以"三个代表"重要思想为指导全面加快西藏药检所的发展

西藏药检所建于1975年,目前是全区唯一的药检所.编制50人,现在职46人(藏族35人),其中大专以上学历有22人(研究生2人,本科生6人).设行政办公室、业务技术管理科以及四个业务科室(化药室、药理室、中藏药室、医疗器械检测中心).西藏药检所自建所以来由于多种原因发展缓慢,底子薄、基础差,检验设备和设施简陋,总体与内地药检所还有较大差距.西藏现有20家药品生产企业,主要生产传统藏药,近200家药品经营单位.与内地相比,尽管生产企业不多,但西藏地广人稀,药品经营单位、医疗诊所遍布全区,涉及药品种类与内地类似,药品技术监督任务十分繁重.     

2005年西藏消除碘缺乏病综合干预试点项目总结报告

西藏全境地处世界公认的碘缺乏地带．是我国受碘缺乏危害最严重的省区之一。全区7地（市）73个县的自然环境中含碘量很低．其中严重缺碘的有57个县．受危害的人群约占全区人口的70％以上。据2002年碘缺乏病（IDD）监测结果显示：8-10岁儿童甲状腺肿大率为13．8％．8～10岁儿童和育龄妇女的尿碘中位数分别为93．7、51.3μg／L，碘盐覆盖率为34．7％．合格碘盐食用率为26-3％。碘缺乏病已成为西藏地区严重影响民族人口素质．制约社会、经济协调发展的公共卫生问题。为了尽快解决这一问题，在联合国儿童基金会的资助下．于2004年正式启动了在西藏开展以推广碘盐、健康教育和病情监测为主要内容的《西藏消除碘缺乏病综合干预项目（2004—2008）》，加快西藏实现消除碘缺乏病目标的进程。现将2005年度项目执行情况报告如下。[第一段]     

高原地区腹腔镜治疗结石性胆囊炎的诊疗体会

目的总结高原地区腹腔镜治疗结石性胆囊炎的临床经验,提高围手术期的安全性。方法回顾性分析2015年1月至2016年6月60例行腹腔镜下胆囊切除术患者的临床资料。结果本组60例患者术中探查胆囊周围严重粘连、三角区解剖不清32例,结石位于胆囊壶腹部或胆囊管结石嵌顿11例,急性化脓性胆囊炎伴胆囊结石13例。顺利实施腹腔镜下胆囊切除52例,中转开腹8例,中转开放率13.3%。平均手术时间56 min(40~115 min),无严重并发症与死亡病例。结论高原地区结石性胆囊炎病程长,手术野炎症粘连重,解剖结构不清,中转开放率相对较高,并发症多。积极完善术前准备,充分评估手术风险,术中仔细操作等均是保障围手术期安全的关键。     

低氟砖茶对儿童总摄氟量的影响

在砖茶型氟中毒重病区的西藏那曲县 ,通过对儿童总摄氟量、尿氟、血清氟变化的观察 ,探讨低氟砖茶在预防与控制砖茶型氟中毒中的作用。1 材料与方法 :根据世界卫生组织等编著的《化学污染物的膳食摄入量研究指南》中推荐的方法 ,调查了那曲县第三小学 16 1名 8～ 15岁寄宿儿童饮用低氟砖茶前及饮用低氟砖茶后 1周、2周、3周、4周 ,每人每天各种食物的摄入量 ,通过各种食物的氟含量测定 ,计算儿童每人每日总摄氟量。在同样的时间段内 ,随机选择 2 1名儿童进行尿氟、血清含量检测。低氟砖茶由中南大学湘雅医学院茶与健康研究室研制。2 结果 :…     

2007年西藏自治区碘缺乏病高危地区重点人群调查分析

Objective To propose prevention and control strategy against iodine deficiency disorders to prevent new cases of endemic cretinism from occurring. Methods In April and August 2007, all the suspected cretinism patients born after the first of January, 1997 were searched for in 16 counties from Lhasa, Shannan, Nyingchi, Qamdo and Xigaze. Meanwhile, 60 children aged 8-10 years were selected in each of the two rural villages of each county chosen. Goiter was examined using palpation and B-ultrasound, urinary iodine was determined, inteligence quotient(IQ) was tested; 30 women of childbearing age from each village chosen underwent urinary iodine test and household salt semi-quantitative detection. Results No new cases of endemic cretinism had been found; Palpation identified goiter at 4.5% (257/5680) in children, B-ultrasound revealed a rate of 4.7% (258/5433). Median of urinary iodine was 159.4 μg/L, the averaged IQ was 78.3±14.5; women of childbearing age had a median urinary iodine of 70.2 μg/L. The coverage rate of iodized salt was 52.8%. Conclusions Goiter rate in children, urinary iodine level meet the standard set for the elimination of iodine deficiency disorders; however, the low IQ children, low coverage of iodized salt and the level of urinary iodine in women of childbearing age are less than desirable. Iodine deficiency disorders prevention and control need to be strengthened.     

2007年西藏自治区碘缺乏病高危地区重点人群调查分析

Objective To propose prevention and control strategy against iodine deficiency disorders to prevent new cases of endemic cretinism from occurring. Methods In April and August 2007, all the suspected cretinism patients born after the first of January, 1997 were searched for in 16 counties from Lhasa, Shannan, Nyingchi, Qamdo and Xigaze. Meanwhile, 60 children aged 8-10 years were selected in each of the two rural villages of each county chosen. Goiter was examined using palpation and B-ultrasound, urinary iodine was determined, inteligence quotient(IQ) was tested; 30 women of childbearing age from each village chosen underwent urinary iodine test and household salt semi-quantitative detection. Results No new cases of endemic cretinism had been found; Palpation identified goiter at 4.5% (257/5680) in children, B-ultrasound revealed a rate of 4.7% (258/5433). Median of urinary iodine was 159.4 μg/L, the averaged IQ was 78.3±14.5; women of childbearing age had a median urinary iodine of 70.2 μg/L. The coverage rate of iodized salt was 52.8%. Conclusions Goiter rate in children, urinary iodine level meet the standard set for the elimination of iodine deficiency disorders; however, the low IQ children, low coverage of iodized salt and the level of urinary iodine in women of childbearing age are less than desirable. Iodine deficiency disorders prevention and control need to be strengthened.     

2007年西藏自治区碘缺乏病高危地区重点人群调查分析

目的 掌握西藏自治区碘缺乏病防治工作现况,提出有针对性的防治对策,杜绝新发地方性克汀病(简称地克病)的发生.方法 2007年4-8月在拉萨、山南、林芝、昌都、日喀则5个地区的16个县,搜索所有1997年1月1日以后出生的疑似克汀病患者,在每个乡选择2个村,每个村选取60名8～10岁儿童,采用触诊法和B超法进行甲状腺检查、尿碘测定、智商测查;每个村选择30户育龄妇女进行尿碘测定,并对其家中食盐进行半定量检测.结果 调查未发现新发克汀病患者.触诊法检查,8～10岁儿童甲状腺肿大(简称甲肿)率为4.5%(257/5680);B超法检查,甲肿率为4.7%(258/5433).8～10岁儿童尿碘中位数为159.4μg/L,智商为78.3±14.5;育龄妇女的尿碘中位数为70.2μg/L;碘盐覆盖率为52.8%.结论 儿童甲肿率、尿碘水平达到了消除碘缺乏病标准;但是儿童智商偏低,育龄妇女尿碘水平较低,碘盐覆盖率较低,碘缺乏病的防治工作需要加强.     

2009年西藏自治区饮水型氟中毒病情监测结果分析

目的 了解西藏饮水型地方性氟中毒的病情动态,评价防治措施的效果,为及时调整防治策略提供科学依据.方法 按照"2008年中央补助地方公共卫生专项资金西藏饮水型氟中毒防治项目"技术方案,于2009年9-10月选取日喀则谢通门和林芝察隅两县作为项目县,在每个项目县采用单纯随机抽样的方法选择3个项目村,以自然村为单位,对改水及改水工程运转情况、饮水含氟量、儿童氟斑牙和成人临床氟骨症进行调查.按照<生活饮用水标准检验方法非金属指标>(GB/T 5750.6-2006)测定水氟;尿中氟化物的测定采用离子选择电极法(WS/T 89-1996);氟斑牙诊断采用Dean法;成人氟骨症诊断按<地方性氟骨症临床诊断标准>(WS192-2008)进行.结果 已改水病区水氟均值在0.18～0.34 mg/L,未改水病区水氟均值在0.70～2.13 mg/L;已改水病区8～10岁儿童氟斑牙检出率为50.78%(65/128),氟斑牙指数为1.04,儿童尿氟均值为1.64 mg/L,未改水病区氟斑牙检出率为80.65%(25/31),氟斑牙指数为1.50,儿童尿氟均值为2.08;已改水病区成人氟骨症患病率为38.7%(104/269),尿氟为1.61 mg/L,未改水病区成人氟骨症患病率为15.4%(18/117),尿氟为3.54mg/L.结论 改水降氟使氟斑牙的检出率降低至控制水平,严重程度也在降低,改水病区尿氟低于未改水病区,说明改水仍对消除氟中毒的危害有重要意义,但氟骨症患病率出现了在改水病区反而高于未改水病区的现象.

Abstract：

Objective To find out the dynamics of drinking water borne endemic fluorosis in Tibet's, to evaluate the effect of control measures, and to provide a scientific basis for the timely adjustment of control strategies. Methods During september to october 2009, according to the "2008 Central Government Special Funds to Subsidize Local Public Health in Drinking Water Borne Fluorosis in Tibet", Xigaze Xietongmen and Nyingchi Zayu were selected as project counties, three project villages were selected with simple random sampling method in each county, the functioning of water improvement projects, drinking water fluoride content, children's dental fluorosis and adult skeletal fluorosis were investigated. Water fluoride was detected by the "standard examination methods for drinking water the non-metallic targets"(GB/T 5750.6-2006) determination of fluoride; urinary fluoride was tested by ion selective electrode (WS/T 89-1996); dental fluorosis was diagnosed using Deans method; adult skeletal fluorosis was diagnosed by "endemic skeletal fluorosis clinical diagnostic criteria" (WS 192-2008). Results Mean water fluoride was 0.18 - 0.34 mg/L in drinking water changed areas, and 0.70 - 2.13 mg/L in not changed areas; prevalence of dental fluorosis of children 8 - 10 was 50.78% (65/128), dental fluorosis index was 1.04,mean urinary fluoride was 1.64 mg/L in drinking water changed areas; prevalence of dental fluorosis of children 8 -10 years old was 80.65%(25/31 ) in not changed areas, dental fluorosis index was 1.50, mean urinary fluoride of children was 2.08; adult clinical skeletal fluorosis was 38.7%(104/269) in drinking water changed areas, the mean urinary fluoride was 1.61 mg/L, prevalence of skeletal fluorosis was 15.4% (18/117) in not changed areas, mean urinary fluoride was 3.54 mg/L. Conclusions The method of change the water to reduce fluoride decreases dental fluorosis to control levels, and severity is also reduced, urinary fluoride is decreased. However, the prevalence of skeletal fluorosis is higher than that of drinking water not changed areas.     

西藏西部地区儿童高原性心脏病临床分析及前列地尔靶向治疗评价

目的：探讨西藏西部地区儿童高原性心脏病的临床特点及应用前列地尔靶向治疗的临床疗效及安全性。方法：选择日喀则人民医院儿科2018年1月至10月收治的50例高原性心脏病患儿，随机分为观察组和对照组各25例。对照组患儿予以常规治疗：卧床休息，必要时镇静、吸氧、控制感染、利尿减轻心脏负荷、纠正水电解质酸碱平衡紊乱等处理。观察组患儿在常规治疗基础上应用前列地尔（凯时）5~10 ng/（h·kg）静脉泵入12 h，连续7~15 d。记录治疗前后患儿的血流动力学改变及超声心动图变化。结果：观察组患儿治疗后的肺动脉压下降程度、心脏超声指数上升程度均大于对照组（P均<0.05），且平均体动脉压治疗前后无明显变化（P>0.05），未发现明显不良反应。结论：高原性心脏病是西藏西部地区小儿常见的心脏疾病，呼吸道感染为常见诱发因素。前列地尔治疗小儿高原性心脏病，可有效降低肺动脉压力，改善患儿心功能，且无不良反应，初步评估安全性良好。     

西藏自治区碘干预与儿童智力水平调查

目的了解西藏自治区实行碘干预后儿童智力水平。方法采用人口比例概率抽样方法(PPS),在西藏自治区抽样调查30个县的30所小学,8～10岁学生尿碘、家中食用盐含碘量和智商,智商测验应用中国联合型瑞文测验(CRT-C_2)。结果西藏自治区碘盐覆盖率33．2%,合格碘盐食用率21．7%；儿童平均尿碘＜50μg/L占30．4%；智商为77．3(处于边缘水平),智力落后的比例高达32%。结论普及碘盐,加强宣传,对孕妇及育龄妇女应额外补碘。