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目的观察山东省克山病病情,掌握克山病的发病情况,科学指导防治工作的开展。方法按照山东省克山病监测方案的要求,在7个克山病县(市、区)进行了病例搜索,选择有代表性的3个县(市)6个自然村进行了病情重点监测,每个监测点对420名居民详细询问病史、临床查体和心电图描记,可疑心脏异常者拍摄后前位X线胸片,同时采集部分居民头发和粮食检测内外环境硒含量,并收集居民经济收入及人均占有粮食等基本情况。结果共搜索医疗单位246个,心肌疾病病例831例,确定疑似克山病128例,诊断慢型克山病26例;6个监测点调查居民2 527人,检出克山病患者32例(其中潜在型21例,慢型11例),检出率为1.27%,描记心电图2 527例,异常心电图检出率为20.34%,以ST-T改变、T波改变、窦性心动过缓、窦性心律不齐、窦性心动过速、房性早搏等多见,拍摄X线胸片108张,16例心脏增大(其中轻度增大13例,中度增大3例),异常检出率为14.8%;采集头发、粮食等样品418份,病区居民发硒含量接近硒适宜地区的水平,粮食硒含量仍处于较低水平,各监测点人均年收入2 400~7 200元,居民主食以面粉为主。结论山东省克山病病情处于稳定态势,但监测中仍有慢型、潜在型患者检出;内环境硒含量明显升高,与病区居民生活水平的提高和膳食营养的改善有关。
Objective To observe the condition of Keshan disease in Shandong province, grasp the incidence of Keshan disease, and conduct scientific guidance and prevention work. Methods According to the requirements of Keshan Disease Surveillance Program in Shandong Province, case searching was conducted in 7 Keshan counties (cities and districts), and 6 representative natural villages were selected to monitor the disease focus. A total of 420 residents were asked about the history, clinical examination and electrocardiogram tracing of suspected residents. X-ray images of suspected anomalies were collected before and after sampling. At the same time, part of residents’ hair and food were collected to test the selenium content of internal and external environment. Per capita food and other basic conditions. Results A total of 246 medical units, 831 myocardial disease cases were identified, 128 cases of suspected Keshan disease were identified, 26 cases of chronic Keshan disease were diagnosed, 2 527 residents were surveyed in 6 monitoring sites, 32 cases of Keshan disease were detected Among them, 21 were latent and 11 were slow). The detection rate was 1.27%. There were 2 527 cases of electrocardiogram and 20.34% of abnormal electrocardiogram. The changes of ST-T, T wave, sinus bradycardia, Sinus arrhythmia, sinus tachycardia, atrial premature beats more common, shooting X-ray 108 sheets, 16 cases of cardiac enlargement (of which 13 cases of moderate increase, moderate increase in 3 cases), abnormal The detection rate was 14.8%. 418 samples of hair and grain were collected. The selenium content of residents in the ward reached the level of suitable selenium, and the selenium content in grain was still at a low level. The per capita annual income of each monitoring point was 2 400-7200 yuan , The main staple food to flour. Conclusion The severity of Keshan disease in Shandong Province is in a steady state, but there are still slow and latent patients in the surveillance. The content of selenium in the internal environment is obviously increased, which is related to the improvement of living standard and the improvement of dietary nutrition.