目的 了解北京市两区婴儿睡眠行为和睡眠问题现况并进行影响因素分析,为促进婴儿期睡眠健康提供科学依据.方法 采用整群抽样方法,于2021年6月1日—8月31日期间选取北京市两个区各2个街道/乡镇社区卫生服务中心,并随机抽取894例常住婴儿,对其养护人进行问卷调查,内容包括一般情况和婴儿睡眠状况.结果 婴儿与家人同床睡眠比例为55.0％,41.1％为同屋但不同床睡眠;侧卧和仰卧睡眠比例分别为48.1％和46.9％;奶睡和摇/抱睡分别占50.5％和28.7％.婴儿睡眠问题发生率为65.9％,常见有入睡困难(26.0％)、夜醒≥4次(13.0％)和夜哭(12.8％),昼夜颠倒比例为8.9％.多因素分析显示,昼夜颠倒(OR=2.479,95％CI:1.341～4.584)和夜醒(OR=3.097,95％CI:1.873～5.122)是夜哭的危险因素,而婴儿睡眠困难一般(OR=0.237,95％CI:0.087～0.646)、稍有困难(OR=0.190,95％CI:0.072～0.499)、无困难(OR=0.112,95％CI:0.042～0.294)是夜哭的保护因素.结论 北京地区婴儿以同床睡眠、奶睡/抱睡为主,睡眠问题发生率较高,睡眠节律紊乱会增加夜哭,需要面向家长加强婴儿期睡眠健康宣教和指导工作.

目的 了解学龄前儿童握力的发育特点,并探讨握力与身高、体重和体成分指标的相关性.方法 2020年9-10月,对北京4所幼儿园的900名学龄前儿童进行问卷调查,并进行身高、体重和握力测量,使用生物电阻抗方法检测体成分,采用偏相关、多元线性回归对握力与体成分指标的相关性进行分析.结果 北京学龄前儿童握力随年龄增长逐渐升高,男童由(5.2±1.7)kg增至(9.3±2.5)kg,女童由(4.3±1.6)kg增至(7.9±2.5)kg(F值分别为57.93,48.77,P值均＜0.01),男童握力高于女童(t=6.42,P＜0.01),肥胖男童握力高于超重和正常体重男童(F=5.35,P＜0.01).调整身高、体重、出生体重、母亲文化程度及过去1周家中进食各类食物频率后,男童握力与瘦体重、上肢肌肉量呈正相关,与体脂肪呈负相关(r值分别为0.11,0.09,-0.18,P值均＜0.05);女童握力与体脂肪呈负相关,与瘦体重呈正相关(r值分别为-0.09,0.09,P值均＜0.05).多元线性回归分析发现,年龄、瘦体重和上肢肌肉量对男童的握力影响有统计学意义(F=66.75,P＜0.01);年龄、瘦体重对女童的握力影响有统计学意义(F=150.81,P＜0.01).结论 学龄前期男童握力可以反映瘦体重和上肢骨骼肌水平的变化,女童可以反映瘦体重的变化.增加瘦体重可以提高学龄前儿童握力水平.

乳腺癌和宫颈癌(简称两癌)是最常见的女性恶性肿瘤,发病率分别居女性恶性肿瘤的第1和6位,死亡率居第5和8位 [1].我国乳腺癌发病率以每年3％的速度递增,而宫颈癌全世界每年新增病例46万,其中我国占1/3,且发病率呈上升趋势,并趋于年轻化 [2].为有效降低两癌发病率和死亡率,依据早发现、早诊断和早治疗的原则,我国已将两癌筛查列入国家重大公共卫生项目.本研究对北京市大兴区2013～2019年适龄妇女免费两癌筛查数据进行统计分析,旨在了解本辖区适龄女性乳腺癌及宫颈癌发病特点,为今后两癌筛查工作提供参考和依据.

目的 分析北京市大兴区2013至2017年新生儿死亡情况,为降低新生儿死亡率(NMR)提供科学依据.方法 收集大兴区2013至2017年新生儿死亡监测资料,分析性别、年龄和死因别新生儿死亡率和构成情况等.结果 2013至2017年大兴区新生儿死亡占5岁以下儿童死亡的比例为55.97％,新生儿死亡中早期新生儿死亡占65.33％,24小时内的新生儿死亡占36.00％.NMR为1.60‰,男性和女性NMR分别为1.95‰和1.23‰,早期和晚期NMR分别为1.05‰和0.56‰.新生儿死亡死因前三位为早产或低出生体重(30.67％)、先天异常(25.33％)和出生窒息(22.67％),早产或低出生体重中,极早产儿、中期和晚期早产儿分别占47.83％、43.48％和8.70％.先天异常中以先天性心脏病最多,占38.89％.前三位死因的死亡率分别为0.49‰、0.41‰和0.36‰.不同年份间各率的差异无统计学意义(NMR:χ2=1.623,P=0.805;男性NMR:χ2=1.498,P=0.827;女性NMR:χ2=0.762,P=0.944;早期NMR:χ2=2.322,P=0.677;晚期NMR:χ2=3.804,P=0.426;早产低体NMR:χ2=8.010,P=0.078;出生窒息NMR:χ2=7.847,P=0.073;先天异常NMR:χ2=1.908,P=0.763;先天性心脏病:χ2=2.869,P=0.561).结论 抓住出生后第一周,加强新生儿的保健和诊治,提高极早产儿、中期早产儿、先天性心脏病和出生窒息等危重症新生儿的救治能力等是减少新生儿死亡的关键.

Objective To analyze the mortality rate of children under 5 years old and change trend of major death causes during 2006 to 2015 in Daxing District of Beijing,so as to provide scientific evidence for further reducing under 5-year old children mortality rate (U5MR).Methods Dynamic series were used to describe the time trends of neonatal mortality rate (NMR),infant mortality rate (IMR) and U5MR.The chi-square trend test was conducted on NMR,IMR,U5MR and cause-specific mortality on children under 5 years old.Results In 2015 in Daxing District,NMR,IMR and U5MR was 1.44‰,1.97‰ and 3.01‰,respectively.From 2006 to 2015,descending speed of them was 10.43％,10.19％ and 7.75％,respectively.In these ten years,the top five leading death causes were premature birth or low birth weight,congenital heart disease,pneumonia,birth asphyxia,other congenital anomaly and communication accident in order.The mortality of congenital heart disease declined from 103.65 per 100 000 in 2006 to 52.45 per 100 000 in 2015 with statistical significance (x2 =5.028,P ＜ 0.05).Conclusion The downtrends are observed among NMR,IMR and U5MR from 2006 to 2015.The key points of reducing U5MR are to strengthen maternal and neonatal management and cooperation of obstetrics and pediatric department,to improve prenatal screening and diagnosis technique,and to reduce NMR.

Objective To analyze the status and effect of maternal health care service in China in 2001-2014 and to discuss the correlation between health service index and maternal and prenatal mortality rate.Methods Dynamic series and multiple rank-sum test were respectively used to analyze time trends and regional difference in health service index,and correlation between service index and maternal and prenatal mortality rate was explored.Results Every maternal health service index in China in 2001-2014 presented a uptrend, among which hospital delivery rate increased most quickly with average increase rate of 2.10%.There was still significant difference in hospital delivery rate and new-method delivery rate among different regions in 2014 (χ2 value was 22.587 and 21.357, respectively, both P<0.05).At the same time maternal and perinatal mortality rate had a downtrend, with average annual decline rate of 6.25% and 6.73%, respectively.In 2014, difference in above two indexes among different regions was still significant (χ2 value was 17.856 and 14.455, respectively, both P<0.05).Maternal and perinatal mortality rate had strong negative correlation with health service indexes (rs value ranged from 0.776 to 0.996, all P≤0.001), and correlation between maternal and perinatal mortality rate and hospital delivery rate and new-method delivery rate was most strong.Conclusion Regional difference is still found in hospital delivery rate, new-method delivery rate, maternal and perinatal mortality rate in China in 2014, indicating needs for improving fairness and availability of maternal health service and narrowing regional difference in maternal and perinatal mortality rate.

Objective:To evaluate the value of 3+1 combined fetal cardiac view in prenatal screening of complex congenital heart disease(CHD) in secondary maternal child health hospital.Methods: 3+1 combined fetal cardiac view comprises standard FCV,LVOTV and RVOTV,combined with the three vessels and trachea view(3VT).This combined cardiac view was used on 4 538 pregnant women from January 2010 to October 2012 at our hospital for prenatal screening of congenital heart disease.All image data were recorded and transferred into a database for reanalysis and evaluation.Abnormal and suspicious cases were referred to superior hospitals through green channel to confirm the diagnosis.The screening results were finally verified by echocardiography or autopsy.Results:Among the 4 538 cases,53 were suspected of CHD during prenatal screen,all were confirmed as structural abnormality by superior hospitals.36 were identified complex CHD and 17 with simple CHD.Total 73 cases were finally diagnosed as CHD by postnatal echocardiography or autopsy.38 were complex CHD,of which 2 were missed during prenatal screening,with a prenatal screening sensitivity of 94.7%(36/38).VSD was found the main diagnosis in the simple CHD in fetuses,presenting false negative and also false positive results.31 VSD were confirmed by postnatal echocardiography,of which false positive diagnosis found in 3 cases,21 were missed in prenatal screening,with the false-negative rate of 67.8%.Conclusion: 3+1 combined fetal cardiac view is an easy and efficient method for screening of fetal complex CHD.It is easy to master,thus can be promoted and applied in secondary maternal child hospitals.

Objective To explore the clinical diagnostic value of echocardiography in detecting fetal endocardial cushion defect.Methods Sonographs from 19 cases with fetal endocardial cushion defects were recorded during routine fetal echocardiography.Results 16 cases fetal endocardial cushion defect were confirmed including 11 cases complete type and 4 cases incomplete type endocardial cushion defect by postnatal echocardiography or autopsy,1 case larger atrial septal defect,and 3 cases was lost.In the 15 endocardial cushion defect cases,7 cases were diagnosed as single endocardial cushion defect,2 cases were with pericardial effusion,3 cases were with pleural effusion and ascites,2 cases with transposition of great arteries and 1case with pulmonary stenosis.Conclusion Fetal echocardiography is the leading diagnostic tool for prenatal evaluation of fetal endocardial cushion defect.

<正>我国乳腺癌发病率呈持续上升的趋势,现已占恶性肿瘤的第二位[1],所以乳腺肿块的良恶性的诊断具有重要的意义。乳腺内的肿块可以通过超声、钼靶摄片等常用的影像学检查较直观的观察到肿块的形态、血流等信息,但难以提供明确的病理诊断,不能很好地指导临床治疗。彩色多普勒超声能够清晰地显示乳腺内肿块的形态、部位及与周围的组织关系,为超声引导经皮穿刺活检取得病变组织提供了有利条件。本研究总结分析自2007年以来在我院彩色多普勒超声引导经皮行穿刺活检的49例乳腺肿块患者的超声诊断、穿刺活检诊断结果,并与手术后病理诊断结果进行对照,旨在探讨该项技术应用的临床价值。