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目的掌握山东省地方性氟中毒防治措施落实情况、防治效果与病情变化动态,为制定防治策略提供科学依据。方法按照全国地方性氟中毒监测方案的要求,调查了高密等5县(市)改水降氟进度、部分改水工程使用情况及饮水含氟量;抽查了重点监测点居民饮水含氟量;检查了监测点8~12岁儿童氟斑牙患病情况、30岁以上成人临床与X线氟骨症患病率以及人群尿氟水平。结果高密等5县(市)共有地氟病村2 377个,已完成改水降氟1 537个村,改水率为64.66%;改水设施的正常使用率74.10%,报废与非正常供水率25.87%;正常运转的工程水氟超标率43.37%,水氟最大值6.02 mg/L。5县(市)14个重点监测点居民水氟均值为2.06 mg/L,以博兴县最高5.09 mg/L;重点监测点8~12岁儿童平均氟斑牙检出率86.17%,缺损率17.80%,氟斑牙指数1.94,病情以博兴、嘉祥2县为重;30岁以上成人临床氟骨症阳性率平均43.84%,中度以上为32.12%,X线氟骨症检出率平均25.57%,Ⅱ度以上阳性率为6.70%,并检出13例Ⅲ度病例,其中高密、嘉祥两地病情较重;病区人群尿氟水平明显增高,儿童与成人群体几何均值分别为3.14 mg/L、3.55 mg/L。结论病区改水降氟措施落实进度比较缓慢且不平衡,改水设施水氟超标严重,病情仍存在一定程度流行,对此应增加投入,加大防治工作力度。
Objective To grasp the implementation of prevention and control measures, prevention and treatment and endemic situation of endemic fluorosis in Shandong Province, and to provide a scientific basis for formulating prevention and treatment strategies. Methods According to the requirements of the local fluorosis monitoring program, the progress of water and fluoride removal in five counties (cities) such as Gaomi were investigated, the use of some water diversion projects and the fluoride content in drinking water were investigated. The fluoride content of drinking water in key monitoring spots was investigated. Check the prevalence of dental fluorosis in children aged 8 to 12 years at monitoring points, the prevalence of clinical skeletal fluorosis and the incidence of fluorosis in adults over the age of 30, and urine fluoride levels in the population. Results A total of 2 377 fluorine-contaminated villages in Gaomi and other 5 counties (cities) were completed, and 1 537 villages were changed water quality to reduce fluoride. The water-saving rate was 64.66%. The normal utilization rate of water-changing facilities was 74.10% Rate of 25.87%; normal operation of water fluorine exceeding the standard rate of 43.37%, the maximum water fluoride 6.02 mg / L. The average water fluoride value of residents in 14 key monitoring sites in counties (cities) was 2.06 mg / L and the highest in Boxing County was 5.09 mg / L. The average detection rate of dental fluorosis in children aged 8 ~ 12 years with key monitoring points was 86.17% 17.80%, dental fluorosis index 1.94, the prevalence of Boxing, Jiaxiang 2 counties; over the age of 30 clinical positive rate of clinical skeletal fluorosis average 43.84%, 32.12% moderate, X-ray skeletal detection rate average 25.57%. The positive rate of grade Ⅱ was 6.70%. Thirteen cases of Ⅲ degree were detected, of which the patients in Gaomi and Jiaxiang were heavier than those in Gaomi and Wuxiang. The urinary fluoride levels were significantly higher in the ward and the geometric mean values of children and adults were 3.14 mg /L, 3.55 mg / L. Conclusion The implementation of water-reducing and fluoride-reducing measures in the ward is relatively slow and unbalanced. The water fluoride in water changing facilities exceeds the standard seriously, and the disease still exists in some extent. Therefore, more efforts should be made to increase prevention and control efforts.