抚宁县域2010年-2013年农村小儿腹泻治疗现状分析

The Clinical Analysis of Diarrhea in Rural Children from 2010 to 2013 in Funing County

目的观察县域农村小儿腹泻治疗现状.方法对抚宁县域2010年7月至2013年7月间的47,765例农村小儿腹泻病患儿病例作为研究对象,进行回顾性分析,分别分析县、乡、村三级医疗机构患儿治疗情况.结果村级医疗机构就医为主占67.49%,乡级医疗机构就诊人数偏少占10.41%.抗生素不合理使用,抗生素使用比率高达58.78%,尤其村卫生室高达62.79%,滥用抗生素的现象十分严重;治疗中锌制剂使用率低,只占总数的18.90%;同时静脉补液率过高占到18.54%,而口服补液盐使用率较低只有28.19%;其中只有低至47.41%的治疗过程使用了中医中药;且上述治疗中,遵照"2009年儿童腹泻病诊断治疗原则专家共识"指南,来规范化治疗的比率均低于40%.结论农村小儿腹泻的治疗过程还需要大力加强.尤其是对农村医生加强关于腹泻病规范化诊疗的培训,制定新的农村小儿腹泻病规范化治疗方案及诊治流程,并严格执行,是当前农村儿童腹泻病防治工作的重要任务.

Objective To investigate the treatment status of diarrhea in rural children in Funing county of Hebei Province. Methods We retrospectively inspected the 47765 cases of rural pediatric patients with diarrhea from July 2010 to July 2013 in Funing County. The treatment of pediatric patients in three-level （county, township and village） medical institutions was analyzed separately. Results The 67.49% of rural pediatric patients with diarrhea mainly received treatment in village medical clinic, 10.41% or less were treated in township medical clinic. The abuse of antibiotics was very serious in those clinics when doctors treated the pediatric patients. The use rate of antibiotic in village and township clinics were up to 58.78%, especially 62.79% were used in the village. But the use rate of zinc supplements for curing acute diarrhea in children was as low as 18.90%. At same time, intravenous fluids in the treatment were high, accounting for 18.54%, while oral rehydration salts （ORS） accounted for only 28.19%. Only 47.41% of rural pediatric patients were treated by traditional Chinese medicine. Among the treatments, less than 40% followed the standardized guideline, Expert Consensus and Principle of Diagnosis and Treatment of Childhood Diarrhea 2009. Conclusion The doctors working in rural area should follow the standardized guidelines when they treat diarrhea in children. Strengthening the professional training of doctors, developing standardized treatment regimen and diagnosis process and strictly enforcing these guidelines, are important tasks to prevent and control diarrhea disease in rural children.