不同户籍类型出生缺陷监测分析与干预措施的研究

The analysis and interventions research for different census types of birth defects

目的了解深圳市福田区不同户籍类型围生儿出生缺陷的发生率及变化趋势、出生缺陷儿的转归、常见出生缺陷的种类及变化情况,为制定干预措施提供依据。方法对2003-2009年的出生缺陷和围生儿死亡监测资料进行回顾性分析。结果 7年来出生缺陷发生率呈上升趋势(χ2=23.52,P=0.001),其中主要是流动人口出生缺陷发生率呈上升趋势(χ2=23.70,P=0.001)。7年平均出生缺陷发生率为21.74‰,其中户籍、暂住、流动人口缺陷发生率分别为20.80‰、20.50‰、23.38‰,户籍和暂住人口出生缺陷发生率明显低于流动人口,差异具有显著性(χ2=11.91,P=0.003)。户籍、暂住、流动人口出生缺陷儿死亡率分别为2.95‰、3.74‰、6.42‰,差异具有显著性(χ2=69.35,P<0.001)。出生缺陷排序前五位依次是先天性心脏病、多指(趾)、总唇腭裂、外耳畸形、马蹄内翻足,占出生缺陷的54.14%。结论流动人口孕产妇的医疗保健已成为深圳市孕产妇系统管理所面临的瓶颈问题,拟通过实现妇幼保健服务均等化,启动《深圳市福田区实施免费产前检查、产后访视项目》,来提高流动人口孕产妇的早孕建卡率和系统管理率,从而推进出生缺陷筛查工作,特别是提高孕早、中期出生缺陷的筛查率和确诊率,以达到降低流动人口出生缺陷和围生儿死亡率的目的。

Objective：To know different types of prenatal incidence of birth defects in children and their tendency,and to realize outcome of children with birth defects,common types of birth defects and changes in Futian District,Shenzhen,which would provide the basis for developing interventions.Metheds：Birth defects and prenatal child death observation data from 2003 to 2007 were analyzed in retrospectively.Results：The incidence of birth defects is on an upward trend（χ2 = 23.52,P= 0.001）,for the most part,incidence of birth defects came from the floating population（χ2 = 23.70,P= 0.001）.The average birth defect rate in the 7 years was 21.74 ‰,the residence rate was 20.80 ‰,temporary rate was 20.50 ‰,floating population rate was 23.38 ‰,residence and temporary residents of birth defects rate was significantly lower than the floating population,the difference was significant（χ2 = 11.91,P= 0.003）.Residence,temporary,and floating population,compose the birth defect death rate of 2.95‰,3.74‰,6.42‰;the difference was significant（χ2 = 69.35,P0.001）.The top six of birth defects is：congenital heart disease,multiple fingers（toes）,total cleft lip and palate,ear deformities,clubfoot,and hypospadias.These account for 59.07% of the birth defects.Conclusion：The floating population in maternal health care system for the management of pregnant women in Shenzhen City,which is a bottleneck problem;the proposed solution for maternal and child health services is to make it equal,by establishing＂to introduction the free prenatal care and postpartum visits project in Futian District,Shenzhen＂,to improve the creating card rate of early pregnancy women in floating population and the rate of system management,in order to promote detection of birth defects,particularly to improve the pregnancy early and mid-term detection rate of birth defects and diagnosis rates.To reduce birth defects and prenatal child mortality rates in the floating population.