基层幼儿园学前儿童眼保健服务模式研究及实施效果分析

Research on eye care service model for the primary pre-kindergarten children and analysis of its implementation effectiveness

目的:探讨基层妇幼保健机构开展幼儿园学前儿童眼保健的必要性和可行性,构建一套基层妇幼保健机构开展学前儿童眼保健的适宜技术,以期能早期发现、早期诊断、早期治疗,以避免视觉损伤的儿童眼病。方法:成立市级儿童眼病筛查中心,指导各区(县)妇幼保健机构对辖区内的幼儿园学前儿童进行眼病筛查,筛查异常者告知监护人带孩子到市级中心儿童眼科复查。建立、健全学前儿童眼病筛查方法和流程,实行标准化管理,并对学前儿童眼病干预实施效果进行分析。结果:3年来,市级中心和9个区(县)中心共筛查217 184名学前儿童,筛查总异常率为8.69%(18 876/217 184)。9个区(县)中心中有5个中心开设了眼保健门诊,开设眼保健门诊的区(县)中心筛查异常率为11.79%(9 538/80 924),与市级中心的筛查异常率(11.99%,4 886/40 753)比较差异无统计学意义(χ2=1.068 2,P=0.301 3)。另外4个尚未开设眼保健门诊的区(县)中心筛查异常率为7.80%(7 452/95 507),与市级中心的筛查异常率比较差异有统计学意义(χ2=608.023 4,P=0.000 0)。有眼保健门诊的区(县)中心与没有门诊的区(县)中心筛查异常率比较差异有统计学意义(χ2=798.893 1,P=0.000)。携复查通知单到市级中心复查的人数逐年增多,复查率逐年提高,3年中共有11 462名儿童到市级中心复查,复查率为60.72%(11 462/18 876)。结论:昆明市对学前儿童眼病的早期干预工作已有成效,需要进一步提高学前儿童眼病筛查覆盖率,特别是农村地区,将儿童眼病筛查工作纳入到新农合范围,在基层妇幼保健机构乃至社区医疗机构推广儿童眼保健适宜技术,提高社区儿童眼保健服务意识和技能,以减少视觉残疾人员的发生率,提高人口素质。

Objective： To investigate the necessity and feasibility of carrying out pre - kindergarten children＇s eye care in the pri- mary maternal and child health institutions, to develop a suitable pre - kindergarten childreng eye care technology for those primary institu- tions, so as to detect, diagnose and cure avoidable children＇s eye diseases that might cause visual impairment early. Methods： A municipal childreng eye disease screening center was set up to direct its districts and counties maternal and child care institutions to carry out pre - kin- dergarten children＇s eye disease screening within their jurisdiction. The guardians of children whose screening result were positive would be informed to take their children to the pediatric ophthalmology unit in the municipal center to have a review. The methods and processes of pre -kindergarten childreng eye disease screening were established and improved, standardized management was implemented, and the imple- mentation effectiveness of the intervention of pre -kindergarten children eye diseases was analyzed. Results： （~） In three years, 217 184 pre - kindergarten children were screened from the municipal center and its nine districts and counties centers, the total screening positive rate was 8.69% （ 18 876/217 184） . Among the nine districts and counties centers, five had eye care clinic and the screening positive rate was 11.79% （9 538/80 924）. There was no significant statistic difference in screening positive rate between districts and counties centers and the municipal center （11.99% , 4 886/40 753） （A2= 1. 068 2, P =0. 301 3） . In the other four centers that still did not have eye care clinic, the screening positive rate was 7.80% （7 452/95 507）, which was significantly different from that of the municipal center （X2 = 608. 023 4, P = 0. 000 0） . The screening positive difference was very significant between the two which district - county eye care clinic center and outpatient （X2 = 798. 893 1, P = 0. 000） . （~） The number of people with notice of review in the municipal center was increased year by year, the rate of review was increased year by year. In three years, a total of 11 462 people reviewed in the municipal center, with a total review rate of 60. 72% （ 11 462/17 253 ） . Conclusion ： Kunming has succeeded in early prevention of pre - kindergarten children eye diseases, it needs to further enlarge the coverage of pre -kindergarten children eye disease screening, especially in the rural areas. We should put children＇s eye disease screening into the range of new rural cooperative medical program, develop a suitable children＇s eye care technology for primary maternal and child care institutions and community health agencies and improve the meaning and skills of community childreng eye care services so as to reduce the incidence of visual disability and thus improve the quality of births.