本文選題：先天缺陷 + 發(fā)生率　； 參考：《蘭州大學(xué)》2012年碩士論文

【摘要】：目的 通過定量和定性研究,了解甘肅省5縣(市)先天缺陷干預(yù)工程開展情況,探討甘肅省先天缺陷重點(diǎn)干預(yù)對策,為進(jìn)一步指導(dǎo)優(yōu)生優(yōu)育和有效預(yù)防先天缺陷發(fā)生提供科學(xué)依據(jù)。 方法 對甘肅省敦煌市、涇川縣、徽縣、渭源縣和永靖縣,2008年10月1日～2010年9月30日所有孕28周以上出生的新生兒(包括活產(chǎn)、死胎、死產(chǎn))進(jìn)行普查；比較分析敦煌市、涇川縣、徽縣、渭源縣及永靖縣基線及終末調(diào)查的孕28周以上出生的新生兒(包括活產(chǎn)、死胎、死產(chǎn))先天缺陷發(fā)生率及構(gòu)成的變化；采用1：1配對病例對照研究,分析176例先天缺陷兒母親孕期暴露因素,對先天缺陷可能的危險(xiǎn)因素采用單因素與多因素logistic回歸分析；對縣鄉(xiāng)村婦幼專干和計(jì)生專干、基層醫(yī)務(wù)人員和孕28周以上分娩的婦女進(jìn)行問卷調(diào)查；同時(shí)對縣級和鄉(xiāng)級計(jì)生局及計(jì)生站的計(jì)生工作管理人員、縣級和鄉(xiāng)級醫(yī)院婦保和婦產(chǎn)科專業(yè)技術(shù)人員及部分孕婦進(jìn)行三個(gè)層面的定性訪談。 結(jié)果 (1)2009年5縣(市)先天缺陷總發(fā)生率為7.49%o,居于前三位的先天缺陷病種分別為先天性心臟病、色素痣和神經(jīng)管畸形；2010年5縣(市)先天缺陷總發(fā)生率為8.35‰,居于前三位的先天缺陷病種分別為先天性心臟病、神經(jīng)管畸形和色素痣、腦積水。2年間被調(diào)查各市/縣先天缺陷發(fā)生率不盡相同,其中敦煌市先天缺陷發(fā)生率最高,為14.65‰,徽縣先天缺陷發(fā)生率最低,為3.28%o。 (2)母親患遺傳病(OR=4.407,95%CI=0.925～21.008)、孕期患流感(OR=1.986,95%CI=0.992～3.976)、孕期服用保胎藥(OR=2.466,95%CI=0.981～6.148)是圍產(chǎn)兒先天缺陷發(fā)生的主要危險(xiǎn)因素。 (3)被調(diào)查5縣(市)圍產(chǎn)兒先天缺陷發(fā)生率終末調(diào)查時(shí)為8.35%o,較基線調(diào)查時(shí)的14.02‰,下降了40.44%。基線與終末調(diào)查先天缺陷發(fā)生順位及構(gòu)成不同。 (4)5縣(市)婦女葉酸知曉率和服用率分別為93.85%、84.92%,葉酸規(guī)范服用率為22.19%；育齡婦女主要通過計(jì)生系統(tǒng)宣傳教育來了解葉酸相關(guān)知識。 (5)基層?jì)D幼保健人員對相關(guān)知識如神經(jīng)管畸形發(fā)生的時(shí)間、神經(jīng)管畸形的診斷、生育神經(jīng)管畸形兒的高危人群、增補(bǔ)葉酸人群正確應(yīng)答率較低,均不到50.00%；其中35-44歲的工作人員接受培訓(xùn)(36.21%)、知道健康婦女需要補(bǔ)充葉酸(36.21%)、認(rèn)為有必要向育齡婦女介紹葉酸的重要性(37.45%)、對婦女進(jìn)行宣傳教育(37.24%)、免費(fèi)發(fā)放葉酸(37.24%)、指導(dǎo)并監(jiān)督服用葉酸率(34.98%)較低。 (6)基層醫(yī)務(wù)人員相關(guān)知識知曉率較低,知道我國神經(jīng)管畸形發(fā)生存在性別差異的縣級醫(yī)務(wù)人員有123人,占51.04%,鄉(xiāng)級醫(yī)務(wù)人員有41人,占24.26%；知道生育神經(jīng)管畸形兒高危人群的縣、鄉(xiāng)級醫(yī)務(wù)人員分別有47人(19.50%)、42人(24.85%)。知道孕期葉酸缺乏會對孕婦、胎兒造成影響的縣、鄉(xiāng)級醫(yī)務(wù)人員分別有89人(36.93%)、85人(50.30%)；會給每位育齡婦女講解增補(bǔ)葉酸重要性的縣、鄉(xiāng)級醫(yī)務(wù)人員分別有236人(97.93%)、169人(100.00%)；有129名(53.00%)縣級醫(yī)務(wù)人員和152名(89.94%)鄉(xiāng)級醫(yī)務(wù)人員接受相關(guān)知識的培訓(xùn)；通過專家講座、培訓(xùn)獲取相關(guān)知識的縣級醫(yī)務(wù)人員有169人(70.12%),鄉(xiāng)級醫(yī)務(wù)人員有92人(54.44%)。 結(jié)論 甘肅省5縣(市)出生缺陷干預(yù)工程實(shí)施效果明顯,育齡婦女自我保健認(rèn)知得到進(jìn)一步提高,但仍需進(jìn)一步加強(qiáng)干預(yù)工程的宣傳和實(shí)施力度,提高基層?jì)D幼保健人員的綜合業(yè)務(wù)素質(zhì)。
[Abstract]:objective
Through quantitative and qualitative research, the development of congenital defect intervention projects in 5 counties (cities) of Gansu province was understood, and the key intervention measures of congenital defects in Gansu were discussed, which provided scientific basis for further guidance of eugenics and effective prevention of congenital defects.
Method
In Dunhuang, Jingchuan County, Hui County, Weiyuan county and Yongjing County, all newborn babies born in 28 weeks from October 1, 2008 to September 30, 2010 (including live birth, stillbirth and stillbirth) were surveyed, and the newborn babies born in Dunhuang City, Jingchuan County, Hui County, Weiyuan County, Yongjing county and Yongjing County were compared and analyzed for more than 28 weeks of birth (package). The incidence of congenital defects and the change of the constitution of the congenital defects were included. The 1:1 matched case control study was used to analyze the factors of pregnancy exposure in 176 cases of congenital defect mothers. The possible risk factors of congenital defects were analyzed by single factor and multiple factor Logistic regression analysis. At the same time, a questionnaire survey was conducted among women who gave birth for more than 28 weeks of pregnancy; at the same time, a qualitative interview was conducted on three levels of the county-level and rural family planning bureaus and the management staff of the family planning stations, the women's Insurance and obstetrics and gynecological professionals at the county and township level hospitals and some pregnant women.
Result
(1) in 2009, the total incidence of congenital defects in 5 counties (cities) was 7.49%o. The first three congenital defects were congenital heart disease, pigmented nevus and neural tube malformation, and the total incidence of congenital defects in 5 counties (cities) was 8.35 per thousand in 2010. The first three congenital defect diseases were divided into congenital heart disease, neural tube malformation, pigmented nevus and hydrocephalus. In.2, the incidence of congenital defects in every city / county was different. The incidence of congenital defects in Dunhuang was the highest, 14.65 per thousand. The incidence of congenital defects in Hui County was the lowest, which was 3.28%o.
(2) mothers suffering from genetic diseases (OR=4.407,95%CI=0.925 to 21.008), influenza in pregnancy (OR=1.986,95%CI=0.992 to 3.976) and pregnancy protective drugs (OR=2.466,95%CI=0.981 to 6.148) during pregnancy (OR=2.466,95%CI=0.981 to 6.148) are the main risk factors for congenital defects in perinatal infants.
(3) the survey of the incidence of congenital defects in perinatal infants in 5 counties was 8.35%o, which was 14.02 per thousand compared with the baseline survey, which decreased the incidence and composition of congenital defects in the 40.44%. baseline and terminal survey.
(4) the awareness rate and taking rate of folic acid in women in 5 counties (cities) were 93.85%, 84.92%, and 22.19% of the folic acid standard, and women of childbearing age were mainly educated to understand folic acid related knowledge.
(5) the workers and children at the grass-roots level, such as the time of the occurrence of neural tube malformation, the diagnosis of neural tube malformation, the high risk population of the birth nerve tube malformation, the correct response rate of the supplemented folic acid group were lower than 50%, and the staff of 35-44 years of age received training (36.21%), and the health women needed to supplement folic acid (36.21%). It is necessary to introduce the importance of folic acid to women of childbearing age (37.45%), publicity and education for women (37.24%), free folic acid (37.24%), and guidance and supervision of the low rate of folic acid (34.98%).
(6) the awareness rate of basic medical staff related knowledge was low. There were 123 county-level medical personnel who knew that there were gender differences in neural tube malformation in China, accounting for 51.04%, and 41 in township level medical personnel, accounting for 24.26%. There were 47 (19.50%) and 42 people (24.85%) in rural areas with high risk of birth neural tube malformation, and 42 people (24.85%). There were 89 (36.93%) and 85 (50.30%) medical staff in the county where the acid deficiency could affect the pregnant women and the fetus, and the importance of supplementing folic acid was explained to every woman of childbearing age. There were 236 (97.93%) and 169 (100%) from the township level medical staff, and 129 (53%) county-level medical staff and 152 (89.94%) township medical staff accepted. The training of related knowledge; through the expert lectures, the training of the county level medical staff was 169 (70.12%), and the township medical staff had 92 people (54.44%).
conclusion
The implementation effect of the birth defect intervention project in 5 counties (cities) of Gansu province is obvious, and the self-care cognition of women of childbearing age has been further improved, but it still needs to further strengthen the propaganda and implementation of the intervention project to improve the comprehensive service quality of the women and children health care workers at the grass-roots level.

【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R174

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