related information. Follow-up information was collected on the 14th Day, according to which a Postpartum Hidrosis or puerperium sweating diagnosis was down. ④ Sample groups:According to the definitions of puerperium sweating and Postpartum Hidrosis, and the diagnostic criteria of Postpartum Hidrosis, all of the subjects were divided into the following 2 groups:A. Normal group:subjects who had no longer had the complaint of increased sweating till to the follow-up, and the sweating symptom was disappeared or relieved evidently within 7 days after the accouchement. B. Postpartum Hidrosis group:cut-off to the follow-up, subjects still had complaint of increased sweating, and the sweating symptom was not relieved within 7 days after the accouchement. ⑤Instruments:Our research group developed a sweating rate detector in collaboration with Beijing Guohao Technology Institute. This instrument can detect sweating rate on measuring accuracy of 0.01μg/cm2/s. ⑥Testing process: Testing cite:medial forearm,2-5cm below the elbow stripes. Testing conditions: Subjects were all dressed on unified cotton unlined clothes, room temperature was 28±1℃, and humidity was 30%-50%, with no air flow. Testing time:1-7 days after delivery, during the hospitalization. Test steps:A. Testers explain the testing purpose, meaning, stems and precautions to the subjects to eliminate their tension, fix the probe to the testing cite and instruct the participants to keep resting supine state during the testing process. B. Open the sweating rate detector and set the air flow rate to 500ml/min. C. Click "start test" and "start recording" buttons, and the instrument began to detect and record data automatically. D. Keep testing 5min of resting state (hereinafter referred to as "resting phase"). E. Instruct the participants to drink 200ml of 50℃ warm water on the 5th minute to induce sweating increasing. F. Continue to detect the induced sweating rate 5min (hereinafter referred to as "induced phase"). G. Remove the probe when the test is over, export test data, shut down and tell the subjects detection ending.⑦Data processing and parameter extraction:Process the raw data of sweating rate by both linear and nonlinear methods, which include the arithmetic mean, standard deviation, coefficient of variation, and the Induced/resting phase ratio of the 3 above. Poincare plot analyzing is a kind of nonlinear method. The short axis diameter (SD1), the major axis diameter (SD2) and the center position (OC) were used. ⑧Statistical analysis:A. Take x2 tests of sweating complaint ratio and Chinese Medicine Syndrome ratio between normal group and Postpartum Hidrosis group to find whether the 2 ratios have any specificity. B. Take normality test of the raw data and SD1, SD2, OC of Poincare Plots to confirm its distributing features, and then find the special parameters through t test or rank sum test.Results:①Among all the 62 cases in this study,21 subjects were diagnosed as Postpartum Hidrosis, accounting for 33.9%, and 41 subjects were diagnosed as Puerperium sweating, accounting for 66.1%. ②There were 38 cases who had complaint of increased sweating in normal group, accounting for 92.7%, and 21 cases in Postpartum Hidrosis group, accounting for 100%. The difference between groups was not statistically significant. Among normal subjects,23 cases were diagnosed as Qi Deficiency Syndrome, accounting for 56.1%,21 cases were diagnosed as Yin Deficiency Syndrome, accounting for 51.2%, and 5 cases were diagnosed as Heat Syndrome, accounting for 12.2%. Among Postpartum Hidrosis subjects,13 cases were diagnosed as Qi Deficiency Syndrome, accounting for 61.9%,11 cases were diagnosed as Yin Deficiency Syndrome, accounting for 52.4%, and 4 cases were diagnosed as Heat Syndrome, accounting for 19.0%. The difference of the 3 main syndromes above between groups was not statistically significant (Qi Deficiency Syndrome:χ2=0.0075, p=0.9936. Yin Deficiency Syndrome:χ2=0.0075, p=0.9310. Heat Syndrome:corrected χ2=0.1184, p=0.7308). ③The normality test of sweating rate parameters show that all the parameters dispersed in a relatively large range and does not show the typical normal distribution. Therefore we apply "median (upper quartile, lower quartile)" for statistical description and rank sum test for comparison between groups. ④In early puerperium, maternal sweating rate is 1.46 (1.22,1.74) μg/cm2/s, significantly higher than normal physical sweating rate (0.20-0.33μg/cm2/s). ⑤ In normal group, the resting phase sweating rate is 1.29 (1.20,1.69) μg/cm2/s, and the induced phase sweating rate is 1.31 (1.19,1.62) μg/cm2/s. The difference is not statistically significant. In Postpartum Hidrosis group, the resting phase sweating rate is 1.65 (1.46,2.30) μg/cm2/s, and the induced phase sweating rate is 2.23 (1.91,2.97) μg/cm2/s. The difference is statistically significant (p<0.05). The sweating rate of resting phase and induced phase in Postpartum Hidrosis group are both higher than those in normal group, and the difference is statistically significant (p<0.01). The induced/resting ratio of sweating rate in Postpartum Hidrosis group is 1.28(1.07,1.39), higher than 0.99(0.96,1.03) in normal group, and the difference is statistically significant (p<0.01). ⑥In normal group, the resting phase coefficient of variation is 1.83%(1.46%,2.93%), and the induced phase coefficient of variation is 2.39% (1.75%,3.57%). The difference is not statistically significant. In Postpartum Hidrosis group, the resting phase coefficient of variation is 6.18% (3.88%,10.29%), and the induced phase coefficient of variation is 13.33% (9.11%,19.91%). The difference is statistically significant (p<0.05). The coefficient of variation of resting phase and induced phase in Postpartum Hidrosis group are both higher than those in normal group, and the difference is statistically significant (p<0.01). The induced/resting ratio of coefficient of variation in Postpartum Hidrosis group is 1.94 (1.19,6.01), higher than 1.13 (0.83,2.03) in normal group, and the difference is statistically significant (p<0.01). ⑦Poincare Plot Analyzing:In normal group, SD1=15.80(12.20,17.60) ng/cm2/s, SD2=42.40 (27.25,95.40) ng/cm2/s, OC=1923.05(1697.27, 2385.85)ng/cm2/s. In Postpartum Hidrosis group, SD1=23.20(15.95,41.10)ng/cm2/s, SD2=343.60 (169.60,534.00) ng/cm2/s, OC= 2953.73 (2343.99,4039.98) ng/cm2/s. The 3 parameters above in Postpartum Hidrosis group are all higher than those in normal group, and the differences are statistically significant (p<0.01).Conclusion: ①ncreased sweating is a widespread phenomenon in early puerperium. The level change of human chorionic gonadotropin, thyroid hormone and adrenal hormone induced by pregnancy and delivery appear in a relatively same phase with the increased sweating. It is inferred that the hormone variance might be an important inducing factor of puerperium sweating. About 33% of delivery women have the disease of Postpartum Hidrosis, and this disease might be one of the important external manifestations of nerve-endocrine dysfunctions. ②The 4 kinds of diagnostic information in Chinese Medicine are relatively subjective and macroscopic, and the diagnosis of Postpartum Hidrosis is mainly based on the progress of sweating symptom. Therefore, it is quite difficult to identify Postpartum Hidrosis and Puerperium Sweating just by sweating complaint or Chinese Medicine Syndromes. ③Dynamic sweating rate test can detect sweat rate in an accuracy of 0.01μg/cm2/s. The curve graph and Poincare Plot graph based on dynamic sweating rate test can reflect sweating rate changes more directly. The parameters, such as arithmetic mean of sweating rate, coefficient of variation and SD1, SD2, OC of Poincare Plot graph can be used to permit an objective evaluation and early diagnosis of Postpartum Hidrosis. ④In Postpartum Hidrosis group, the sweating rate, the coefficient of variation and the induced/resting ratio of the two are all higher than those in normal group. This means, besides the velocity rise, the sweating stability decline is an important feature of Postpartum Hidrosis as well. The stability decline might reflect that the cholinergic sympathetic postganglionic fibers have had a certain degree of dysfunction. ⑤In Postpartum Hidrosis group, the Poincare Plot graph shift to the up-right in xy-coordinate system, and OC values are significantly higher than those in normal group, indicating that the sweating rate of Postpartum Hidrosis is higher than that of puerperal sweating. ⑥In Postpartum Hidrosis group, SD1, SD2 values of Poincare Plot graph are both significantly higher than those in normal group, indicating that the variability of sweating rate of Postpartum Hidrosis is than that of puerperal sweating, and contains compositions of high-frequency and low-frequency. The high-frequency variation might be an external appearance of the neurological stability decline of the sweating nerves, and the low-frequency variation might be related to some endocrine dysfunctions. |
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