摘要:
目的 初步筛查西藏极高海拔地区学龄前儿童的主要健康问题，以期为将来大规模流行病学调查提供前期依据。方法 对西藏自治区北部平均海拔＞5000米的某县幼儿园儿童进行健康体检，包括年龄、性别、身高、体质量、口腔健康情况、胸廓视诊、肺部及心脏听诊等一般查体项目，对一般查体提示可能存在心脏异常的儿童进一步行超声心动图检查。结果 共128名藏族学龄前儿童接受了一般查体项目，其中男童61名、女童67名，平均年龄（6.7±0.6）岁（范围： 3.5~7.5岁）。43.8%（56/128）听诊或查体提示可能存在心脏异常的儿童接受了超声心动图检查，检出先天性心脏病患儿10例，筛查阳性率为7.8%。受检儿童中，营养不良21例（16.4%），其中身材矮小15例、消瘦6例；营养过剩9例（7.03%），其中肥胖5例、超重4例。存在明显佝偻病后遗症期表现者37例（28.9%），具体表现为肋缘外翻、鸡胸、方颅、漏斗胸及其他胸廓畸形。受检儿童普遍存在口腔卫生状况不佳，龋齿患病率为76.6%（98/128）。4例（3.13%）存在先天性畸形（多指3例、软腭隐裂1例），均未进行手术矫正治疗。7例（5.47%）存在皮肤疾病（寻常疣5例、白癜风1例、汗孔角化症1例），均未得到相应诊治。结论 西藏极高海拔地区可能存在学龄前儿童先天性心脏病和营养性疾病患病率均较高、家长就诊意识较差、儿童保健知识欠缺的普遍现象，亟需开展大规模筛查，同时加强基层医生儿童保健知识培训，以实现疾病的早期发现和及时治疗。
Abstract:
Objective To conduct a preliminary screening of the primary health issues among preschool children in extremely high-altitude areas of Tibet, providing a basis for future large-scale epidemiological investigations. Methods Health examinations were conducted on children from a kindergarten in a county in northern Tibet, where the average altitude exceeds 5 000 meters. The examinations included general physical assessments such as age, gender, height, weight, oral health status, thoracic visual inspection, and auscultation of the lungs and heart. Children with potential cardiac abnormalities identified during the general examination were further evaluated using echocardiography. Results A total of 128 Tibetan preschool children underwent general physical examinations, including 61 boys and 67 girls, with an average age of (6.7 ±0.6) years (range: 3.5–7.5 years). Among them, 43.8% (56/128) with suspected cardiac abnormalities based on auscultation or physical examination underwent echocardiography, revealing 10 cases of congenital heart disease, yielding a screening positivity rate of 7.8%. Additionally, 21 children (16.4%) were diagnosed with malnutrition, including 15 cases of stunting and 6 cases of wasting, while 9 children (7.03%) exhibited overnutrition, including 5 cases of obesity and 4 cases of overweight. Signs of rickets sequelae were observed in 37 children (28.9%), manifested as costal margin flaring, pigeon chest, square skull, funnel chest, and other thoracic deformities. Poor oral hygiene was prevalent, with a dental caries rate of 76.6% (98/128). Four children (3.13%) had congenital deformities (3 cases of polydactyly and 1 case of submucous cleft palate), none of which had undergone surgical correction. Seven children (5.47%) presented with skin diseases (5 cases of verruca vulgaris, 1 case of vitiligo, and 1 case of porokeratosis), all of which had not received appropriate treatment. Conclusions Preschool children in extremely high-altitude areas of Tibet may exhibit a high prevalence of congenital heart disease and nutritional disorders, coupled with poor parental awareness of medical care and insufficient knowledge of child health. There is an urgent need for large-scale screening initiatives and enhanced training of primary healthcare providers in child health to facilitate early detection and timely treatment of these conditions.
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