儿科病房常见病与儿童疾病综合管理关系的探讨

Relationship between the Common Diseases of Hospitalized Pediatric Patients Over a 6Year Period and Integrated Management of Childhood Illness

摘要:

目的：探讨5岁以内儿科住院病例常见病与儿童疾病综合管理(IMCI)的关系。方法：分析该院1995～2000年住院的1周至5岁的肺炎、腹泻病、营养不良、麻疹和疟疾3 468例次。结果：①肺炎和腹泻病分别占5种疾病的 62.1%和 34.1%；5种疾病并发症中营养不良最常见(62.1%)。②1周至2月住院患儿中前3位死因依次为：肺炎(32.1%)、晚期新生儿高胆红素血症(25.0%)和维生素K缺乏症(23.2%)，常见病则以晚期新生儿高胆红素血症最多见(43.8%)；2月至5岁住院患儿中前3位死因依次为肺炎(25.4%)、颅内感染(23.6%)和败血症(10.9%)，常见病则以肺炎(20.2%)、急性上呼吸道炎(16.8%)和腹泻病(10.5%)多见。③5种疾病患儿占儿内科和传染科同期住院人数的 21.0%和 2.1%，儿内科住院病例占同期门、急诊人数的 1.2%。结论：除肺炎、腹泻病和营养不良外，该地区的IMCI中，1周至2月的患儿应包括晚期新生儿高胆红素血症和维生素K缺乏症，2月至5岁患儿应包括急性上呼吸道炎和颅内感染。应加强门、急诊工作和儿内科与传染科的合作。

Abstract:

OBJECTIVE: To explore the relationship between the common diseases of hospitalized pediatric patients and integrated management of childhood illness (IMCI). METHODS: A retrospective review of the medical records of 3 468 children (raging 1 week～5 years) with pneumonia, diarrhea, malnutrition, measles and malaria (5 diseases for IMCI) admitted between 1995～2000 was done. RESULTS: ① Of the 3 468 cases, 62.1% and 34.1% had pneumonia and diarrhea, respectively. Only 3.3% of the cases had malnutrition, but malnutrition was commonly associated ( 62.1% ) with the 5 diseases for IMCI. ② In the children between 1 week～2 months, pneumonia was the greatest cause of death ( 32.1% ), followed by late neonatal hyperbilirubinemia ( 25.0% ) and delayed vitamin K deficiency ( 23.2% ); late neonatal hyperbilirubinemia was the most common disease ( 43.8% ). In the children between 2 months～5 years, pneumonia was also the greatest cause of death ( 25.4% ), followed by intracranial infection ( 23.6% ) and septicemia ( 10.9% ); pneumonia, acute upper respiratory tract infection and diarrhea were the most common diseases ( 20.2% , 16.8% and 10.5% , respectively). ③ During the study period, the cases of the 5 diseases for IMCI accounted for 21.0% and 2.1% of all the cases admitted to the Department of Pediatrics and to the Infectious Diseases Unit, respectively; 1.2% of pediatric outpatients were hospitalized. CONCLUSIONS: In Guangdong Province, China, besides pneumonia, diarrhea and malnutrition, IMCI for children aged 1 week～2 months must include late neonatal hyperbilirubinemia, hemorrhagic disease (delayed onset) of newborns due to vitamin K deficiency. Acute upper respiratory tract infection and intracranial infection should be added to the IMCI for children aged 2 months～5 years. In addition, it is necessary to improve the services in the outpatient department and to strengthen the cooperation between the Pediatric and Infectious Diseases Departments.