河南省小儿脑性瘫痪流行特征及防治现状

ATHESISSUBMITTEDTOZHENGZHOUUNIVERSITYFORTHEDEGREEOFMASTEREPIDEMICCHARACTERISTICSANDCURRENTPREVENTIONOFCEREBRALPALSYINHENANPROVINCEBYZHENHUANZHANGSUPERVISORPROF．JUNWANGPEDIATRICSTHETHIRDAFFILIATEDHOSPITALOFZHENGZHOUUNIVERSITYMAY2013学位论文原创性声明本人郑重声明所呈交的学位论文，是本人在导师的指导下，独立进行研究所取得的成果。除文中已经注明引用的内容外，本论文不包含任何其他个人或集体已经发表或撰写过的科研成果。对本文的研究作出重要贡献的个人和集体，均已在文中以明确方式标明。本声明的法律责任由本人承担。学位论文作者矛尺荧J欠日期≯，弓年月7日学位论文使用授权声明本人在导师指导下完成的论文及相关的职务作品，知识产权归属郑州大学。根据郑州大学有关保留、使用学位论文的规定，同意学校保留或向国家有关部门或机构送交论文的复印件和电子版，允许论文被查阅和借阅本人授权郑州大学可以将本学位论文的全部或部分编入有关数据库进行检索，可以采用影印、缩印或者其他复制手段保存论文和汇编本学位论文。本人离校后发表、使用学位论文或与该学位论文直接相关的学术论文或成果时，第一署名单位仍然为郑州大学。保密论文在解密后应遵守此规定。学位论文作者多}∈定灼良日期≯／乡年‘月7同摘要河南省J、JL脑性瘫痪流行特征及防治现状研究生张贞焕导师王军教授专业儿科学郑州大学第三附属医院河南郑州450052摘要目的脑性瘫痪是严重危害儿童身心健康的常见疾病，随着医学进步和新生儿抢救技术的提高，脑瘫发病率有增高趋势。这不仅对患儿产生巨大的生理及心理影响，也使家庭和社会蒙上精神压力及经济负担的阴影，同时对提高人口素质及计划生育这一基本国策的落实产生消极影响。遗憾的是至今还没有一个国家能够建立一个政府监控机构，及时了解、报道脑瘫发病及防治情况。国外调查分析认为活产婴儿脑瘫的发生率在23％0，而作为人口大省的河南省还没有脑瘫患病率的精确数据和流行病学资料，没有预防措施及防治指南。通过此次脑瘫的流行病学调查，不仅搞清楚我省脑瘫患病率情况，建立脑瘫相关信息资料库，筛查出脑瘫患儿，对其进行早期干预康复治疗，提高他们生活质量和适应社会的能力，减残脱残回归社会创造价值。同时普及脑瘫防治知识，为政府制定脑瘫相关扶助政策提供依据。脑瘫早期干预往往会取得良好疗效，因此制定预防和筛查、干预措施，控制和减少脑瘫患儿的出生，对减轻患儿家庭、社会精神和经济负担有重要作用，这样将节约大量资本，减轻社会压力。材料与方法采用分层整群随机抽样原则对郑州、新乡、驻马店、开封、登封、新密、洛阳、濮阳、三门峡、商丘、漯河等特定区域内0至6岁2005．1．1日至2010．12．31I摘要日出生的全体常住儿童进行调查。本课题以问卷形式进行入户流行病学调查以调查地区县市级医院合作的方式，每个医院派专人负责当地于2005．1．1日至2010．12．31日出生儿章的入户调查工作，城市以社区为单位，农村以乡为单位整体抽样。对所有适龄儿童填写儿童发育调查表漏查率10％以内，疑似脑瘫病例由医生体检和诊断，确诊脑瘫病例填写脑瘫儿童发育调查表和脑瘫防治现状调查表。采用EPIDATA3．2数据库，输录前后核对原始数据，实行双人双录入并进行逻辑检错；资料分析采用一般描述性分析、单因素分析、分层分析和卡方检验，检验水准A0．05。幺士田日木1．本次共调查O．6岁儿童50596例，男27556例，女23040例，河南省人口出生性别比11．196。筛查出脑瘫患儿120例，男76例，女44例，脑瘫患儿的男女比为1．7351，河南省脑瘫患病率2．37％O。脑瘫高危因素主要依次为HIE、窒息、早产、低体重、脐带绕颈、病理性黄疸、颅内出血等。2．脑瘫患儿88．33％接受过产前检查，42．50％能坚持定期检查。产前检查项目选择B超检查的比例相对较高，占脑瘫总数的75．00％，其余检查项目比例较低。脑瘫患儿出生后新生儿随访率仅20．00％，9个月时，患儿能到医院检查占53．33％。3．根据统计，在调查的120例CP患儿中，接受过康复训练的有95例，占79．17％，发现异常能进行登记60％，发现异常进行随访45．83％，建立监测档案37．50％，享受医保或新农合报销69．17％，政府给予专项经济资助占9．17％。结论1．河南省脑瘫患病率2．37％O。2．脑瘫的高危因素主要有HIE、窒息、早产、低体重。3．脑瘫患儿的产前检查比例低，检查项目不全面，围产期保健意识不强。4．脑瘫患儿接受康复治疗、登记、随访比例低，脑瘫防治知识有待普及，防治现状不容乐观。关键词脑性瘫痪患病率流行特征河南省IIEPIDEMICCHARACTERISTICSANDCURRENTPREVENTIONOFCEREBRALPALSYINHENANPROVINCEPOSTGRADUATEZHENHUANZHANGSUPERVISORPROF．JBNWANGMAJORPEDIATRICSTHETHIRDAFFILIATEDHOSPITALOFZHENGZHOUUNIVERSITYZHENGZHOUHENAN450052ABSTRACTPURPOSECEREBRALPALSYCPISASERIOUSHARMTOCHILDREN’SPHYSICALANDMENTALHEALTHOFNONNALDISEASES．WITHTHEIMPROVEMENTOFMEDICALTECHNOLOGYPROGRESSANDNEONATALRESCUE．THEINCIDENCEOFCPISINCREASINGGRADUALLY．CPISNOTONLYSERIOUSLYAFLEETINGCHNDRENSPHYSICALANDMENTALDEVELOPMENTANDQUALITYOFLIFE，AGREATDEALOFMENTALSTRESS觚DAHEAVYECONOMICBURDENTOFAMILIESANDSOCIETY,BUTALSOSERI．OUSLYA虢CTINGTHEQUALITYOFTHEPOPULATIONINTHEPROVINCETOIMPROVETHEIMPL锄ENTATLONOFTHEBASICNATIONALPOLICYOFFAMILYPLANNING．UNFORTUNATELYSTILLNOCOUNTRYH嬲BEENABLETOESTABLISHAGOVERNMENTMONITORINGAGENCY,TOKEEPABREASTOFREPORTEDCPINCIDELLCE砸LDCOR山F0ITHESITUATION．ABROADINVESTIGATIONANDANALYSISTHINKTHATLIVEBIMLS丘DMTHEINCIDENCEOFCPIS23‰．HENAN,ASONELARGESTPOPULATIONINCHINA．THEREISNOCPINCIDENCEOFACCURATEDATAANDEPIDEMIOLOGICALDATA,NO优EVENTIVCMEASURESANDPREVENTIONGUIDE．THROUGHTHECEREBRALPALSYEPIDEINI0109ICALINVESTIGATION，WECANFIGUREOUTTHERATEOFCPANDESTABLISHRELA泓INF0册ATIONDATAB邪E．WECANSCREENOFCHILDRENWITHCP，THEN，INORDERTO1MPROVET11EIRQUALITYOFLIFEANDTHEABILITYOFADAPTINGTOSOCIETY，WECALLMAIEE盯IYINTERVENTION锄DRCHABILITATION．THROUGHTHATTHECHILDRENCANALLEVIATETHEDISABILITYANDRC臼L加T0SOCIETY，THENCREATEVALUE．THROUGHTHISISSUE，WECANPOPULARIZECPIIIABSTRACTPREVENTIONKNOWLEDGE，THENPROVIDETHEBASISFORTHEGOVERNMENTTODEVELOPCEREBRALPALSYRELATEDSUPPORTPOLICIES．EARLYINTERVENTIONWITHCPOFTENOBTAINGOODEFFECT．THEREFOREINORDERTOCONTROLANDREDUCTIONOFTHEBIRTHOFCHILDRENWITHCEREBRALPALSY,THEDEVELOPMENTOFPREVENTIONANDSCREENING,INTERVENTIONSAREPLAYINGANIMPORTANTROLEINALLEVIATINGTHECHILDREN谢THFAMILIES，SOCIALSPIRITUALANDECONOMICBURDEN．THESEMEASURESWILLSAVEALOTOFCAPITAL，REDUCINGTHESOCIALPRESSURE．METHODSALLCHILDRENWEREINVESTIGATEDCOMINGFROMTHESPECIFICAREASOFZHENGZHOU,XINXIANG,ZHUMADIAN，KAIFENGANDDENGFENG,XINMIN，LUOYANG,PUYANG,SANMENXIA,SHANGQIU,LUOHE．THEWEREINVESTIGATEDBYSTRATIFIEDCLUSTERRANDOMSAMPLINGPRINCIPLE．THEYARE0TO6YEARSOLDBORN200511TO20101231．THEEPIDEMIOLOGICALINVESTIGATIONISCONDUCTEDINTHEFORMOFHOUSEHOLDQUESTIONNAIRE．THEISSUEISINVESTIGATEDWITHTHECOOPERATIONOFTHECOUNTYORCITYLEVELHOSPITALS．EACHHOSPITALISRESPONSIBLEFORLOCALCHILDRENWHOISBORN200511TO20101231．INTHESURVEY,WEADOPTTHEWHOLESAMPLINGMETHOD，SUCHASURBANCOMMUNITYASTHEUNIT，THERURALTOWNSHIPASTHEUNIT．ALLCHILDRENWHOISBORN200511TO20101231，MUSTFILLINTHEFIELDOFCHILDDEVELOPMENTQUESTIONNAIRECHECKLEAKAGERATELESSTHANLO％．IFWEFOUNDSUSPECTEDCEREBRALPALSYINCHILDREN，FIRST，PHYSICALEXAMINATIONSHOULDBEDONEBYAPROFESSIONALDOCTOR．ANDTHENTHEDIAGNOSISCANBEMADE．ONCECONFIRMED，WESHOULDFILLINTHEQUESTIONNAIRE，WHICHISCEREBRALPALSYCHILDREN’SDEVELOPMENT，THESTATUSOFPREVENTIONANDCUREOFCEREBRALPALSY．SORTALLQUESTIONNAIRESPAPERMATERIALBYEPIDATA3．2DATABASE．DATAWEREANALYZEDUSINGGENERALDESCRIPTIVEANALYSIS，UNIVARIATEANALYSIS，STRATIFIEDANALYSISANDCHI．SQUARETESTSIGNIFICANCELEVELA0．05．RESULTS1．THESITUATIONWERESURVEYED0TO6YEARSOLDCHILDRENIN50596CASES，27556CASESOFMALE，FEMALE，23040CASESOFHENANPROVINCEPOPULATIONSEXRATIOATBIRTH11．196．WESCREENEDCHILDRENWITHCP120CASES，AMONGWHICH76WEREMALE，FEMALEIN‘ⅣABSTRACT44CASES．CEREBRALPALSYOFMALEANDFEMALERATIOWAS1．7351．CPINCIDENCEOF2．37PERTHOUSANDINHENANPROVINCE．THEMAJORRISKFACTORSFORCPARCHIE，ASPHYXIA,PRETERMBIRTH，LOWWEIGHT,UMBILICALCORDAROUNDTHENECK,PATHOLOGICJAUNDICE,INTRAERANIALHEMORRHAGE，ETC．2．88．33％CPUNDERWENTANTENATALEXAMINATION，OFWHICH42．50％COULDADHERETOTHEREGULARINSPECTIONS．INANTENATALEXAMINATIONPROJECT,THECHOICEOFTHEPROPORTIONOFBULTRASONICEXAMINATIONWERERELATIVELYHIGH,ACCOUNTINGFOR75．00％OFTOTALCEREBRALPALSY．BUTTHERESTOFTHEINSPECTIONITEMSWEREINALOWERPROPORTION．CPNEONATALFOLLOWUPRATEOFONLY20．00％．WHENCHILDREN9MONTHS，MEYCOULDGOTOTHEHOSPITALTOCHECKACCOUNTINGFOR53．33％．3．ACCORDINGTOSTATISTICS，INTHEINVESTIGATIONOF120CASESOFCHILDREN、L，IⅡLCP,95CASESOFCHILDRENWITHCPTREATEDWIMREHABILITATIONTRAINING,ACCOUNTINGFOR79．17％．WHENTHECHILDRENWEREFOUNDABNORMALANDCOULDBEREGISTEREDBY60％，ATTHESAMETIME45．83％COULDFOLLOWUP37．50％TOESTABLISHMONITORINGFILE69．17％OFTHECHILDRENENJOYEDMEDICALINSURANCEORNEWFARMINGORSUBMITANEXPENSEACCOUNT．9．17％OFCHILDRENWITHCPTREATEDWITHSPECIALFINANCIALAIDFROMTHEGOVERNMENT．CONCLUSIONS1．HENANCEREBRALPALSYPREVALENCEIS2．37‰．‘2．THEMAINRISKFACTORSOFCEREBRALPALSYAREHIE，ASPHYXIA，PRETERMBIRTH，LOWWEIGHT．3．CEREBRALPALSYOFANTENATALEXAMINATIONRATEISLOW．PARENTSOFPERINATALHEALTHCARECONSCIOUSNESSISNOTSTRONG,4．THEPROPORTIONOFCHILDRENWITHCPREHABILITATIONINHENANPROVINCEISLOW．THEREGISTRATIONOFCHILDRENWITHCP,FOLLOWUPRATIOISLOW．THEKNOWLEDGEOFCEREBRALPALSYNEEDTOBEPOPULARIZED．EARLYPREVENTIONANDCONTROLSITUATIONOFCEREBRALPALSYINOURPROVINCEISNOTOPTIMISTIC．KEYWORDSCEREBRALPALSYPREVALENCEEPIDEMIOLOGICALCHARACTERISTICSHENANPROVINEEV目录正文部分目录中英文缩略词表I河南省D,JL脑性瘫痪流行特征及防治现状1L引言L2材料与方法33结果54讨论LL5结论L5参考文献”16综述部分小儿脑性瘫痪的诊疗现状和进展19参考文献”28附录部分个人简介及发表论文”3L致访}32中英文缩略词表英文缩写CPPT0TPSIMSPSSCEPI啪姆TBINSCSHBDNFGDNFADIGF．1EGFBFGFTGF中英文缩略词表英文全称CEREBRALPALSY、PHYSICALTHERAPYOCCUPATIONALTHERAPYPARENTINGSTRESSINDEXMUHIDIMENSIONALSCALEOFPERCEIVEDSOCIALSUPPORTCONDUCTIVEEDUCATIONPROGESTERONEALLOPREGNANOLONETRAUMATICBRAININJURYNEURALSTEMCELLSHUMANBRAINDERIVEDNEUROTROPHICFACTORGLIALCELLDERIVEDNEUROTROPHICFACTORA1ZHEIMERSDISEASEINSULINLIKEGROWTHFACTOR1EPIDERMALGROWTHFACTORBASICFIBROBLASTGROWTHFACTORTRANSFORMINGGROWTHFACTOR中文全称脑性瘫痪理学疗法作业疗法父母压力指数多元领悟社会支持量表引导式教育孕酮别孕烯醇酮创伤性脑损伤神经干细胞脑源性神经营养冈子胶质源性神经营养冈子阿尔茨海默病胰岛素样生长因子．1表皮生长因子碱性成纤维生长因子转化生长因子