杭州市2013─2017学年中小学生视力不良现况分析及教学环境的关联作用

目的：了解杭州市中小学生视力不良分布变化情况，确定重点人群，探索教学环境等影响因素，为制定干预政策和措施提供科学依据。方法：横断面调查研究。参照《全国学生体质健康调研细则》的要求，于2013─2017学年采用分层整群随机抽样的方法，在杭州市每个行政区县，分别随机抽取3所学校（小学1所、初中1所、高中1所）的在校学生进行视力检查。通过卡方检验和趋势卡方检验， 比较不同性别、城乡及学段间学生视力不良分布状况及严重程度的差异。通过秩相关分析，探讨教 学环境指标合格率与视力不良率之间的关联性。结果：共调查了48所学校244 338名中小学生，这 5个学年学生视力不良总检出率为76.44%。各学年女生的视力不良率高于男生（χ2 =546，P<0.001）， 郊县学生视力不良率高于市区（χ2 =5 313，P<0.001），小学、初中、高中学生的视力不良总检出率依次增高，学段间差异有统计学意义（P<0.001）。教学环境指标中课椅符合率与视力不良率之间具有相关性（r=-0.581，P=0.029）。结论：杭州市中小学生视力不良率处于全国较高水平。小学是关键阶段，女生和郊县学生是重点干预对象。

The Status of Reduced Vision among Primary and Middle School Students in Hangzhou during the 2013-2017 Academic Years and the Relevance of the Classroom Environment

Objective: To describe the status and classroom environment and factors related to reduced vision (RV) among students in Hangzhou. Methods: This was a cross-sectional study using the Chinese National Survey on Students' Constitution and Health for reference. Three schools (one primary school, one middle school and one high school) were randomly selected in each administrative district of Hangzhou by stratified cluster random sampling method in 2013-2017 academic year. A Chi square test and trend Chi square test were used to compare the distribution and severity of visual impairment among different genders, urban and rural areas and school grade levels. A rank correlation analysis was used as the basis for relevance between the qualified rate of the classroom environmental index and the rate of reduced vision. Results: Forty-eight schools and 244 338 students in Hangzhou were included as the subjects of interest. In the past 5 years, the average rate of RV among students in Hangzhou has been 76.44%. The RV rate for females in each grade was higher than males (χ2 =546, P<0.001). The RV rates in the suburbs and counties were higher than in the urban areas (χ2 =5 313, P<0.001). Also, rate was directly proportional to the school grade level. The RV rate in high schools was higher than the rate in junior high schools, which was higher than the rate in primary schools (P<0.001). There was a significant correlation between the chair height compliance rate and the RV rate in the classroom environment with significant differences (r=-0.581, P=0.029). Conclusions: The RV rate among students in Hangzhou is considered to be high. Students in primary schools were at the key stage of developing vision-related problems. Females and county schools need to be of concern.