河南省小儿脑性瘫痪流行特征及防治现状

A thesis submitted toZhengzhou Universityfor the degree of MasterEpidemic characteristics and current prevention of cerebralpalsy in Henan ProvinceBy Zhenhuan ZhangSupervisor：ProfJun WangPediatricsThe Third Affiliated Hospital of Zhengzhou UniversityMay 201 3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2-30，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(200511日至20101231I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200511日至20101231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Epidata32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a=005。幺士 田：日 木1本次共调查O6岁儿童50596例，男27556例，女23040例，河南省人口出生性别比1：1196。筛查出脑瘫患儿120例，男76例，女44例，脑瘫患儿的男女比为1735：1，河南省脑瘫患病率237o。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8833接受过产前检查，4250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7500，其余检查项目比例较低。脑瘫患儿出生后新生儿随访率仅2000，9个月时，患儿能到医院检查占5333。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7917，发现异常能进行登记60，发现异常进行随访4583，建立监测档案3750，享受医保或新农合报销6917，政府给予专项经济资助占917。结论1河南省脑瘫患病率237o。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IIEpidemic characteristics and current prevention of cerebralpalsy in Henan ProvincePostgraduate：Zhenhuan ZhangSupervisor：ProfJBn WangMajor：pediatricsThe third affiliated hospital of zhengzhou universityZhengzhou Henan 450052AbstractPurposeCerebral palsy(CP)is a serious harm to childrens physical and mental health ofno nnal diseasesWith the improvement of medical technology progress and neonatalrescuethe incidence of CP is increasing graduallyCP is not only seriouslY afleetingchndrens physical and mental development and quality of life，a great deal of mentalstress觚d a heavy economic burden to families and society,but also seriouslya虢cting the quality of the population in the province to improve the impl锄entatlonof the basic national policy of family planningUnfortunately still no countryh嬲been able to establish a government monitoring agency,to keep abreast of reportedCP incidellce砸ld cor山f0I the situationAbroad investigation and analysis thinkthatliVe bimls丘Dm the incidence of CP is 2-3Henan,as one largest population inChinathere is no CP incidence of accurate data and epidemiological data,no优eventivc measures and prevention guideThrough the cerebral palsyepideIni0109ical investigation，we can figure out the rate of CP and establishrela泓inf0册ation datab邪ewe Can screen of children with CP，then， in order to 1mproVet11eir quality of life and the ability of adapting to society，we Call ma：I(e e盯Iyintervention锄d rchabilitationThrough that the children Can alleviate the disabilityand rc臼l加t0 society，then create valueThrough this issue，we can popularize CPIIIAbstractprevention knowledge，then provide the basis for the government tO develop cerebralpalsy related support policiesEarly intervention with CP often obtain goodeffectTherefore in order to control and reduction of the birth of children with cerebralpalsy,the development of prevention and screening,interventions are playing animportant role in alleviating the children谢th families，social spiritual and economicburdenThese measures will save a lot of capital，reducing the social pressureMethodsAll children were investigated coming from the specific areas of Zhengzhou,Xinxiang,Zhumadian，Kaifeng and Dengfeng,Xinmin，Luoyang,Puyang,Sanmenxia,Shangqiu,LuoheThe were investigated by stratified cluster random samplingprincipleThey are 0 to 6 years old(born 2005-11 to 201012-31)Theepidemiological investigation is conducted in the form of householdquestionnaireThe issue is investigated with the cooperation of the county or city levelhospitalsEach hospital is responsible for local children who is born 2005-1-1 to2010-1231In the survey,we adopt the whole sampling method，such as urbancommunity as the unit，the rural township as the unitAll children who is born2005-11 to 20 1 0-1 2-3 1，must fill in the field of child development questionnaire(check leakage rate less than l O)If we found suspected cerebral palsy in children，first，physical examination should be done by a professional doctorAnd then thediagnosis Can be madeOnce confirmed，we should fill in the questionnaire，which iscerebral palsy childrenS development，the status of prevention and cure of cerebralpalsySort all questionnaires paper material by Epidata32 databaseData wereanalyzed using general descriptive analysis，univariate analysis，stratified analysis andchisquare testsignificance level a=005Results1The situation were surveyed 0 to 6 years old children in 50596 cases，27556cases of male，female，23040 cases of henan province population sex ratio at birth 1：11 96We screened children with CP 1 20 cases，among which 76 were male，female inAbstract44 casesCerebral palsy of male and female ratio was 1735：1CP incidence of 237per thousand in Henan provinceThe major risk factors for CP arc HIE，asphyxia,preterm birth，low weight,umbilical cord around the neck,pathologic jaundice,intraeranial hemorrhage，etc28833CP underwent antenatal examination，of which 4250could adhereto the regular inspectionsIn antenatal examination project,the choice of theproportion of B ultrasonic examination were relatively high,accounting for 7500of total cerebral palsyBut the rest of the inspection items were in a lowerproportionCP neonatal follow-up rate of only 2000When children 9 months，meycould go to the hospital to check accounting for 53333According to statistics，in the investigation of 1 20 Cases of children、)l，il cP,95 Cases of children with CP treated wim rehabilitation training,accounting for791 7When the children were found abnormal and could be registered by 60，atthe same time 4583could followup 3750to establish monitoring file 691 7ofthe children enjoyed medical insurance or new farming or submit an expense account91 7of children with CP treated with special financial aid from the governmentConclusions1Henan cerebral palsy prevalence is 237 2The main risk factors of cerebral palsy are HIE，asphyxia，preterm birth，lowweight3Cerebral palsy of antenatal examination rate is lowParents ofperinatal healthcare consciousness is not strong,4The proportion of children with CP rehabilitation in henan province is lowThe registration of children with CP,follow-up ratio is lowThe knowledge ofcerebral palsy need to be popularizedEarly prevention and control situation ofcerebral palsy in our province is not opti