黄山市0-5岁儿童出生缺陷调查报告

为了解黄山市0-5岁儿童出生缺陷的患病率情况,采用流行病学的筛查方法,通过对黄山市在2006年1月1日-2010年12月31日期间出生的围产儿和0-5岁户籍儿童进行出生缺陷入户筛查。共筛查出生缺陷儿981例,出生缺陷发生率为158.63/万。排在前5位的是先天性心脏病、肢体畸形、总唇腭裂、脑萎缩和先天性脑积水。出生缺陷发生率呈逐年上升趋势,农村高于城市,男孩高于女孩,差异均有统计学意义。建议全面实施出生缺陷干预工程,将出生缺陷干预工作的重点放在农村,尤其加强前5位发生率较高病种的预防。     

站在“珠穆朗玛”上──山西畸形儿情况调查

背景介绍：１９８８年至１９９２年，卫生部组织全国各省市共同实施国家“七五”重点科技攻关课题《中国出生缺陷监测》。山西省１１个地（市）及５个县的２５所医院、妇幼保健院参加了监测。结果显示：全国新生儿出生缺陷总发生率为９９．６２／万，其中神经管略形发生率为２３．９６／万，位居世界第一，被称为世界出生缺陷的“珠穆朗玛峰”；山西省新生儿出生缺陷率高达１８９．８６／万，其中神经管略形发生率为１０２．２７／万，又位居全国之首，被称为珠峰的“峰顶”。据山西省１９９７年所做的出生缺陷回顾调查，出生缺陷总发生率１８６．４８／万，神经管畸形发生率 ９７．９７／万，仍与卫生部监测结果不相上下。     

常熟市出生缺陷状况分析

常熟市自20世纪90年代起开展出生缺陷监测工作,2000～2007年八年中,常熟市共监测围产儿75779例,发现出生缺陷820例,发生率为10.82‰,处于1987年卫生部检测的全国出生缺陷率的下限.提高市民人口出生质量的意识,有利于降低出生缺陷发生率.     

人性化护理干预对股骨粗隆间骨折患者围术期的影响

目的：探讨人性化护理干预对股骨粗隆间骨折患者围术期的影响.方法：选取于2013年1月~2014年2月来院行股骨粗隆间骨折术患者62例作为本次研究对象,随机数字表法分为对照组和观察组,各组31例,对照组行常规护理,观察组在常规护理基础上实施人性化护理干预,比较两组患者的康复效果.结果：观察组的优良率为96.77%,显著高于对照组的80.65%,差异有统计学意义（P<0.05）;观察组骨折愈合时间、住院时间优于对照组,差异均有统计学意义（P<0.05）;观察组并发症发生率为6.45%,显著低于对照组的16.13%,差异有统计学意义（P<0.05）.结论：人性化护理干预在股骨粗隆间骨折围手术期中的应用效果显著,能够加快骨折愈合,减少并发症的发生,促进患者早日康复,值得临床推广应用.     

无痛护理干预在骨折围术期疼痛患者中的应用分析

目的：探讨无痛护理干预在骨折围术期疼痛患者中的应用价值。方法：对本院2011年6月至2013年2月收治的110例骨折患者的临床资料进行分析,所有患者均给予无痛护理干预,评估患者入院时、术前及术后6、12、24h时的疼痛评分。结果：110例患者入院时均为重度疼痛,术前经过无痛护理后疼痛程度减轻,但与入院时比较,差异无统计学意义（P〉0．05）;患者术后6、12、24h时的疼痛程度明显减轻,与入院时和术前比较,差异有统计学意义（P〈0．05）。结论：无痛护理干预可明显减轻骨折围术期疼痛患者的疼痛情况,值得临床推广应用。     

北京市平谷区围产儿死亡103例分析

目的 探讨围产儿死亡的原因,进一步降低围产儿病死率.方法 对2005-2009年平谷区围产儿死亡病例的一般情况、产前检查情况、死亡原因进行分析.结果 2005-2009年全区围产儿病死率为7.60‰,本市户口病死率为6.18‰,外地户口病死率为15.58‰,65例未进行定期的产前检查,死亡原因中出生缺陷为首位因素.结论 加强流动人口孕产妇保健水平及提高孕产妇的知识技能水平,有效降低围产儿的病死率.     

遗传优生咨询者220例的细胞遗传学分析

目的：为进一步探讨了解遗传优生咨询者患者的染色体检查对于出生缺陷干预的工作意义。方法：以2008年12月～2010年12月期间到我院进行遗传优生咨询的220例痛例为研究对象,对其外周血淋巴细胞进行培养,制作常规的染色体标本,G显带,然后对染色体核型进行分析。结果：检查所有咨询者的外周血发现：发生染色体异常者有23例（10．5％）,染色体核型异常者有9例（4．1％）,188例为正常核型（85．5％）。结论：开展遗传优生咨询,对咨询者进行细胞遗传学检查,有助于出生缺陷率的降低。     

甘精胰岛素联合阿卡波糖在糖尿病围手术期应用的疗效和安全性评价

目的：探讨甘精胰岛素联合阿卡波糖在糖尿病围手术期治疗中的疗效及安全性。方法：32例围手术期糖尿病患者分为甘精胰岛素联合阿卡波糖组18例和每日多次胰岛素治疗组（MSII）14例,观察患者治疗期间血糖变化及术后并发症情况。结果：32例患者血糖均明显降低（P〈0．05）,两组间血糖下降水平比较无统计学差异（P〉0．05）,甘精胰岛素联合阿卡波糖组低血糖发生率明显低于MSII组,伤口愈合均良好。结论：在2型糖尿病患者围手术期中应用甘精胰岛素联合阿卡波糖能安全、有效地控制血糖,使患者顺利渡过围手术期。     

地特胰岛素与甘精胰岛素治疗2型糖尿病的临床疗效观察

目的：探讨地特胰岛素与甘精胰岛素治疗2型糖尿病的临床疗效对比．方法：选取我院内分泌科门诊自2010年5月~2013年6月期间的206例2型糖尿病患者作为研究对象．采用随机数字表法将所有患者分为对照组（n=109）和治疗组（n=109）,对照组给予皮下注射甘精胰岛素注射液治疗,治疗组给予皮下注射地特胰岛素注射液治疗,治疗3个月后,以空腹血糖、餐后2小时血糖、糖化血红蛋白以及不良反应发生率作为观察指标对比两组的疗效．结果：治疗组的空腹血糖、餐后2小时血糖以及糖化血红蛋白均明显低于对照组,差异均具有统计学意义（p〈O．05）;治疗组不良反应发生率明显高于对照组,差异具有统计学意义（p〈O．05）．结论：地特胰岛素治疗2型糖尿病的临床疗效确切,明显好于甘精胰岛素,不良反应发生率虽然略高于甘精胰岛素,但均较轻微。可自行消失,因此值得在临床上大力推广使用．     

新农村建设的思考——我国出生缺陷监测系统有待完善

“建设社会主义新农村”;“提高出生人口素质”,“推进社会主义和谐社会建设”,这是“十一五”时期的战略重点和主要任务。该文从新生儿不容乐观的现状出发,指出出生缺陷预防的重要性。通过分析我国现有的以医院为基础的出生缺陷监测系统所存在的问题,提出覆盖城乡以人群为对象建立全国出生缺陷监测系统的必要性,解释了何谓出生缺陷监测系统,最后着重从监测方法和工作过程的角度提出了建议。     

在校大学生足部真菌带菌情况及菌种分布的调查

目的：了解大学生足部真菌的带菌状况,对培养出来的真菌进行病原学研究及为临床预防和治疗提供依据。方法：对262名自愿受检大学生用棉签对其足部进行涂擦,然后将标本直接镜检,同进进行真菌培养,对培养出来的真菌进行菌种鉴定。结果：262份标本中,共分离出397株真菌,阳性率为74．04％,其中男生为71．8％,女生为77．4％,男、女生真菌携带率差异无统计学意义（P〉0.05）。所分到的菌株中,皮肤癣菌113株,占28．4％（113／397）;酵母属114株,占28．7％（114／397）;其他未能分类多细胞真菌23株,占5．8％（23／397）。多细胞真菌在男、女生中的携带率差异无统计学意义（P〉0.05）;酵母菌在男、女生中的携带率分别为35．2％、55．7％,差异有统计学意义（Х^2=10．6904,P〈0.01）。大学生群体中,足部真菌病的发病率为11．1％。结论：大学生足部真菌的携带率较高,男、女生差异不明显,但总体发病率相对较低。多细胞真菌、酵母菌的携带率在人群中的整体分布无明显差异,但酵母菌在女生中的携带率明显高于男生。     

4760例孕中期产前筛查和产前诊断产妇随访结果分析

目的：探讨孕中期产前筛查和产前诊断在临床中的应用和意义。方法：应用时间分辨法,以血清AFP、β-HCG作为指标,对4 760例在孕15～20＋6周孕妇进行产前筛查,对筛查为高风险的孕妇进行一对一的遗传咨询和产前诊断,并在产后3月内对其分娩结局进行随访观察。结果：随访中发现有不同程度畸形、流产、死胎等不良妊娠共29例：高风险者6例,低风险者23例。其中羊水染色体异常2例、超声检查检出各种畸形（开放性神经管畸形如脊柱裂、小头畸形、脑膨出等）6例、内脏畸形（如先心病、肾发育不良、胎儿宫内发育异常等）5例。不明原因死胎、晚期流产3例,21-三体新生儿1例（产前筛查唐氏高风险而拒绝羊水穿刺细胞学检查所致）。结论：孕中期产前筛查和产前诊断可降低出生缺陷的发生。     

宾川县2005年至2012年流行性腮腺炎流行病学分析

目的：分析2005年至2012年宾川县流行性腮腺炎报告发病情况,为开展预防控制工作提供科学依据。方法：应用描述性流行病学方法,对宾川县2005年至2012年报告的流行性腮腺炎病例进行统计分析。结果：宾川县2005年至2012年共报告流行性腮腺炎病例670例,无死亡病例,年平均发病率15．98／10万,发病季节主要集中在11—125份,以3-15岁儿童发病为主,职业分布以学生、幼托儿童居多。结论：宾川县流行性腮腺炎常年均有发病,以11-12月份居多,发病人群以〈15岁青少年为主,提示今后防治的重点场所是学校和托幼机构。     

Prenatal diagnosis of congenital fetal heart abnormalities and clinical analysis

INTRODUCTION Congenital heart disease (CHD) is the most common congenital disorder resulting in significant prenatal and postnatal morbidity and mortality (Gil- lum, 1994; Gembruch, 1997) and is believed to be a multifactorial disorder arising from the combined effect of genetic predisposition and environmental factors. Prenatal diagnosis of CHD is very important for both fetal prognosis and decreasing economic burden of family and society. It was demonstratedt t - l t recently that fe…     

First-time maltreatment in children ages 2–10 with and without specific birth defects: A population–based study

Children with disabilities are at an increased risk for maltreatment. However, little is known about the risk of maltreatment in children with specific types of birth defects. This study was conducted to determine whether the risk and predictors of maltreatment in children 2 to 10 years of age differ between those without and with specific birth defects: Down syndrome, cleft lip with/without cleft palate, and spina bifida. State administrative and United States Census data were linked to identify study groups, variables of interest, and outcome measures. Kaplan-Meier and multivariate Cox proportional hazard analyses were used to identify study groups and variables associated with an increased risk for maltreatment. The prevalence of substantiated maltreatment was consistently highest among children with cleft lip with/without cleft palate. After adjusting for birth-level factors, children with Down syndrome and cleft lip with/without cleft palate were 34% and 26% more likely to have been maltreated than those without birth defects, respectively. In all three birth defect groups, the risk of medical neglect was higher (relative risks ranged from 3 to 11) than in the unaffected group. The factors associated with increased risk for maltreatment were similar across all groups. Of note, parity, maternal education, and maternal Medicaid use at birth were all associated with greater than 2-fold increased risk for maltreatment. Our findings suggest that the families of children with birth defects may need support services throughout early childhood to help families cope with the needs of their children and reduce the risk of maltreatment.     

献血不良反应对献血者再次献血的影响及护理对策

目的：分析无偿献血者发生献血不良反应后再次参加献血的情况,并制定有针对性的护理措施,稳定献血者队伍。方法：对2008年1月1日-2011年12月31日间参加献血的61067例无偿献血者资料进行统计分析。结果：2008年-2011年参加献血的61067人次献血者有272人次发生了程度不同的献血不良反应,发生率为0．45％。在1～4年间,未发生献血不良反应的60795人次献血者中重复献血的有18379人次,占30．23％,发生献血不良反应的272人次中仅有39人次重复参加了无偿献血,再次献血率为14．34％。发生献血不良反应的39人次献血者中,轻度献血不良反应发生者再次献血的比率为76．92％,中、重度献血不良反应发生者再次献血的比率为23．08％。结论：血站必须从全面质量管理的角度推行人性化护理,通过对献血者开展个体化护理,加强健康教育和心理疏导,营造安全、舒适的献血环境,及时处理献血不良反应,避免中、重度献血反应的发生,加强献血后回访等措施,确保献血者安全,建立和巩固志愿献血者队伍。     

The incidence of severe physical child abuse in Wales

OBJECTIVES: The purposes of this study were: (1) to ascertain the incidence and nature of severe physical child abuse in Wales; (2) to ascertain the incidence of all physical abuse in babies under 1 year of age; and (3) to determine whether child protection registers (CPR) accurately reflect the numbers of children who are physically abused. METHODS: This is a population-based incidence study based in Wales, UK, for 2 years from April 1996 through March 1998. Children studied were under the age of 14 with severe physical abuse consistent with the criminal law level of Grievous Bodily Harm. This included seven categories of injury (death; head injury including subdural hemorrhage; internal abdominal injury; physical injury in Munchausen Syndrome by Proxy including suffocation; fracture; burn or scald; adult bite). Cases were ascertained by a pediatrician surveillance reporting system (WPSU). A criterion for inclusion was multidisciplinary agreement that physical abuse had occurred (at case conference, strategy meeting, or Part 8 Review). The incidence of all babies under 1 year of age with physical abuse was also studied. Ascertainment of babies under the age of 1 year was undertaken from CPR as well as the WPSU. RESULTS: Severe abuse is six times more common in babies [54/100,000/year (95% CI +/- 17.2)] than in children from 1 year to 4 years of age [9.2/100,000 (95% CI +/- 3.6)]. It is 120 times more common than in 5- to 13-year-olds [0.47/100,000 (95% CI +/- 0.47)]. This is mainly because two types of serious abuse (brain injury including subdural hemorrhage and fractures) are more common in babies under the age of 1 year than older children. Using data from two sources (the WPSU and CPRs), the incidence of physical abuse in babies is 114/100,000 (CI 114 +/- 11.8) per year. This equates to 1 baby in 880 being abused in the first year of life. The largely rural Health Authority area in Wales had incidence figures for abuse in babies that were 50% of the three other predominantly urban Health Authority areas. Boys throughout the series were more at risk of being severely abused than girls (p < .025). Only 29% of the babies under 1 year of age on the CPR had actually been injured. Thirty percent of abused babies under the age of 1 year and 73% of severely abused children over the age of 1 year had caused previous concern to health professionals regarding abuse or neglect. Conclusions: Physical abuse is a significant problem in babies under the age of 1 year. Very young babies (under 6 months old) have the highest risk of suffering damage or death as a result of physical abuse. Severe abuse, in particular subdural hematoma and fracture, is much more common in babies than in older children. There is evidence of failure of secondary prevention of child abuse by health professionals, with a greater need to act on concerns regarding abuse and neglect. Interagency child protection work in partnership with parents should focus more on protecting babies under age 1 year from further abuse than on maintenance of the infant within an abusive home. The CPR is not intended as an accurate measure of children suffering abuse. It is a record of children requiring a child protection plan and must not be used as a measure of numbers of abused children.     

Outcomes for Women and Infants Following Assisted Conception: Implications for Perinatal Education,Care, and Support

Assisted conception is becoming an increasingly more common treatment option for women and couples who experience fertility problems. Links have been made in the literature between assisted conception and a greater incidence of pregnancy or birth complications, low birth weight or premature babies, and babies with congenital abnormalities. In addition, evidence suggests that the experience of assisted conception may influence the development of early mothering relationships and impact parenting adjustment. Although this commentary article does not strategically review all available literature, it provides an overview of the health issues that women and families undergoing assisted conception have experienced or may experience. Through raising awareness and promoting discussion of these issues, practitioners will be better equipped to provide informed education and support.     

中学生面部蠕形螨感染调查分析

目的：调查大理州永平县龙门乡中学生面部蠕形螨的感染情况,并分析感染的原因。方法：采用透明胶带粘贴法对211名中学生面部蠕形螨的感染情况进行调查,并观察其面部皮肤状况。结果：蠕形螨总感染率为6．16％;男生感染率（7．34％）高于女生（4．9％）;感染虫种多为毛囊蠕形螨,少数为皮脂蠕形螨,差异有统计学意义（x。=7．538,P〈0．05）;采用清水、香皂、洗面奶、药皂四种洗脸方式间差异有统计学意义（x。=1．526,P〈0．05）;学生住校与住家的感染率差异有统计学意义（x2=10．972,P〈0．05）;面额部的检出率高于其他部位,且油性与中性皮肤较干性皮肤检出率高,差异有统计学意义（x：=1-314,P〈O．05）。结论：永平县龙门乡中学生面部存在蠕形螨感染的情况,应加强对学生面部蠕形螨的防治。     

切开复位锁定钢板内固定治疗跟骨骨折100例临床观察

目的：探讨切开复位锁定钢板内固定治疗跟骨骨折的临床疗效。方法：分析2008年9月至2011年9月,行切开复位植骨锁定钢板内固定治疗跟骨骨折100例（共103足）。男性76例,女性24例,其中单侧97例,双侧3例。年龄18-64岁,平均（33.19±5.97）岁。按Sanders分型Ⅱ型28例,Ⅲ型62例,IV型10例。均采用跟骨外侧L型切口,切开复位锁定钢板内固定。结果：92例获得随访,随访时间6-30个月,平均18个月。应用Maryland评分系统进行疗效评定。优46例、良40例、中4例（1例双侧跟骨骨折）,优良率93.4%。其中1例出现骨不愈合,再次行距下关节融合术,1例出现皮肤坏死经换药后治愈,1例出现腓肠神经症状。结论：切开复位植骨锁定钢板内固定是治疗跟骨骨折的有效方法。