北京食用含三聚氰胺婴幼儿配方奶粉致婴幼儿泌尿系统结石的筛查、诊断与应对工作模式

Screening of and working model on urinary system lithiasis caused by infant formula contaminated with melamine in Beijing

目的调查北京地区含三聚氰胺的婴幼儿配方奶粉（问题奶粉）致婴幼儿泌尿系统结石的情况，分析北京卫生应急处置机制和工作模式（北京模式）的效果。方法三鹿牌婴幼儿配方奶粉致泌尿系统结石事件发生后，成立了北京婴幼儿泌尿系统结石筛查和救治工作领导小组和专家组，指定103家二级及以上医疗机构为医疗救治和筛查医院，启用全市社区卫生服务组织开展社区门诊筛查，收集、整理、分析每日各有关医疗卫生机构上报的相关信息报告。9月21日～10月24日，130142人次的社区卫生人员入户访视了307054名有食用问题奶粉的婴儿。结果2008年9月17日～12月2日，累计接诊患儿216285人次；确诊患泌尿系统结石阳性患儿3449例（确诊率1．59％），其中外省（市、区）患儿为1715例，本市患儿1734例，住院患儿141例（住院率4．1％）。在住院患儿中外省（市、区）为105例，占住院总数的74．5％，无危重病例和死亡病例。社区筛查累计接诊婴幼JL24708人，占食用问题奶粉婴幼儿总数的29．3％；累计上转至二级及以上医疗机构1842人，转诊率7．46％。全市流行病学调查了29677名婴幼儿，郊区问题奶粉婴幼儿泌尿系统结石患儿的发病率为3．2％，显著高于城区（0．9％，P〈00．5）。在事件处置早期医疗服务资源明显不足，而在事件处置中、晚期，则出现大量医疗资源浪费。结论北京地区问题奶粉所致婴幼儿泌尿系统结石的情况轻于其他省市，郊区重于城区；曾食用问题奶粉的婴儿仅1／3受影响。应对问题奶粉所致婴幼儿泌尿系统结石的北京模式是有效的。

Objective To investigate the epidemiology of urinary system lithiasis caused by infant formula contaminated with melamine in Beijing and evaluate the effect of the Beijing Health Emergency Mechanism and relevant working model. Methods after the revelation of the accident of urinary system lithiasis caused by the ＂Sanlu＂ brand infant formula contaminated with melamine a Leading Group of Screening and Clinical Diagnosis and Treatment of Urinary System Lithiasis among Infants was established, and 103 hospitals at the grade 2 and over were designated to screen and treat pediatric patients concerned. From 21 September to 24 October 130,142 person-times of community health workers visited the families with 307,054 infants who had consumed the contaminated formula to screen the cases. The community health service institutions in the whole city were used to screen the patients, and collect, collate, and report the data to the Beijing Public Health Information Center. Results From 17 September to 2 December 2008 accumulatively 216,285 infants visited the different medical institutions, and 3449 cases were confirmed as with urinary system lithiasis with an incidence rate of 1.59%, among which 1715 confirmed patients were from outside of Beijing and 1734 were Beijing residents. 141 confirmed patients （4.1%） were hospitalized among which 105 were from outside of Beijing （74.5%）. No severe patients and death were found. 24708 infants were screened in the community health serve organizations, accounting for 29% of the infants who had consumed the melamine fainted formula. 1842 pediatric patients were transferred to hospitals at the grade 2 and over （7.46%）. 29 677 infants underwent epidemiological survey in the whole city. The incidence rate of urinary system lithiasis caused by melamine fainted formula of the infants in suburbs was 3.2%, significantly higher than that of the infants in the city proper （0.9%, P〈0.05）. The medical service resource was obviously insufficient during the early stage, but was extravagant during the middle and late stages. Conclusion The situation of urinary system lithiasis caused by infant formula contaminated with melamine in Beijing is milder than in many other provinces, and the situation in the suburb of Beijing is more severe than that in the city proper. Only 1/3 of the infants who consumed the fainted formula are affected. The Beijing model is effective in screening and tackling this problem.