1材料和方法

1.1材料

在做二級接種實驗(yan)時所用的(de)材料：冬蟲(chong)夏(xia)草(Cordycepssinensissacc)一級種是由2005年5月從西藏(zang)采來(lai)的(de)冬蟲(chong)夏(xia)草子實體經無菌分離培養(yang)所得(de)。根據(ju)多次(ci)試驗(yan)培養(yang)基成分結論如下：葡萄糖10g、磷(lin)酸氫(qing)二鉀(jia)1g、蛋(dan)白胨(dong)7g、維(wei)生素B2兩片、七水硫酸鎂0.3g、水1000ml、650ml大(da)米。

1.2方法

藥(yao)品(pin)的稱(cheng)(cheng)(cheng)(cheng)量：對于一克以下的用精確(que)的天平稱(cheng)(cheng)(cheng)(cheng)量。在(zai)稱(cheng)(cheng)(cheng)(cheng)量過程中，先調節(jie)天平所在(zai)的平面平衡(heng)以及天平平衡(heng)，并在(zai)左(zuo)盤(pan)(pan)中放(fang)張濾紙后(hou)也(ye)要平衡(heng)。然后(hou)，制定規格，用藥(yao)匙向左(zuo)盤(pan)(pan)中放(fang)入所要稱(cheng)(cheng)(cheng)(cheng)取得(de)藥(yao)品(pin)直到平衡(heng)。但要注意(yi)先把天平放(fang)下來，再(zai)取盤(pan)(pan)中的藥(yao)品(pin)。

大于等于一克的(de)物(wu)品用托(tuo)盤(pan)(pan)天(tian)平(ping)量取(qu)即可。首(shou)先調節(jie)托(tuo)盤(pan)(pan)天(tian)平(ping)平(ping)衡，在(zai)這一過程中(zhong)，要注意先把游(you)碼(ma)調到零(ling)點，調平(ping)后按左物(wu)右碼(ma)的(de)規(gui)則。移動游(you)碼(ma)直(zhi)(zhi)到所(suo)需的(de)規(gui)格，然后，用藥匙向(xiang)左盤(pan)(pan)中(zhong)放藥品直(zhi)(zhi)到平(ping)衡，則左盤(pan)(pan)中(zhong)的(de)藥品即為所(suo)稱(cheng)量的(de)。

1材料和方法

1.1材料

在做二級接種實(shi)驗時所用的材料(liao)：冬蟲夏(xia)草(Cordycepssinensissacc)一(yi)級種是由(you)2005年5月從西(xi)藏采來的冬蟲夏(xia)草子實(shi)體經無(wu)菌分離培(pei)養所得。根據(ju)多(duo)次試驗培(pei)養基(ji)成分結論如(ru)下：葡萄糖(tang)10g、磷酸氫二鉀(jia)1g、蛋白胨(dong)7g、維(wei)生(sheng)素B2兩片、七水(shui)硫(liu)酸鎂0.3g、水(shui)1000ml、650ml大米(mi)。

1.2方法

藥品(pin)的(de)(de)稱(cheng)量(liang)：對于一克以(yi)下(xia)的(de)(de)用精(jing)確的(de)(de)天(tian)平稱(cheng)量(liang)。在稱(cheng)量(liang)過程中(zhong)(zhong)(zhong)(zhong)，先(xian)調節天(tian)平所(suo)(suo)在的(de)(de)平面平衡以(yi)及天(tian)平平衡，并在左盤中(zhong)(zhong)(zhong)(zhong)放(fang)張濾紙后也要平衡。然后，制(zhi)定規格，用藥匙向左盤中(zhong)(zhong)(zhong)(zhong)放(fang)入所(suo)(suo)要稱(cheng)取得藥品(pin)直(zhi)到平衡。但要注意先(xian)把天(tian)平放(fang)下(xia)來(lai)，再(zai)取盤中(zhong)(zhong)(zhong)(zhong)的(de)(de)藥品(pin)。

大于等于一(yi)克的(de)(de)物品(pin)用托盤天平(ping)(ping)量(liang)取(qu)即(ji)可。首先調(diao)節托盤天平(ping)(ping)平(ping)(ping)衡，在這一(yi)過(guo)程中，要注意(yi)先把游碼調(diao)到零點(dian)，調(diao)平(ping)(ping)后按左(zuo)物右碼的(de)(de)規(gui)則(ze)。移動游碼直到所需的(de)(de)規(gui)格，然后，用藥(yao)(yao)匙向左(zuo)盤中放(fang)藥(yao)(yao)品(pin)直到平(ping)(ping)衡，則(ze)左(zuo)盤中的(de)(de)藥(yao)(yao)品(pin)即(ji)為所稱量(liang)的(de)(de)。

1監督評價方法

1.1資料來源。評(ping)(ping)(ping)價(jia)數據來源于(yu)國家(jia)(jia)(jia)衛生(sheng)(sheng)計(ji)生(sheng)(sheng)委《醫(yi)(yi)療(liao)(liao)(liao)衛生(sheng)(sheng)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)傳染(ran)病(bing)(bing)(bing)防(fang)(fang)治分(fen)(fen)(fen)(fen)類(lei)(lei)(lei)監(jian)(jian)(jian)督(du)(du)(du)綜合(he)(he)(he)評(ping)(ping)(ping)價(jia)試(shi)點工作方(fang)案》統(tong)一(yi)(yi)表格(ge)，由河南省(sheng)衛生(sheng)(sheng)監(jian)(jian)(jian)督(du)(du)(du)局對執(zhi)法人員統(tong)一(yi)(yi)培訓后，對醫(yi)(yi)療(liao)(liao)(liao)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)、疾(ji)病(bing)(bing)(bing)預防(fang)(fang)控(kong)(kong)制(zhi)(zhi)(zhi)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)、采供血機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)三類(lei)(lei)(lei)醫(yi)(yi)療(liao)(liao)(liao)衛生(sheng)(sheng)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)進行現場監(jian)(jian)(jian)督(du)(du)(du)時(shi)填寫、評(ping)(ping)(ping)分(fen)(fen)(fen)(fen)、匯總、評(ping)(ping)(ping)價(jia)。1.2方(fang)法。2014年9月至2016年12月周口市全面(mian)參與并實施全國傳染(ran)病(bing)(bing)(bing)防(fang)(fang)治分(fen)(fen)(fen)(fen)類(lei)(lei)(lei)監(jian)(jian)(jian)督(du)(du)(du)綜合(he)(he)(he)評(ping)(ping)(ping)價(jia)試(shi)點工作。試(shi)點工作實行分(fen)(fen)(fen)(fen)類(lei)(lei)(lei)監(jian)(jian)(jian)督(du)(du)(du)，對醫(yi)(yi)療(liao)(liao)(liao)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)、疾(ji)病(bing)(bing)(bing)預防(fang)(fang)控(kong)(kong)制(zhi)(zhi)(zhi)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)、采供血機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)等三類(lei)(lei)(lei)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)分(fen)(fen)(fen)(fen)別(bie)進行監(jian)(jian)(jian)督(du)(du)(du)；對每(mei)一(yi)(yi)類(lei)(lei)(lei)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)就(jiu)綜合(he)(he)(he)管理、預防(fang)(fang)接種(zhong)、傳染(ran)病(bing)(bing)(bing)疫情(qing)報(bao)告、傳染(ran)病(bing)(bing)(bing)疫情(qing)控(kong)(kong)制(zhi)(zhi)(zhi)、消(xiao)毒隔離、醫(yi)(yi)療(liao)(liao)(liao)廢(fei)物處(chu)置、病(bing)(bing)(bing)原微生(sheng)(sheng)物實驗室(shi)生(sheng)(sheng)物安全管理等七大項(xiang)(xiang)目(mu)分(fen)(fen)(fen)(fen)別(bie)進行監(jian)(jian)(jian)督(du)(du)(du)；最(zui)終(zhong)按(an)醫(yi)(yi)療(liao)(liao)(liao)衛生(sheng)(sheng)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)類(lei)(lei)(lei)別(bie)（3類(lei)(lei)(lei)）對監(jian)(jian)(jian)督(du)(du)(du)結(jie)果(guo)進行綜合(he)(he)(he)評(ping)(ping)(ping)價(jia)，按(an)每(mei)一(yi)(yi)類(lei)(lei)(lei)別(bie)的(de)監(jian)(jian)(jian)督(du)(du)(du)項(xiang)(xiang)目(mu)（7項(xiang)(xiang)）結(jie)果(guo)進行綜合(he)(he)(he)評(ping)(ping)(ping)價(jia)。按(an)照(zhao)河南省(sheng)衛生(sheng)(sheng)計(ji)生(sheng)(sheng)委確定的(de)名單，周口市參加全國傳染(ran)病(bing)(bing)(bing)防(fang)(fang)治分(fen)(fen)(fen)(fen)類(lei)(lei)(lei)監(jian)(jian)(jian)督(du)(du)(du)綜合(he)(he)(he)評(ping)(ping)(ping)價(jia)試(shi)點的(de)醫(yi)(yi)療(liao)(liao)(liao)衛生(sheng)(sheng)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)共(gong)64家(jia)(jia)(jia)，其(qi)中醫(yi)(yi)療(liao)(liao)(liao)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)54家(jia)(jia)(jia)（其(qi)中三級醫(yi)(yi)院(yuan)(yuan)2家(jia)(jia)(jia)，二級醫(yi)(yi)院(yuan)(yuan)14家(jia)(jia)(jia)，一(yi)(yi)級醫(yi)(yi)院(yuan)(yuan)4家(jia)(jia)(jia)，其(qi)他醫(yi)(yi)療(liao)(liao)(liao)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)34家(jia)(jia)(jia)），疾(ji)病(bing)(bing)(bing)預防(fang)(fang)控(kong)(kong)制(zhi)(zhi)(zhi)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)9家(jia)(jia)(jia)、采供血機(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)1家(jia)(jia)(jia)。分(fen)(fen)(fen)(fen)別(bie)從上述(shu)7大項(xiang)(xiang)和(he)53個小(xiao)(xiao)項(xiang)(xiang)進行監(jian)(jian)(jian)督(du)(du)(du)檢查(cha)(cha)。檢查(cha)(cha)結(jie)果(guo)以100分(fen)(fen)(fen)(fen)計(ji)算，大于(yu)85分(fen)(fen)(fen)(fen)的(de)為(wei)合(he)(he)(he)格(ge)單位；60~85分(fen)(fen)(fen)(fen)為(wei)待改進單位；小(xiao)(xiao)于(yu)60分(fen)(fen)(fen)(fen)為(wei)重點監(jian)(jian)(jian)督(du)(du)(du)單位。

2結果

2.1綜合(he)(he)監(jian)(jian)(jian)(jian)督(du)(du)(du)評(ping)價(jia)(jia)結(jie)(jie)果(guo)(guo)。2.1.1總(zong)(zong)(zong)體(ti)評(ping)價(jia)(jia)結(jie)(jie)果(guo)(guo)。64家(jia)(jia)(jia)(jia)試(shi)(shi)點(dian)單(dan)(dan)位(wei)(wei)(wei)(wei)(wei)總(zong)(zong)(zong)體(ti)監(jian)(jian)(jian)(jian)督(du)(du)(du)評(ping)價(jia)(jia)結(jie)(jie)果(guo)(guo)為(wei)(wei)合(he)(he)格(ge)單(dan)(dan)位(wei)(wei)(wei)(wei)(wei)25家(jia)(jia)(jia)(jia)，占(zhan)39.1%；待改(gai)進(jin)(jin)(jin)(jin)單(dan)(dan)位(wei)(wei)(wei)(wei)(wei)36家(jia)(jia)(jia)(jia)，占(zhan)56.2%；重點(dian)監(jian)(jian)(jian)(jian)督(du)(du)(du)單(dan)(dan)位(wei)(wei)(wei)(wei)(wei)3家(jia)(jia)(jia)(jia)，占(zhan)4.7%，見(jian)(jian)表1。2.1.2醫(yi)療(liao)(liao)(liao)(liao)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)評(ping)價(jia)(jia)結(jie)(jie)果(guo)(guo):（1）二級以上醫(yi)院(yuan)(yuan)：共監(jian)(jian)(jian)(jian)督(du)(du)(du)評(ping)價(jia)(jia)二級以上醫(yi)院(yuan)(yuan)16家(jia)(jia)(jia)(jia)，合(he)(he)格(ge)單(dan)(dan)位(wei)(wei)(wei)(wei)(wei)11家(jia)(jia)(jia)(jia)，待改(gai)進(jin)(jin)(jin)(jin)單(dan)(dan)位(wei)(wei)(wei)(wei)(wei)5家(jia)(jia)(jia)(jia)；（2）一(yi)級醫(yi)院(yuan)(yuan)：共監(jian)(jian)(jian)(jian)督(du)(du)(du)評(ping)價(jia)(jia)一(yi)級醫(yi)院(yuan)(yuan)4家(jia)(jia)(jia)(jia)，其(qi)中(zhong)待改(gai)進(jin)(jin)(jin)(jin)單(dan)(dan)位(wei)(wei)(wei)(wei)(wei)3家(jia)(jia)(jia)(jia)，重點(dian)監(jian)(jian)(jian)(jian)督(du)(du)(du)單(dan)(dan)位(wei)(wei)(wei)(wei)(wei)1家(jia)(jia)(jia)(jia)。（3）其(qi)他醫(yi)療(liao)(liao)(liao)(liao)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)：包括(kuo)鄉級衛(wei)生(sheng)院(yuan)(yuan)、門診部(bu)、診所等，共監(jian)(jian)(jian)(jian)督(du)(du)(du)評(ping)價(jia)(jia)34家(jia)(jia)(jia)(jia)，其(qi)中(zhong)合(he)(he)格(ge)單(dan)(dan)位(wei)(wei)(wei)(wei)(wei)7家(jia)(jia)(jia)(jia)，待改(gai)進(jin)(jin)(jin)(jin)單(dan)(dan)位(wei)(wei)(wei)(wei)(wei)25家(jia)(jia)(jia)(jia)，重點(dian)監(jian)(jian)(jian)(jian)督(du)(du)(du)單(dan)(dan)位(wei)(wei)(wei)(wei)(wei)2家(jia)(jia)(jia)(jia)。2.1.3疾(ji)病(bing)預(yu)(yu)防(fang)(fang)(fang)控(kong)制(zhi)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)評(ping)價(jia)(jia)結(jie)(jie)果(guo)(guo)。評(ping)價(jia)(jia)疾(ji)病(bing)預(yu)(yu)防(fang)(fang)(fang)控(kong)制(zhi)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)9家(jia)(jia)(jia)(jia)，評(ping)價(jia)(jia)合(he)(he)格(ge)單(dan)(dan)位(wei)(wei)(wei)(wei)(wei)6家(jia)(jia)(jia)(jia)，待改(gai)進(jin)(jin)(jin)(jin)單(dan)(dan)位(wei)(wei)(wei)(wei)(wei)3家(jia)(jia)(jia)(jia)。2.1.4采供(gong)(gong)血(xue)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)評(ping)價(jia)(jia)結(jie)(jie)果(guo)(guo):評(ping)價(jia)(jia)中(zhong)心血(xue)站1家(jia)(jia)(jia)(jia)，評(ping)價(jia)(jia)為(wei)(wei)合(he)(he)格(ge)單(dan)(dan)位(wei)(wei)(wei)(wei)(wei)。2.2分(fen)(fen)(fen)項(xiang)監(jian)(jian)(jian)(jian)督(du)(du)(du)評(ping)價(jia)(jia)結(jie)(jie)果(guo)(guo)。對64家(jia)(jia)(jia)(jia)試(shi)(shi)點(dian)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)的(de)(de)(de)綜合(he)(he)管(guan)(guan)理(li)、傳染病(bing)疫(yi)情報告(gao)、傳染病(bing)疫(yi)情控(kong)制(zhi)、消(xiao)毒(du)隔(ge)離(li)(li)(li)、醫(yi)療(liao)(liao)(liao)(liao)廢(fei)(fei)(fei)物處置進(jin)(jin)(jin)(jin)行(xing)(xing)分(fen)(fen)(fen)項(xiang)監(jian)(jian)(jian)(jian)督(du)(du)(du)評(ping)價(jia)(jia)，其(qi)得(de)(de)分(fen)(fen)(fen)大于85分(fen)(fen)(fen)的(de)(de)(de)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)比例分(fen)(fen)(fen)別為(wei)(wei)53.1%、59.4%、67.2%、32.8%、35.9%；對55家(jia)(jia)(jia)(jia)承擔預(yu)(yu)防(fang)(fang)(fang)接(jie)(jie)(jie)種的(de)(de)(de)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)進(jin)(jin)(jin)(jin)行(xing)(xing)監(jian)(jian)(jian)(jian)督(du)(du)(du)評(ping)價(jia)(jia)，其(qi)預(yu)(yu)防(fang)(fang)(fang)接(jie)(jie)(jie)種項(xiang)得(de)(de)分(fen)(fen)(fen)大于85分(fen)(fen)(fen)的(de)(de)(de)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)為(wei)(wei)52.7%；對30家(jia)(jia)(jia)(jia)具有病(bing)原(yuan)微(wei)生(sheng)物實(shi)驗室(shi)的(de)(de)(de)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)進(jin)(jin)(jin)(jin)行(xing)(xing)監(jian)(jian)(jian)(jian)督(du)(du)(du)評(ping)價(jia)(jia)，其(qi)生(sheng)物安全(quan)(quan)管(guan)(guan)理(li)項(xiang)得(de)(de)分(fen)(fen)(fen)大于85分(fen)(fen)(fen)的(de)(de)(de)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)為(wei)(wei)70.0%。總(zong)(zong)(zong)體(ti)情況(kuang)為(wei)(wei)：三類機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)消(xiao)毒(du)隔(ge)離(li)(li)(li)、醫(yi)療(liao)(liao)(liao)(liao)廢(fei)(fei)(fei)物處置總(zong)(zong)(zong)體(ti)得(de)(de)分(fen)(fen)(fen)較低；疾(ji)控(kong)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)的(de)(de)(de)疫(yi)情報告(gao)、疫(yi)情控(kong)制(zhi)、預(yu)(yu)防(fang)(fang)(fang)接(jie)(jie)(jie)種工(gong)(gong)(gong)作(zuo)做得(de)(de)較好，而基層醫(yi)療(liao)(liao)(liao)(liao)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)的(de)(de)(de)疫(yi)情報告(gao)、疫(yi)情控(kong)制(zhi)、預(yu)(yu)防(fang)(fang)(fang)接(jie)(jie)(jie)種得(de)(de)分(fen)(fen)(fen)普遍(bian)較低。疾(ji)控(kong)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)的(de)(de)(de)病(bing)原(yuan)微(wei)生(sheng)物實(shi)驗室(shi)生(sheng)物安全(quan)(quan)管(guan)(guan)理(li)需(xu)要加強，見(jian)(jian)表2。2.3試(shi)(shi)點(dian)工(gong)(gong)(gong)作(zuo)成(cheng)效(xiao)。預(yu)(yu)防(fang)(fang)(fang)接(jie)(jie)(jie)種監(jian)(jian)(jian)(jian)督(du)(du)(du)得(de)(de)到(dao)加強，通(tong)過試(shi)(shi)點(dian)工(gong)(gong)(gong)作(zuo)逐步(bu)將醫(yi)療(liao)(liao)(liao)(liao)衛(wei)生(sheng)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)預(yu)(yu)防(fang)(fang)(fang)接(jie)(jie)(jie)種納(na)入監(jian)(jian)(jian)(jian)督(du)(du)(du)范圍，推進(jin)(jin)(jin)(jin)了(le)(le)預(yu)(yu)防(fang)(fang)(fang)接(jie)(jie)(jie)種工(gong)(gong)(gong)作(zuo)的(de)(de)(de)依(yi)法(fa)開(kai)展和(he)依(yi)法(fa)監(jian)(jian)(jian)(jian)督(du)(du)(du)。疫(yi)情網絡直報系(xi)統進(jin)(jin)(jin)(jin)一(yi)步(bu)完善，醫(yi)療(liao)(liao)(liao)(liao)機(ji)(ji)(ji)確定了(le)(le)專人負責傳染病(bing)報告(gao)，疫(yi)情報告(gao)相關制(zhi)度齊全(quan)(quan)，鄉鎮衛(wei)生(sheng)院(yuan)(yuan)全(quan)(quan)部(bu)實(shi)行(xing)(xing)了(le)(le)疫(yi)情網絡直報。城(cheng)區(qu)(qu)小(xiao)型(xing)醫(yi)療(liao)(liao)(liao)(liao)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)醫(yi)療(liao)(liao)(liao)(liao)廢(fei)(fei)(fei)物集中(zhong)處置得(de)(de)到(dao)推進(jin)(jin)(jin)(jin)，解決了(le)(le)城(cheng)區(qu)(qu)小(xiao)型(xing)醫(yi)療(liao)(liao)(liao)(liao)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)醫(yi)療(liao)(liao)(liao)(liao)廢(fei)(fei)(fei)物分(fen)(fen)(fen)散處置的(de)(de)(de)狀(zhuang)況(kuang)。消(xiao)毒(du)隔(ge)離(li)(li)(li)工(gong)(gong)(gong)作(zuo)得(de)(de)到(dao)加強，醫(yi)療(liao)(liao)(liao)(liao)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)加強了(le)(le)消(xiao)毒(du)隔(ge)離(li)(li)(li)知(zhi)識培訓(xun)和(he)有關設施設備的(de)(de)(de)更新配(pei)置，市衛(wei)生(sheng)監(jian)(jian)(jian)(jian)督(du)(du)(du)局建立了(le)(le)消(xiao)毒(du)供(gong)(gong)應(ying)中(zhong)心模擬執法(fa)室(shi)，衛(wei)生(sheng)監(jian)(jian)(jian)(jian)督(du)(du)(du)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)查處醫(yi)療(liao)(liao)(liao)(liao)衛(wei)生(sheng)機(ji)(ji)(ji)構(gou)(gou)(gou)(gou)(gou)消(xiao)毒(du)隔(ge)離(li)(li)(li)相關案件力度加大。

3討論

醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)衛生(sheng)(sheng)(sheng)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)承(cheng)擔(dan)著(zhu)傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)防(fang)(fang)(fang)治(zhi)(zhi)的(de)(de)(de)重要(yao)(yao)職責(ze)，但實(shi)(shi)(shi)(shi)際工(gong)(gong)作(zuo)(zuo)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)，醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)廢(fei)(fei)(fei)物(wu)(wu)(wu)處(chu)置(zhi)、傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)疫情(qing)(qing)報(bao)告(gao)與控(kong)(kong)制(zhi)(zhi)(zhi)(zhi)、消(xiao)(xiao)(xiao)毒(du)(du)(du)(du)隔(ge)離(li)制(zhi)(zhi)(zhi)(zhi)度(du)(du)執(zhi)行(xing)(xing)、病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)原(yuan)微(wei)生(sheng)(sheng)(sheng)物(wu)(wu)(wu)實(shi)(shi)(shi)(shi)驗(yan)(yan)(yan)(yan)室(shi)(shi)(shi)生(sheng)(sheng)(sheng)物(wu)(wu)(wu)安全(quan)等(deng)(deng)(deng)傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)防(fang)(fang)(fang)治(zhi)(zhi)工(gong)(gong)作(zuo)(zuo)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)還(huan)存(cun)(cun)在不(bu)(bu)(bu)(bu)少(shao)薄弱環節(jie)(jie)。通(tong)過兩年多(duo)的(de)(de)(de)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)衛生(sheng)(sheng)(sheng)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)防(fang)(fang)(fang)治(zhi)(zhi)分(fen)(fen)(fen)(fen)類監(jian)(jian)(jian)(jian)督(du)(du)綜合(he)評(ping)價(jia)試點(dian)工(gong)(gong)作(zuo)(zuo)，周口市各級(ji)(ji)(ji)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)、疾(ji)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)預(yu)防(fang)(fang)(fang)控(kong)(kong)制(zhi)(zhi)(zhi)(zhi)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)、采供(gong)(gong)(gong)血機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)不(bu)(bu)(bu)(bu)斷加(jia)強(qiang)和規范了法(fa)(fa)律(lv)法(fa)(fa)規賦予的(de)(de)(de)傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)防(fang)(fang)(fang)治(zhi)(zhi)職責(ze)，取得(de)了顯著(zhu)成效(xiao)，分(fen)(fen)(fen)(fen)類監(jian)(jian)(jian)(jian)督(du)(du)工(gong)(gong)作(zuo)(zuo)值得(de)堅持推廣(guang)。但是在實(shi)(shi)(shi)(shi)施分(fen)(fen)(fen)(fen)類監(jian)(jian)(jian)(jian)督(du)(du)過程中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)，發現不(bu)(bu)(bu)(bu)同醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)存(cun)(cun)在不(bu)(bu)(bu)(bu)同問(wen)(wen)(wen)(wen)(wen)題(ti)(ti)(ti)。3.1醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)存(cun)(cun)在的(de)(de)(de)問(wen)(wen)(wen)(wen)(wen)題(ti)(ti)(ti)。64家醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)合(he)格率39.06%，其(qi)余存(cun)(cun)在不(bu)(bu)(bu)(bu)同問(wen)(wen)(wen)(wen)(wen)題(ti)(ti)(ti)。（1）二(er)(er)級(ji)(ji)(ji)以上(shang)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)(yuan)：問(wen)(wen)(wen)(wen)(wen)題(ti)(ti)(ti)主(zhu)要(yao)(yao)集(ji)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)在傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)疫情(qing)(qing)報(bao)、傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)疫情(qing)(qing)控(kong)(kong)制(zhi)(zhi)(zhi)(zhi)、消(xiao)(xiao)(xiao)毒(du)(du)(du)(du)隔(ge)離(li)三(san)個(ge)方面，主(zhu)要(yao)(yao)表現為(wei)：傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)登記(ji)填寫(xie)漏項(xiang)；檢(jian)驗(yan)(yan)(yan)(yan)科或放射科傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)登記(ji)填寫(xie)不(bu)(bu)(bu)(bu)齊全(quan)，陽性(xing)(xing)結果(guo)(guo)無(wu)(wu)反饋(kui)記(ji)錄；傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)預(yu)檢(jian)、分(fen)(fen)(fen)(fen)診(zhen)工(gong)(gong)作(zuo)(zuo)不(bu)(bu)(bu)(bu)經常，發熱門診(zhen)建(jian)(jian)設達不(bu)(bu)(bu)(bu)到(dao)要(yao)(yao)求(qiu)(qiu)；一(yi)(yi)些醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)(yuan)消(xiao)(xiao)(xiao)毒(du)(du)(du)(du)供(gong)(gong)(gong)應(ying)室(shi)(shi)(shi)建(jian)(jian)設不(bu)(bu)(bu)(bu)達標(biao)；重點(dian)科室(shi)(shi)(shi)消(xiao)(xiao)(xiao)毒(du)(du)(du)(du)、滅(mie)菌(jun)過程不(bu)(bu)(bu)(bu)符(fu)(fu)合(he)規范要(yao)(yao)求(qiu)(qiu)等(deng)(deng)(deng)。（2）一(yi)(yi)級(ji)(ji)(ji)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)(yuan)：此類多(duo)為(wei)民(min)營(ying)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)(yuan)，多(duo)項(xiang)監(jian)(jian)(jian)(jian)督(du)(du)評(ping)分(fen)(fen)(fen)(fen)不(bu)(bu)(bu)(bu)足85分(fen)(fen)(fen)(fen)，得(de)分(fen)(fen)(fen)(fen)率低于(yu)60%的(de)(de)(de)過半，存(cun)(cun)在問(wen)(wen)(wen)(wen)(wen)題(ti)(ti)(ti)較(jiao)(jiao)多(duo)，特別是消(xiao)(xiao)(xiao)毒(du)(du)(du)(du)滅(mie)菌(jun)、醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)廢(fei)(fei)(fei)物(wu)(wu)(wu)處(chu)置(zhi)問(wen)(wen)(wen)(wen)(wen)題(ti)(ti)(ti)突出，亟需(xu)加(jia)大監(jian)(jian)(jian)(jian)督(du)(du)力度(du)(du)。（3）其(qi)它醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)：該類包括(kuo)鄉鎮衛生(sheng)(sheng)(sheng)院(yuan)(yuan)、社(she)區(qu)衛生(sheng)(sheng)(sheng)服務中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)心、門診(zhen)（部(bu)）、診(zhen)所等(deng)(deng)(deng)，總體綜合(he)管理能(neng)力較(jiao)(jiao)低，綜合(he)管理得(de)分(fen)(fen)(fen)(fen)在85%以上(shang)的(de)(de)(de)僅占35.3%；問(wen)(wen)(wen)(wen)(wen)題(ti)(ti)(ti)較(jiao)(jiao)多(duo)的(de)(de)(de)項(xiang)目(mu)為(wei)傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)疫情(qing)(qing)報(bao)告(gao)、疫情(qing)(qing)控(kong)(kong)制(zhi)(zhi)(zhi)(zhi)、消(xiao)(xiao)(xiao)毒(du)(du)(du)(du)隔(ge)離(li)、醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)廢(fei)(fei)(fei)物(wu)(wu)(wu)處(chu)置(zhi)及(ji)預(yu)防(fang)(fang)(fang)接(jie)種(zhong)等(deng)(deng)(deng)，主(zhu)要(yao)(yao)表現為(wei)門診(zhen)日(ri)志、傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)登記(ji)本、傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)報(bao)告(gao)卡缺(que)少(shao)或不(bu)(bu)(bu)(bu)全(quan)，或相(xiang)關記(ji)錄漏項(xiang)較(jiao)(jiao)多(duo)；消(xiao)(xiao)(xiao)毒(du)(du)(du)(du)供(gong)(gong)(gong)應(ying)室(shi)(shi)(shi)建(jian)(jian)設嚴重不(bu)(bu)(bu)(bu)達標(biao)，或運(yun)行(xing)(xing)不(bu)(bu)(bu)(bu)正規、消(xiao)(xiao)(xiao)毒(du)(du)(du)(du)滅(mie)菌(jun)不(bu)(bu)(bu)(bu)符(fu)(fu)合(he)相(xiang)關規范要(yao)(yao)求(qiu)(qiu)，消(xiao)(xiao)(xiao)毒(du)(du)(du)(du)滅(mie)菌(jun)效(xiao)果(guo)(guo)檢(jian)測(ce)未(wei)進(jin)(jin)行(xing)(xing)或未(wei)按(an)規定(ding)進(jin)(jin)行(xing)(xing)；個(ge)別單位(wei)手術前不(bu)(bu)(bu)(bu)進(jin)(jin)行(xing)(xing)“三(san)項(xiang)傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)”檢(jian)測(ce)；醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)廢(fei)(fei)(fei)物(wu)(wu)(wu)收(shou)集(ji)、暫存(cun)(cun)、移交、登記(ji)等(deng)(deng)(deng)違規問(wen)(wen)(wen)(wen)(wen)題(ti)(ti)(ti)明顯；消(xiao)(xiao)(xiao)毒(du)(du)(du)(du)產(chan)品進(jin)(jin)貨(huo)查(cha)驗(yan)(yan)(yan)(yan)未(wei)開(kai)展或不(bu)(bu)(bu)(bu)符(fu)(fu)合(he)要(yao)(yao)求(qiu)(qiu)等(deng)(deng)(deng)。該類醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)防(fang)(fang)(fang)治(zhi)(zhi)監(jian)(jian)(jian)(jian)督(du)(du)任(ren)務艱巨。以上(shang)問(wen)(wen)(wen)(wen)(wen)題(ti)(ti)(ti)主(zhu)要(yao)(yao)集(ji)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)在違反《醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)廢(fei)(fei)(fei)物(wu)(wu)(wu)管理條例》、《消(xiao)(xiao)(xiao)毒(du)(du)(du)(du)管理辦法(fa)(fa)》和《傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)防(fang)(fang)(fang)治(zhi)(zhi)法(fa)(fa)》方面，同北京、湖(hu)南、安徽等(deng)(deng)(deng)地情(qing)(qing)況類似［1-4］,應(ying)作(zuo)(zuo)為(wei)傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)防(fang)(fang)(fang)治(zhi)(zhi)監(jian)(jian)(jian)(jian)督(du)(du)工(gong)(gong)作(zuo)(zuo)的(de)(de)(de)長期重點(dian)關注(zhu)對(dui)象(xiang)。3.2疾(ji)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)預(yu)防(fang)(fang)(fang)控(kong)(kong)制(zhi)(zhi)(zhi)(zhi)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)的(de)(de)(de)主(zhu)要(yao)(yao)問(wen)(wen)(wen)(wen)(wen)題(ti)(ti)(ti)。存(cun)(cun)在問(wen)(wen)(wen)(wen)(wen)題(ti)(ti)(ti)較(jiao)(jiao)多(duo)的(de)(de)(de)是消(xiao)(xiao)(xiao)毒(du)(du)(du)(du)隔(ge)離(li)、醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)廢(fei)(fei)(fei)物(wu)(wu)(wu)處(chu)置(zhi)項(xiang)目(mu)。具體問(wen)(wen)(wen)(wen)(wen)題(ti)(ti)(ti)有(you)(you)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)原(yuan)微(wei)生(sheng)(sheng)(sheng)物(wu)(wu)(wu)實(shi)(shi)(shi)(shi)驗(yan)(yan)(yan)(yan)室(shi)(shi)(shi)人(ren)員衛生(sheng)(sheng)(sheng)安全(quan)防(fang)(fang)(fang)護有(you)(you)缺(que)陷、實(shi)(shi)(shi)(shi)驗(yan)(yan)(yan)(yan)室(shi)(shi)(shi)產(chan)生(sheng)(sheng)(sheng)的(de)(de)(de)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)廢(fei)(fei)(fei)物(wu)(wu)(wu)處(chu)置(zhi)不(bu)(bu)(bu)(bu)符(fu)(fu)合(he)規定(ding)、消(xiao)(xiao)(xiao)毒(du)(du)(du)(du)產(chan)品進(jin)(jin)貨(huo)查(cha)驗(yan)(yan)(yan)(yan)不(bu)(bu)(bu)(bu)到(dao)位(wei)等(deng)(deng)(deng)。各地衛生(sheng)(sheng)(sheng)監(jian)(jian)(jian)(jian)督(du)(du)工(gong)(gong)作(zuo)(zuo)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)較(jiao)(jiao)少(shao)將(jiang)疾(ji)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)預(yu)防(fang)(fang)(fang)控(kong)(kong)制(zhi)(zhi)(zhi)(zhi)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)作(zuo)(zuo)為(wei)傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)防(fang)(fang)(fang)治(zhi)(zhi)監(jian)(jian)(jian)(jian)督(du)(du)關注(zhu)對(dui)象(xiang)［5-6］，而實(shi)(shi)(shi)(shi)驗(yan)(yan)(yan)(yan)室(shi)(shi)(shi)安全(quan)管理直接(jie)影響到(dao)疾(ji)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)預(yu)防(fang)(fang)(fang)控(kong)(kong)制(zhi)(zhi)(zhi)(zhi)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)應(ying)急能(neng)力的(de)(de)(de)強(qiang)弱［7］。通(tong)過分(fen)(fen)(fen)(fen)類監(jian)(jian)(jian)(jian)督(du)(du)管理，我們認為(wei)疾(ji)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)預(yu)防(fang)(fang)(fang)控(kong)(kong)制(zhi)(zhi)(zhi)(zhi)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)本身的(de)(de)(de)消(xiao)(xiao)(xiao)毒(du)(du)(du)(du)管理、醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)廢(fei)(fei)(fei)物(wu)(wu)(wu)處(chu)置(zhi)和實(shi)(shi)(shi)(shi)驗(yan)(yan)(yan)(yan)室(shi)(shi)(shi)安全(quan)管理應(ying)該進(jin)(jin)一(yi)(yi)步加(jia)強(qiang)。3.3采供(gong)(gong)(gong)血機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)的(de)(de)(de)主(zhu)要(yao)(yao)問(wen)(wen)(wen)(wen)(wen)題(ti)(ti)(ti)。采供(gong)(gong)(gong)血機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)如果(guo)(guo)監(jian)(jian)(jian)(jian)管不(bu)(bu)(bu)(bu)力極(ji)易傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)播傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)［8］。總體評(ping)價(jia)較(jiao)(jiao)好，但疫情(qing)(qing)報(bao)告(gao)及(ji)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)原(yuan)微(wei)生(sheng)(sheng)(sheng)物(wu)(wu)(wu)實(shi)(shi)(shi)(shi)驗(yan)(yan)(yan)(yan)室(shi)(shi)(shi)生(sheng)(sheng)(sheng)物(wu)(wu)(wu)安全(quan)管理、醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)廢(fei)(fei)(fei)物(wu)(wu)(wu)暫存(cun)(cun)、醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)廢(fei)(fei)(fei)物(wu)(wu)(wu)交接(jie)登記(ji)等(deng)(deng)(deng)環節(jie)(jie)需(xu)要(yao)(yao)完(wan)善加(jia)強(qiang)。為(wei)進(jin)(jin)一(yi)(yi)步總結推廣(guang)分(fen)(fen)(fen)(fen)類監(jian)(jian)(jian)(jian)督(du)(du)工(gong)(gong)作(zuo)(zuo)經驗(yan)(yan)(yan)(yan)，針對(dui)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)衛生(sheng)(sheng)(sheng)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)傳(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)(chuan)染(ran)(ran)(ran)(ran)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)防(fang)(fang)(fang)治(zhi)(zhi)分(fen)(fen)(fen)(fen)類監(jian)(jian)(jian)(jian)督(du)(du)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)存(cun)(cun)在問(wen)(wen)(wen)(wen)(wen)題(ti)(ti)(ti)，我們建(jian)(jian)議：（1）加(jia)強(qiang)一(yi)(yi)、二(er)(er)級(ji)(ji)(ji)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)原(yuan)微(wei)生(sheng)(sheng)(sheng)物(wu)(wu)(wu)實(shi)(shi)(shi)(shi)驗(yan)(yan)(yan)(yan)室(shi)(shi)(shi)的(de)(de)(de)備(bei)案工(gong)(gong)作(zuo)(zuo)。在各類醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)衛生(sheng)(sheng)(sheng)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)(bing)原(yuan)微(wei)生(sheng)(sheng)(sheng)物(wu)(wu)(wu)實(shi)(shi)(shi)(shi)驗(yan)(yan)(yan)(yan)室(shi)(shi)(shi)評(ping)價(jia)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)，周口市新(xin)建(jian)(jian)、改建(jian)(jian)、擴建(jian)(jian)一(yi)(yi)、二(er)(er)級(ji)(ji)(ji)實(shi)(shi)(shi)(shi)驗(yan)(yan)(yan)(yan)室(shi)(shi)(shi)均未(wei)向市衛生(sheng)(sheng)(sheng)計生(sheng)(sheng)(sheng)主(zhu)管部(bu)門備(bei)案。建(jian)(jian)議國家、省級(ji)(ji)(ji)衛生(sheng)(sheng)(sheng)計生(sheng)(sheng)(sheng)行(xing)(xing)政部(bu)門統一(yi)(yi)規范。（2）著(zhu)力加(jia)強(qiang)基(ji)(ji)層(ceng)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)的(de)(de)(de)消(xiao)(xiao)(xiao)毒(du)(du)(du)(du)隔(ge)離(li)工(gong)(gong)作(zuo)(zuo)。基(ji)(ji)層(ceng)民(min)營(ying)醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)院(yuan)(yuan)和小型醫(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)(yi)療(liao)(liao)(liao)(liao)機(ji)(ji)(ji)(ji)(ji)(ji)(ji)(ji)構(gou)(gou)(gou)(gou)消(xiao)(xiao)(xiao)毒(du)(du)(du)(du)滅(mie)菌(jun)工(gong)(gong)作(zuo)(zuo)亟待加(jia)強(qiang)，監(jian)(jian)(jian)(jian)督(du)(du)檢(jian)查(cha)標(biao)準需(xu)要(yao)(yao)修訂，分(fen)(fen)(fen)(fen)值權重需(xu)增加(jia)，監(jian)(jian)(jian)(jian)督(du)(du)檢(jian)查(cha)及(ji)其(qi)違法(fa)(fa)查(cha)處(chu)力度(du)(du)需(xu)要(yao)(yao)加(jia)大。（3）建(jian)(jian)議對(dui)“評(ping)分(fen)(fen)(fen)(fen)標(biao)準”進(jin)(jin)行(xing)(xing)再細(xi)化(hua)量化(hua)。當(dang)前執(zhi)行(xing)(xing)標(biao)準定(ding)性(xing)(xing)判斷多(duo)，量化(hua)評(ping)定(ding)少(shao)。建(jian)(jian)議對(dui)某監(jian)(jian)(jian)(jian)督(du)(du)檢(jian)查(cha)內容按(an)“是”、“否”及(ji)“不(bu)(bu)(bu)(bu)齊全(quan)”、“漏項(xiang)”、“不(bu)(bu)(bu)(bu)完(wan)整”、“記(ji)錄錯(cuo)誤(wu)”、“資料不(bu)(bu)(bu)(bu)實(shi)(shi)(shi)(shi)”、“邏輯錯(cuo)誤(wu)”、“有(you)(you)但未(wei)運(yun)行(xing)(xing)”、“有(you)(you)但缺(que)幾人(ren)”、“有(you)(you)轉診(zhen)但無(wu)(wu)記(ji)錄”、“有(you)(you)記(ji)錄但未(wei)索證”等(deng)(deng)(deng)定(ding)量用語描述，使評(ping)分(fen)(fen)(fen)(fen)標(biao)準更(geng)具量化(hua)操作(zuo)(zuo)性(xing)(xing)。

1材料與方法

1.1資料來源

2011—2013年(nian)新(xin)生兒數據(ju)來(lai)源于鞍(an)山(shan)(shan)市統計年(nian)鑒；脊灰疫(yi)(yi)苗常規(gui)免疫(yi)(yi)接(jie)種情況、急性(xing)弛(chi)緩(huan)性(xing)麻痹（AFP）病例監(jian)測(ce)(ce)資(zi)(zi)料(liao)來(lai)源于“中(zhong)(zhong)國(guo)免疫(yi)(yi)規(gui)劃監(jian)測(ce)(ce)信(xin)息管理(li)系統”，常規(gui)免疫(yi)(yi)接(jie)種率報告數據(ju)、AFP監(jian)測(ce)(ce)數據(ju)及脊灰疫(yi)(yi)苗強化(hua)免疫(yi)(yi)資(zi)(zi)料(liao)為(wei)鞍(an)山(shan)(shan)市免疫(yi)(yi)規(gui)劃歷年(nian)工作痕跡資(zi)(zi)料(liao)；麻疹疫(yi)(yi)情數據(ju)來(lai)源于中(zhong)(zhong)國(guo)傳染(ran)病疫(yi)(yi)情監(jian)測(ce)(ce)信(xin)息報告管理(li)系統。

1.2評估指標

按照《2014年脊灰野(ye)病(bing)(bing)毒輸(shu)入傳播(bo)風(feng)(feng)險(xian)評(ping)(ping)估(gu)(gu)方案》，根(gen)據得(de)分(fen)(fen)情況綜合判(pan)定風(feng)(feng)險(xian)等級(ji)(ji)(ji)。風(feng)(feng)險(xian)評(ping)(ping)估(gu)(gu)總分(fen)(fen)由(you)3項一級(ji)(ji)(ji)指標(biao)(biao)評(ping)(ping)分(fen)(fen)乘(cheng)以不同權重系數(shu)后(hou)相加(jia)得(de)到(dao)，根(gen)據總分(fen)(fen)分(fen)(fen)值獲得(de)情況判(pan)定風(feng)(feng)險(xian)高、中、低的(de)分(fen)(fen)級(ji)(ji)(ji)。一級(ji)(ji)(ji)評(ping)(ping)估(gu)(gu)指標(biao)(biao)包括(kuo)人群免疫情況、AFP病(bing)(bing)例監(jian)測(ce)系統運轉(zhuan)情況和脊灰野(ye)病(bing)(bing)毒輸(shu)入風(feng)(feng)險(xian)。每項一級(ji)(ji)(ji)評(ping)(ping)估(gu)(gu)指標(biao)(biao)由(you)相對獨立(li)的(de)二(er)級(ji)(ji)(ji)指標(biao)(biao)構成，各(ge)二(er)級(ji)(ji)(ji)指標(biao)(biao)根(gen)據相關標(biao)(biao)準(zhun)給出評(ping)(ping)分(fen)(fen)，各(ge)二(er)級(ji)(ji)(ji)指標(biao)(biao)分(fen)(fen)數(shu)相加(jia)，得(de)到(dao)一級(ji)(ji)(ji)評(ping)(ping)分(fen)(fen)，見(jian)表(biao)1。對15歲以下人口數(shu)少(shao)于(yu)10萬人的(de)地(di)區，應累計年度計算AFP病(bing)(bing)例報(bao)告(gao)發病(bing)(bing)率。

2結果

狂(kuang)(kuang)犬病(bing)(bing)(bing)是由狂(kuang)(kuang)犬病(bing)(bing)(bing)病(bing)(bing)(bing)毒感染引(yin)起［1］，病(bing)(bing)(bing)死率幾(ji)乎(hu)100%。全球每年(nian)超(chao)過55000人(ren)死于狂(kuang)(kuang)犬病(bing)(bing)(bing)，其中95％以(yi)上來(lai)自亞洲和(he)非洲，我(wo)國發(fa)病(bing)(bing)(bing)人(ren)數僅(jin)次于印度，居全球第2位［2-3］。1949年(nian)后我(wo)國狂(kuang)(kuang)犬病(bing)(bing)(bing)先后出現(xian)3次流(liu)行(xing)高(gao)峰(feng)，雖然疫情(qing)得到控制(zhi)，但(dan)缺乏長效機制(zhi)，疫情(qing)可(ke)再度上升［4］。近(jin)年(nian)來(lai)，北(bei)京市狂(kuang)(kuang)犬病(bing)(bing)(bing)有(you)流(liu)行(xing)趨(qu)勢，順義(yi)區也(ye)出現(xian)病(bing)(bing)(bing)例增多現(xian)象(xiang)。通過對順義(yi)區有(you)檔案記錄(lu)以(yi)來(lai)的(de)狂(kuang)(kuang)犬病(bing)(bing)(bing)病(bing)(bing)(bing)例歷(li)史數據、2002－2016年(nian)狂(kuang)(kuang)犬病(bing)(bing)(bing)免(mian)疫預(yu)防(fang)門診監測數據和(he)2010－2016年(nian)發(fa)生(sheng)的(de)一犬致(zhi)傷多人(ren)事件進行(xing)分析，評估順義(yi)區狂(kuang)(kuang)犬病(bing)(bing)(bing)的(de)發(fa)病(bing)(bing)(bing)風險，為制(zhi)定狂(kuang)(kuang)犬病(bing)(bing)(bing)防(fang)控策略(lve)提供科學(xue)依據。

1材料與方法

1.1資(zi)料來源。狂(kuang)(kuang)犬(quan)(quan)(quan)病(bing)(bing)(bing)(bing)病(bing)(bing)(bing)(bing)例(li)信息來自(zi)中國疾病(bing)(bing)(bing)(bing)監(jian)測信息報告管理(li)系統(tong)和(he)(he)順(shun)義區CDC流(liu)行(xing)(xing)病(bing)(bing)(bing)(bing)學調查資(zi)料。人(ren)口資(zi)料來自(zi)北京市統(tong)計局。狂(kuang)(kuang)犬(quan)(quan)(quan)病(bing)(bing)(bing)(bing)暴(bao)(bao)露(lu)監(jian)測資(zi)料來源于順(shun)義區狂(kuang)(kuang)犬(quan)(quan)(quan)病(bing)(bing)(bing)(bing)免疫預防(fang)門診(zhen)2002－2016年(nian)(nian)就診(zhen)登(deng)(deng)記(ji)數據(ju)(ju)。1.2方法(fa)。1.2.1狂(kuang)(kuang)犬(quan)(quan)(quan)病(bing)(bing)(bing)(bing)暴(bao)(bao)露(lu)分(fen)級。2008年(nian)(nian)及以前數據(ju)(ju)根據(ju)(ju)衛生部《狂(kuang)(kuang)犬(quan)(quan)(quan)病(bing)(bing)(bing)(bing)暴(bao)(bao)露(lu)后處(chu)(chu)置工作規(gui)范（試行(xing)(xing)）》執(zhi)行(xing)(xing)，2009年(nian)(nian)后狂(kuang)(kuang)犬(quan)(quan)(quan)病(bing)(bing)(bing)(bing)暴(bao)(bao)露(lu)分(fen)級按《狂(kuang)(kuang)犬(quan)(quan)(quan)病(bing)(bing)(bing)(bing)暴(bao)(bao)露(lu)預防(fang)處(chu)(chu)置工作規(gui)范（2009年(nian)(nian)版）》執(zhi)行(xing)(xing)。1.2.2狂(kuang)(kuang)犬(quan)(quan)(quan)病(bing)(bing)(bing)(bing)診(zhen)斷標準(zhun)2007年(nian)(nian)10月15日前根據(ju)(ju)《狂(kuang)(kuang)犬(quan)(quan)(quan)病(bing)(bing)(bing)(bing)診(zhen)斷標準(zhun)及處(chu)(chu)理(li)原則》（GB17014－1997），之后根據(ju)(ju)《狂(kuang)(kuang)犬(quan)(quan)(quan)病(bing)(bing)(bing)(bing)診(zhen)斷標準(zhun)》（WS281－2008）。1.3統(tong)計學處(chu)(chu)理(li)。將(jiang)登(deng)(deng)記(ji)資(zi)料核(he)對無誤(wu)后錄入EpiData數據(ju)(ju)庫，利用(yong)SPSS13.0和(he)(he)Excel2010軟件進行(xing)(xing)描述(shu)性流(liu)行(xing)(xing)病(bing)(bing)(bing)(bing)學統(tong)計分(fen)析(xi)；定性資(zi)料率(lv)的比較采用(yong)χ2檢(jian)驗。P＜0.05為差異有統(tong)計學意義。

2結果

2.1狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)歷史發病(bing)(bing)(bing)(bing)(bing)(bing)(bing)情況(kuang)。1960－2016年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)順(shun)(shun)義(yi)(yi)區(qu)共(gong)報(bao)(bao)(bao)告狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)26例(li)(li)(li)(li)(li)，其(qi)(qi)發病(bing)(bing)(bing)(bing)(bing)(bing)(bing)情況(kuang)與全國狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)流行(xing)(xing)基本一(yi)(yi)致(zhi)(zhi)［4］，20世紀(ji)70年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)代(dai)開(kai)始至80年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)代(dai)末出(chu)(chu)現(xian)第(di)(di)1個(ge)高(gao)峰(feng)，1992－2009無(wu)(wu)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)例(li)(li)(li)(li)(li)報(bao)(bao)(bao)告，2010年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)出(chu)(chu)現(xian)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)例(li)(li)(li)(li)(li)，發病(bing)(bing)(bing)(bing)(bing)(bing)(bing)數(shu)(shu)及(ji)發病(bing)(bing)(bing)(bing)(bing)(bing)(bing)率見圖(tu)1。2010－2016年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)順(shun)(shun)義(yi)(yi)區(qu)共(gong)報(bao)(bao)(bao)告狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)例(li)(li)(li)(li)(li)6例(li)(li)(li)(li)(li)，男(nan)女性(xing)(xing)各(ge)(ge)3例(li)(li)(li)(li)(li)，年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)齡為(wei)(wei)(wei)43～56歲(sui)(sui)。病(bing)(bing)(bing)(bing)(bing)(bing)(bing)例(li)(li)(li)(li)(li)分布后(hou)沙(sha)峪(yu)鎮3例(li)(li)(li)(li)(li)，趙(zhao)全營、李(li)遂和北(bei)石槽鎮各(ge)(ge)1例(li)(li)(li)(li)(li)。其(qi)(qi)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)4例(li)(li)(li)(li)(li)被(bei)(bei)犬(quan)(quan)(quan)(quan)致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)后(hou)未到(dao)(dao)狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)免(mian)(mian)(mian)疫(yi)(yi)(yi)(yi)(yi)(yi)預防(fang)(fang)門(men)(men)(men)診(zhen)(zhen)(zhen)(zhen)(zhen)進(jin)行(xing)(xing)正規(gui)處(chu)(chu)置(zhi)，1例(li)(li)(li)(li)(li)無(wu)(wu)明(ming)(ming)確(que)咬傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)史，1例(li)(li)(li)(li)(li)先在非狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)門(men)(men)(men)診(zhen)(zhen)(zhen)(zhen)(zhen)進(jin)行(xing)(xing)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)口(kou)(kou)縫合后(hou)再到(dao)(dao)狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)免(mian)(mian)(mian)疫(yi)(yi)(yi)(yi)(yi)(yi)預防(fang)(fang)門(men)(men)(men)診(zhen)(zhen)(zhen)(zhen)(zhen)接(jie)(jie)種(zhong)疫(yi)(yi)(yi)(yi)(yi)(yi)苗(miao)，未進(jin)行(xing)(xing)正規(gui)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)口(kou)(kou)處(chu)(chu)置(zhi)。從發病(bing)(bing)(bing)(bing)(bing)(bing)(bing)到(dao)(dao)死(si)亡一(yi)(yi)般≤7d。傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)人(ren)(ren)(ren)犬(quan)(quan)(quan)(quan)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)2只(zhi)(zhi)為(wei)(wei)(wei)自(zi)(zi)(zi)養犬(quan)(quan)(quan)(quan)，4只(zhi)(zhi)為(wei)(wei)(wei)流浪犬(quan)(quan)(quan)(quan)；3例(li)(li)(li)(li)(li)患者(zhe)(zhe)(zhe)(zhe)家中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)出(chu)(chu)現(xian)犬(quan)(quan)(quan)(quan)只(zhi)(zhi)異(yi)常死(si)亡現(xian)象，表現(xian)為(wei)(wei)(wei)異(yi)常吼叫、吃煤(mei)、腦(nao)脊髓(sui)膜炎等疑似犬(quan)(quan)(quan)(quan)間(jian)狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)疫(yi)(yi)(yi)(yi)(yi)(yi)情。2.2狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)免(mian)(mian)(mian)疫(yi)(yi)(yi)(yi)(yi)(yi)預防(fang)(fang)門(men)(men)(men)診(zhen)(zhen)(zhen)(zhen)(zhen)設(she)(she)置(zhi)。順(shun)(shun)義(yi)(yi)區(qu)2005年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)前(qian)僅有區(qu)衛生(sheng)(sheng)(sheng)防(fang)(fang)疫(yi)(yi)(yi)(yi)(yi)(yi)站1家狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)免(mian)(mian)(mian)疫(yi)(yi)(yi)(yi)(yi)(yi)預防(fang)(fang)門(men)(men)(men)診(zhen)(zhen)(zhen)(zhen)(zhen)（2002年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)順(shun)(shun)義(yi)(yi)區(qu)衛生(sheng)(sheng)(sheng)防(fang)(fang)疫(yi)(yi)(yi)(yi)(yi)(yi)站根據上(shang)級要(yao)求分為(wei)(wei)(wei)順(shun)(shun)義(yi)(yi)區(qu)CDC和衛生(sheng)(sheng)(sheng)監督(du)所2個(ge)單位(wei)，狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)免(mian)(mian)(mian)疫(yi)(yi)(yi)(yi)(yi)(yi)預防(fang)(fang)門(men)(men)(men)診(zhen)(zhen)(zhen)(zhen)(zhen)設(she)(she)在順(shun)(shun)義(yi)(yi)區(qu)CDC），于2005年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)底增設(she)(she)楊鎮衛生(sheng)(sheng)(sheng)院(yuan)門(men)(men)(men)診(zhen)(zhen)(zhen)(zhen)(zhen)，2007年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)6月(yue)(yue)(yue)增設(she)(she)空港醫院(yuan)門(men)(men)(men)診(zhen)(zhen)(zhen)(zhen)(zhen)，2009年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)7月(yue)(yue)(yue)增設(she)(she)牛山衛生(sheng)(sheng)(sheng)院(yuan)門(men)(men)(men)診(zhen)(zhen)(zhen)(zhen)(zhen)，2010年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)3月(yue)(yue)(yue)順(shun)(shun)義(yi)(yi)區(qu)CDC門(men)(men)(men)診(zhen)(zhen)(zhen)(zhen)(zhen)停(ting)診(zhen)(zhen)(zhen)(zhen)(zhen)，增設(she)(she)順(shun)(shun)義(yi)(yi)區(qu)結核病(bing)(bing)(bing)(bing)(bing)(bing)(bing)防(fang)(fang)治中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)心和馬(ma)坡衛生(sheng)(sheng)(sheng)院(yuan)門(men)(men)(men)診(zhen)(zhen)(zhen)(zhen)(zhen)，2014年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)3月(yue)(yue)(yue)增設(she)(she)木(mu)林衛生(sheng)(sheng)(sheng)院(yuan)門(men)(men)(men)診(zhen)(zhen)(zhen)(zhen)(zhen)，目前(qian)，順(shun)(shun)義(yi)(yi)區(qu)有6家狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)免(mian)(mian)(mian)疫(yi)(yi)(yi)(yi)(yi)(yi)預防(fang)(fang)門(men)(men)(men)診(zhen)(zhen)(zhen)(zhen)(zhen)。2.3狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)情況(kuang)。2.3.1狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)概況(kuang)2002－2016年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)順(shun)(shun)義(yi)(yi)區(qu)共(gong)接(jie)(jie)診(zhen)(zhen)(zhen)(zhen)(zhen)狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)患者(zhe)(zhe)(zhe)(zhe)124019例(li)(li)(li)(li)(li)，自(zi)(zi)(zi)2002年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)開(kai)始暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)率呈逐年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)增長趨(qu)勢，2008年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)達到(dao)(dao)高(gao)峰(feng)后(hou)有所回落，2014年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)再次升高(gao)，見圖(tu)2。致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)男(nan)女性(xing)(xing)別比為(wei)(wei)(wei)1.26∶1，男(nan)性(xing)(xing)多(duo)(duo)于女性(xing)(xing)，差異(yi)有統(tong)計(ji)學(xue)(xue)意義(yi)(yi)（χ2＝228.450，P＜0.05）。2.3.2暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)時間(jian)分布2002－2016年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)各(ge)(ge)月(yue)(yue)(yue)均有狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)發生(sheng)(sheng)(sheng)，2005年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)前(qian)季節分布不明(ming)(ming)顯(xian)。2005年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)后(hou)夏(xia)季有明(ming)(ming)顯(xian)的季節性(xing)(xing)高(gao)峰(feng)，5－8月(yue)(yue)(yue)致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)人(ren)(ren)(ren)數(shu)(shu)達54665例(li)(li)(li)(li)(li)，占(zhan)(zhan)全年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)總病(bing)(bing)(bing)(bing)(bing)(bing)(bing)例(li)(li)(li)(li)(li)數(shu)(shu)的44.10%，見圖(tu)3。2.3.3暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)部(bu)位(wei)患者(zhe)(zhe)(zhe)(zhe)下(xia)肢和手(shou)為(wei)(wei)(wei)易受(shou)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)害部(bu)位(wei)，共(gong)100955例(li)(li)(li)(li)(li)，占(zhan)(zhan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)例(li)(li)(li)(li)(li)總數(shu)(shu)的81.40%；其(qi)(qi)次為(wei)(wei)(wei)上(shang)肢，占(zhan)(zhan)2.3.4暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)人(ren)(ren)(ren)群(qun)職業(ye)(ye)和年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)齡分布暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)人(ren)(ren)(ren)群(qun)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)最(zui)多(duo)(duo)的為(wei)(wei)(wei)工人(ren)(ren)(ren)及(ji)農(nong)民，占(zhan)(zhan)暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)總數(shu)(shu)的32.68%；其(qi)(qi)次為(wei)(wei)(wei)職員(yuan)，占(zhan)(zhan)30.91%；學(xue)(xue)生(sheng)(sheng)(sheng)和學(xue)(xue)齡前(qian)兒童(tong)分別占(zhan)(zhan)15.00%和9.30%；離退(tui)休、待(dai)業(ye)(ye)、無(wu)(wu)業(ye)(ye)人(ren)(ren)(ren)員(yuan)和其(qi)(qi)他人(ren)(ren)(ren)員(yuan)占(zhan)(zhan)12.11%。自(zi)(zi)(zi)2002年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)開(kai)始，暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)人(ren)(ren)(ren)群(qun)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)職員(yuan)比例(li)(li)(li)(li)(li)逐漸增多(duo)(duo)，工人(ren)(ren)(ren)及(ji)農(nong)民比例(li)(li)(li)(li)(li)逐漸減少，離退(tui)休、待(dai)業(ye)(ye)、無(wu)(wu)業(ye)(ye)人(ren)(ren)(ren)員(yuan)所占(zhan)(zhan)比例(li)(li)(li)(li)(li)逐漸減少。暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)人(ren)(ren)(ren)群(qun)以中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)青(qing)年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)為(wei)(wei)(wei)主，其(qi)(qi)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)20～49歲(sui)(sui)年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)齡組占(zhan)(zhan)51.13%，各(ge)(ge)年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)齡組暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)人(ren)(ren)(ren)群(qun)年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)度變(bian)(bian)化基本穩定，變(bian)(bian)化趨(qu)勢不明(ming)(ming)顯(xian)。2.3.5暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)者(zhe)(zhe)(zhe)(zhe)致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)動(dong)(dong)(dong)物(wu)(wu)順(shun)(shun)義(yi)(yi)區(qu)2002－2016年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)動(dong)(dong)(dong)物(wu)(wu)主要(yao)是(shi)犬(quan)(quan)(quan)(quan)，犬(quan)(quan)(quan)(quan)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)人(ren)(ren)(ren)數(shu)(shu)占(zhan)(zhan)所有致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)后(hou)就診(zhen)(zhen)(zhen)(zhen)(zhen)人(ren)(ren)(ren)數(shu)(shu)的75%以上(shang)（圖(tu)2），其(qi)(qi)余為(wei)(wei)(wei)貓及(ji)其(qi)(qi)他動(dong)(dong)(dong)物(wu)(wu)。2007－2016年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)犬(quan)(quan)(quan)(quan)為(wei)(wei)(wei)92527只(zhi)(zhi)，其(qi)(qi)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)32918只(zhi)(zhi)在1年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)內有狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)疫(yi)(yi)(yi)(yi)(yi)(yi)苗(miao)免(mian)(mian)(mian)疫(yi)(yi)(yi)(yi)(yi)(yi)史，占(zhan)(zhan)總數(shu)(shu)的35.58%，各(ge)(ge)年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)度免(mian)(mian)(mian)疫(yi)(yi)(yi)(yi)(yi)(yi)史在29.00%～40.00%之間(jian)，無(wu)(wu)明(ming)(ming)顯(xian)變(bian)(bian)化趨(qu)勢。2.4狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)后(hou)處(chu)(chu)理(li)(li)情況(kuang)順(shun)(shun)義(yi)(yi)區(qu)參照(zhao)規(gui)范對狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)者(zhe)(zhe)(zhe)(zhe)進(jin)行(xing)(xing)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)口(kou)(kou)處(chu)(chu)理(li)(li)、狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)被(bei)(bei)動(dong)(dong)(dong)免(mian)(mian)(mian)疫(yi)(yi)(yi)(yi)(yi)(yi)制劑(ji)注射及(ji)疫(yi)(yi)(yi)(yi)(yi)(yi)苗(miao)接(jie)(jie)種(zhong)等。自(zi)(zi)(zi)2008年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)開(kai)始統(tong)計(ji)暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)前(qian)免(mian)(mian)(mian)疫(yi)(yi)(yi)(yi)(yi)(yi)人(ren)(ren)(ren)群(qun)，2010年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)出(chu)(chu)現(xian)狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)例(li)(li)(li)(li)(li)后(hou)開(kai)始統(tong)計(ji)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)例(li)(li)(li)(li)(li)密切接(jie)(jie)觸者(zhe)(zhe)(zhe)(zhe)，共(gong)包括344人(ren)(ren)(ren)，占(zhan)(zhan)所有暴(bao)(bao)(bao)(bao)(bao)露(lu)(lu)(lu)人(ren)(ren)(ren)數(shu)(shu)的0.35%。疫(yi)(yi)(yi)(yi)(yi)(yi)苗(miao)接(jie)(jie)種(zhong)一(yi)(yi)直采用(yong)(yong)第(di)(di)0、3、7、14、28天(tian)接(jie)(jie)種(zhong)程(cheng)序(xu)，2014年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)啟(qi)用(yong)(yong)第(di)(di)2-1-1接(jie)(jie)種(zhong)程(cheng)序(xu)（即第(di)(di)0天(tian)2劑(ji)、第(di)(di)7和21天(tian)各(ge)(ge)1劑(ji)）。2002－2008年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)動(dong)(dong)(dong)物(wu)(wu)致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)后(hou)24h內就診(zhen)(zhen)(zhen)(zhen)(zhen)并注射狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)疫(yi)(yi)(yi)(yi)(yi)(yi)苗(miao)的比例(li)(li)(li)(li)(li)為(wei)(wei)(wei)89.87%［5］，2009－2016年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)為(wei)(wei)(wei)75.41%～80.32%。2009年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)前(qian)使(shi)(shi)(shi)用(yong)(yong)被(bei)(bei)動(dong)(dong)(dong)免(mian)(mian)(mian)疫(yi)(yi)(yi)(yi)(yi)(yi)制劑(ji)為(wei)(wei)(wei)抗(kang)狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)血清，2009年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)增加使(shi)(shi)(shi)用(yong)(yong)抗(kang)狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)免(mian)(mian)(mian)疫(yi)(yi)(yi)(yi)(yi)(yi)球蛋(dan)白(bai)。2008－2016年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)Ⅲ級傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)口(kou)(kou)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)例(li)(li)(li)(li)(li)49356例(li)(li)(li)(li)(li)，占(zhan)(zhan)所有就診(zhen)(zhen)(zhen)(zhen)(zhen)致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)人(ren)(ren)(ren)數(shu)(shu)的50.08%；使(shi)(shi)(shi)用(yong)(yong)被(bei)(bei)動(dong)(dong)(dong)免(mian)(mian)(mian)疫(yi)(yi)(yi)(yi)(yi)(yi)制劑(ji)者(zhe)(zhe)(zhe)(zhe)8432人(ren)(ren)(ren)，使(shi)(shi)(shi)用(yong)(yong)率為(wei)(wei)(wei)17.08%，見表2。2.5一(yi)(yi)犬(quan)(quan)(quan)(quan)致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)2010年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)報(bao)(bao)(bao)告一(yi)(yi)犬(quan)(quan)(quan)(quan)致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)8人(ren)(ren)(ren)事(shi)件(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)的其(qi)(qi)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)1名致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)者(zhe)(zhe)(zhe)(zhe)后(hou)，北(bei)京市(shi)自(zi)(zi)(zi)2011年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)開(kai)始要(yao)求一(yi)(yi)犬(quan)(quan)(quan)(quan)致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)＞2人(ren)(ren)(ren)事(shi)件(jian)(jian)(jian)要(yao)進(jin)行(xing)(xing)報(bao)(bao)(bao)告處(chu)(chu)理(li)(li)。目前(qian)，順(shun)(shun)義(yi)(yi)區(qu)共(gong)報(bao)(bao)(bao)告20起一(yi)(yi)犬(quan)(quan)(quan)(quan)致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)多(duo)(duo)人(ren)(ren)(ren)事(shi)件(jian)(jian)(jian)，共(gong)涉及(ji)87人(ren)(ren)(ren)，其(qi)(qi)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)男(nan)性(xing)(xing)48人(ren)(ren)(ren)、女性(xing)(xing)39人(ren)(ren)(ren)，男(nan)女性(xing)(xing)別比為(wei)(wei)(wei)1.23∶1；年(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)(nian)齡最(zui)小者(zhe)(zhe)(zhe)(zhe)1歲(sui)(sui)，最(zui)大者(zhe)(zhe)(zhe)(zhe)80歲(sui)(sui)，中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)位(wei)數(shu)(shu)43歲(sui)(sui)。被(bei)(bei)致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)者(zhe)(zhe)(zhe)(zhe)Ⅰ級傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)口(kou)(kou)1人(ren)(ren)(ren)，Ⅱ級傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)口(kou)(kou)7人(ren)(ren)(ren)，Ⅲ級傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)口(kou)(kou)79人(ren)(ren)(ren)。對其(qi)(qi)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)8起一(yi)(yi)犬(quan)(quan)(quan)(quan)致(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)多(duo)(duo)人(ren)(ren)(ren)事(shi)件(jian)(jian)(jian)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)的44人(ren)(ren)(ren)進(jin)行(xing)(xing)追蹤狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)疫(yi)(yi)(yi)(yi)(yi)(yi)苗(miao)全程(cheng)接(jie)(jie)種(zhong)情況(kuang)，40人(ren)(ren)(ren)完成全程(cheng)接(jie)(jie)種(zhong)，占(zhan)(zhan)追蹤總人(ren)(ren)(ren)數(shu)(shu)的90.91%。對其(qi)(qi)中(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)5只(zhi)(zhi)傷(shang)(shang)(shang)(shang)(shang)(shang)(shang)人(ren)(ren)(ren)犬(quan)(quan)(quan)(quan)進(jin)行(xing)(xing)狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)毒感染情況(kuang)檢測，狂(kuang)(kuang)犬(quan)(quan)(quan)(quan)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)病(bing)(bing)(bing)(bing)(bing)(bing)(bing)毒陽性(xing)(xing)2只(zhi)(zhi)。

3討論

脊(ji)(ji)(ji)(ji)髓灰(hui)(hui)質炎(yan)（以下簡(jian)稱(cheng)(cheng)脊(ji)(ji)(ji)(ji)灰(hui)(hui)）是(shi)由脊(ji)(ji)(ji)(ji)髓灰(hui)(hui)質炎(yan)病(bing)毒(du)(du)(du)(du)引(yin)起的(de)一種急性傳染(ran)病(bing)。臨床(chuang)表現(xian)(xian)主(zhu)要有(you)發(fa)熱，咽痛和(he)肢(zhi)體疼痛，部分病(bing)人(ren)可發(fa)生(sheng)(sheng)遲緩性麻痹［1］。2000年，包括(kuo)我(wo)國(guo)(guo)(guo)(guo)在(zai)內的(de)世界衛(wei)(wei)生(sheng)(sheng)組織西(xi)太平洋區(qu)證(zheng)實無脊(ji)(ji)(ji)(ji)灰(hui)(hui)［2］。近年來，世界上多(duo)個非本土(tu)流(liu)行(xing)(xing)國(guo)(guo)(guo)(guo)家(jia)(jia)發(fa)生(sheng)(sheng)脊(ji)(ji)(ji)(ji)灰(hui)(hui)野(ye)病(bing)毒(du)(du)(du)(du)（簡(jian)稱(cheng)(cheng)WPV）輸(shu)入(ru)并引(yin)起持續傳播(bo)［3］。本土(tu)流(liu)行(xing)(xing)的(de)國(guo)(guo)(guo)(guo)家(jia)(jia)中2個國(guo)(guo)(guo)(guo)家(jia)(jia)（阿富汗和(he)巴基斯(si)坦）與(yu)我(wo)國(guo)(guo)(guo)(guo)相鄰，持續存在(zai)脊(ji)(ji)(ji)(ji)灰(hui)(hui)野(ye)病(bing)毒(du)(du)(du)(du)輸(shu)入(ru)風險(xian)。2011－08，新(xin)疆(jiang)發(fa)生(sheng)(sheng)脊(ji)(ji)(ji)(ji)灰(hui)(hui)野(ye)病(bing)毒(du)(du)(du)(du)輸(shu)入(ru)［4］。截止2011－12－14，新(xin)疆(jiang)自(zi)治區(qu)累(lei)計(ji)確診(zhen)I型脊(ji)(ji)(ji)(ji)灰(hui)(hui)野(ye)病(bing)毒(du)(du)(du)(du)病(bing)例20例［5］。2014年，全球脊(ji)(ji)(ji)(ji)灰(hui)(hui)野(ye)病(bing)毒(du)(du)(du)(du)的(de)傳播(bo)仍未阻斷(duan)，多(duo)個國(guo)(guo)(guo)(guo)家(jia)(jia)發(fa)生(sheng)(sheng)了脊(ji)(ji)(ji)(ji)灰(hui)(hui)野(ye)病(bing)毒(du)(du)(du)(du)的(de)跨境傳播(bo)。2014－05－05，WHO宣布2014年WPV的(de)國(guo)(guo)(guo)(guo)際傳播(bo)為國(guo)(guo)(guo)(guo)際關注的(de)突發(fa)公共衛(wei)(wei)生(sheng)(sheng)事件［6］，脊(ji)(ji)(ji)(ji)灰(hui)(hui)野(ye)病(bing)毒(du)(du)(du)(du)的(de)局(ju)部流(liu)行(xing)(xing)若(ruo)控制不當，有(you)擴大流(liu)行(xing)(xing)的(de)風險(xian)。風險(xian)評估能為公共衛(wei)(wei)生(sheng)(sheng)工作(zuo)者科學有(you)效應對脊(ji)(ji)(ji)(ji)灰(hui)(hui)疫情提(ti)供依據，切(qie)實保護(hu)公眾(zhong)健康安全［7］。現(xian)(xian)就(jiu)成(cheng)都(dou)市青白江區(qu)脊(ji)(ji)(ji)(ji)髓灰(hui)(hui)質炎(yan)野(ye)病(bing)毒(du)(du)(du)(du)輸(shu)入(ru)與(yu)傳播(bo)的(de)風險(xian)進行(xing)(xing)評估以發(fa)現(xian)(xian)薄弱地區(qu)和(he)薄弱環節，為青白江區(qu)提(ti)出針對性的(de)防控措(cuo)施提(ti)供參考。

1材料與方法

1．1資料來源。基(ji)本資料來源于(yu)《青白江(jiang)區統計年(nian)鑒》；常(chang)規免疫接種情(qing)況(kuang)來源于(yu)“中國(guo)(guo)免疫規劃信(xin)息管理(li)系(xi)統”；急(ji)性(xing)弛緩(huan)(huan)性(xing)麻(ma)痹（AFP）病(bing)例監測(ce)資料來源于(yu)“AFP監測(ce)信(xin)息報告(gao)管理(li)系(xi)統”；麻(ma)疹(zhen)疫情(qing)資料來源于(yu)“麻(ma)疹(zhen)監測(ce)報告(gao)管理(li)系(xi)統”。1．2方法(fa)。參照《中國(guo)(guo)疾病(bing)預防控(kong)制中心關(guan)(guan)于(yu)開展脊髓灰(hui)質(zhi)炎野(ye)病(bing)毒(du)輸入傳播風(feng)(feng)(feng)險(xian)(xian)評(ping)(ping)估的(de)(de)通知》，用(yong)兩級(ji)(ji)指(zhi)(zhi)(zhi)標(biao)(biao)進(jin)行風(feng)(feng)(feng)險(xian)(xian)評(ping)(ping)估。一(yi)級(ji)(ji)評(ping)(ping)估指(zhi)(zhi)(zhi)標(biao)(biao)包括人(ren)群免疫情(qing)況(kuang)、急(ji)性(xing)弛緩(huan)(huan)性(xing)麻(ma)痹病(bing)例監測(ce)系(xi)統運轉情(qing)況(kuang)和脊灰(hui)野(ye)病(bing)毒(du)輸入風(feng)(feng)(feng)險(xian)(xian)。每項一(yi)級(ji)(ji)評(ping)(ping)估指(zhi)(zhi)(zhi)標(biao)(biao)由(you)相(xiang)(xiang)對(dui)獨立的(de)(de)二(er)級(ji)(ji)指(zhi)(zhi)(zhi)標(biao)(biao)構成，各二(er)級(ji)(ji)指(zhi)(zhi)(zhi)標(biao)(biao)根據(ju)相(xiang)(xiang)關(guan)(guan)標(biao)(biao)準給出評(ping)(ping)分(fen)(fen)(fen)，各二(er)級(ji)(ji)指(zhi)(zhi)(zhi)標(biao)(biao)分(fen)(fen)(fen)數(shu)相(xiang)(xiang)加(jia)，得到一(yi)級(ji)(ji)評(ping)(ping)分(fen)(fen)(fen)。一(yi)級(ji)(ji)指(zhi)(zhi)(zhi)標(biao)(biao)評(ping)(ping)分(fen)(fen)(fen)乘以不(bu)同權重系(xi)數(shu)（其中人(ren)群免疫情(qing)況(kuang)權重為(wei)5，AFP病(bing)例監測(ce)情(qing)況(kuang)權重為(wei)3，輸入風(feng)(feng)(feng)險(xian)(xian)權重為(wei)1）后相(xiang)(xiang)加(jia)得到總分(fen)(fen)(fen)。1．3風(feng)(feng)(feng)險(xian)(xian)級(ji)(ji)別評(ping)(ping)價標(biao)(biao)準。3項指(zhi)(zhi)(zhi)標(biao)(biao)評(ping)(ping)分(fen)(fen)(fen)乘以不(bu)同權重系(xi)數(shu)后相(xiang)(xiang)加(jia)得到，總分(fen)(fen)(fen)分(fen)(fen)(fen)值＜10分(fen)(fen)(fen)判(pan)定為(wei)低(di)風(feng)(feng)(feng)險(xian)(xian)地區，分(fen)(fen)(fen)值在(zai)10～20分(fen)(fen)(fen)判(pan)定為(wei)中風(feng)(feng)(feng)險(xian)(xian)地區，分(fen)(fen)(fen)值﹥20分(fen)(fen)(fen)判(pan)定為(wei)高風(feng)(feng)(feng)險(xian)(xian)地區。

2結果

2．1基(ji)(ji)(ji)(ji)本(ben)(ben)情(qing)況(kuang)。青(qing)白(bai)江區(qu)(qu)(qu)(qu)(qu)(qu)位于(yu)成(cheng)(cheng)(cheng)都(dou)(dou)(dou)市東北(bei)(bei)，東連金堂(tang)縣，南(nan)(nan)鄰龍泉驛(yi)區(qu)(qu)(qu)(qu)(qu)(qu)，西接(jie)(jie)(jie)新(xin)都(dou)(dou)(dou)區(qu)(qu)(qu)(qu)(qu)(qu)，北(bei)(bei)靠四(si)川省(sheng)(sheng)廣漢市，距(ju)中(zhong)(zhong)心(xin)(xin)城(cheng)區(qu)(qu)(qu)(qu)(qu)(qu)17公里，幅員(yuan)面(mian)(mian)積面(mian)(mian)積378．94平(ping)(ping)方公里，轄11個(ge)(ge)鄉鎮(zhen)（街道(dao)）、121個(ge)(ge)行(xing)政(zheng)村（社(she)區(qu)(qu)(qu)(qu)(qu)(qu)），2016戶籍(ji)總人(ren)(ren)口41．96萬(wan)(wan)，出生(sheng)(sheng)率(lv)(lv)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)10．01‰；2014年(nian)(nian)(nian)、2015年(nian)(nian)(nian)、2016年(nian)(nian)(nian)的(de)(de)新(xin)生(sheng)(sheng)兒(er)(er)人(ren)(ren)數分(fen)(fen)(fen)別(bie)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)3325人(ren)(ren)、4457人(ren)(ren)、4202人(ren)(ren)。青(qing)白(bai)江區(qu)(qu)(qu)(qu)(qu)(qu)是(shi)成(cheng)(cheng)(cheng)都(dou)(dou)(dou)重要的(de)(de)商(shang)用車制造(zao)基(ji)(ji)(ji)(ji)地(di)、新(xin)能(neng)源裝備制造(zao)基(ji)(ji)(ji)(ji)地(di)、新(xin)材料(liao)基(ji)(ji)(ji)(ji)地(di)、國(guo)家(jia)循環經濟示范(fan)基(ji)(ji)(ji)(ji)地(di)和西部(bu)鐵(tie)路(lu)物流(liu)中(zhong)(zhong)心(xin)(xin)。境內交通、能(neng)源、通訊、市政(zheng)等基(ji)(ji)(ji)(ji)礎(chu)設施配套完善，成(cheng)(cheng)(cheng)南(nan)(nan)、成(cheng)(cheng)(cheng)綿高(gao)速公路(lu)和國(guo)道(dao)108線3條主干(gan)(gan)線及(ji)省(sheng)(sheng)道(dao)唐巴路(lu)穿境而(er)過，成(cheng)(cheng)(cheng)青(qing)快速通道(dao)、貨(huo)運—北(bei)(bei)新(xin)干(gan)(gan)線等多條入城(cheng)通道(dao)15分(fen)(fen)(fen)鐘可直(zhi)達(da)(da)(da)中(zhong)(zhong)心(xin)(xin)城(cheng)區(qu)(qu)(qu)(qu)(qu)(qu)；3條出川國(guo)家(jia)干(gan)(gan)線鐵(tie)路(lu)成(cheng)(cheng)(cheng)渝、寶成(cheng)(cheng)(cheng)、達(da)(da)(da)成(cheng)(cheng)(cheng)經過青(qing)白(bai)江，亞洲最大的(de)(de)西部(bu)鐵(tie)路(lu)物流(liu)中(zhong)(zhong)心(xin)(xin)、國(guo)際(ji)鐵(tie)路(lu)物流(liu)樞紐、西南(nan)(nan)地(di)區(qu)(qu)(qu)(qu)(qu)(qu)重要現(xian)代(dai)物流(liu)基(ji)(ji)(ji)(ji)地(di)和成(cheng)(cheng)(cheng)都(dou)(dou)(dou)地(di)區(qu)(qu)(qu)(qu)(qu)(qu)鐵(tie)運唯一(yi)口岸平(ping)(ping)臺。同(tong)時(shi)我區(qu)(qu)(qu)(qu)(qu)(qu)也有勞務人(ren)(ren)員(yuan)前往新(xin)疆(jiang)和西藏地(di)區(qu)(qu)(qu)(qu)(qu)(qu)從事經商(shang)、采(cai)棉、建筑等工(gong)(gong)作。2．2人(ren)(ren)群免(mian)(mian)疫(yi)(yi)狀況(kuang)。2．2．1脊髓灰(hui)質炎疫(yi)(yi)苗(miao)(miao)接(jie)(jie)(jie)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)率(lv)(lv)情(qing)況(kuang)2014－2016年(nian)(nian)(nian)全(quan)(quan)區(qu)(qu)(qu)(qu)(qu)(qu)常住兒(er)(er)童(tong)和流(liu)動(dong)兒(er)(er)童(tong)，脊灰(hui)疫(yi)(yi)苗(miao)(miao)基(ji)(ji)(ji)(ji)礎(chu)和加強免(mian)(mian)疫(yi)(yi)的(de)(de)報(bao)(bao)告(gao)接(jie)(jie)(jie)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)率(lv)(lv)都(dou)(dou)(dou)達(da)(da)(da)到(dao)(dao)了(le)90％以(yi)(yi)(yi)上(shang)；2014－2016年(nian)(nian)(nian)開展的(de)(de)接(jie)(jie)(jie)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)率(lv)(lv)抽樣(yang)調查(cha)，脊灰(hui)疫(yi)(yi)苗(miao)(miao)基(ji)(ji)(ji)(ji)礎(chu)免(mian)(mian)疫(yi)(yi)接(jie)(jie)(jie)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)率(lv)(lv)分(fen)(fen)(fen)別(bie)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)99．52％、100％和98．10％，加強免(mian)(mian)疫(yi)(yi)接(jie)(jie)(jie)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)率(lv)(lv)分(fen)(fen)(fen)別(bie)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)95．24％、93．81％和95．71％。以(yi)(yi)(yi)全(quan)(quan)區(qu)(qu)(qu)(qu)(qu)(qu)戶籍(ji)新(xin)生(sheng)(sheng)兒(er)(er)數為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)分(fen)(fen)(fen)母，脊灰(hui)疫(yi)(yi)苗(miao)(miao)第(di)3劑(ji)次(ci)(ci)(ci)（OPV3）實(shi)(shi)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)數為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)分(fen)(fen)(fen)子，2014－2016年(nian)(nian)(nian)OPV3常規(gui)免(mian)(mian)疫(yi)(yi)估算(suan)接(jie)(jie)(jie)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)率(lv)(lv)分(fen)(fen)(fen)別(bie)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)95．19％（3165／3325）、66．30％（2955／4457）、84．67％（3558／4202），3年(nian)(nian)(nian)平(ping)(ping)均(jun)(jun)估算(suan)接(jie)(jie)(jie)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)率(lv)(lv)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)80．76％。該項(xiang)(xiang)(xiang)(xiang)評(ping)(ping)(ping)(ping)分(fen)(fen)(fen)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)2分(fen)(fen)(fen)（表(biao)1）。2．2．2百(bai)白(bai)破(po)疫(yi)(yi)苗(miao)(miao)接(jie)(jie)(jie)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)率(lv)(lv)情(qing)況(kuang)2014－2016年(nian)(nian)(nian)全(quan)(quan)區(qu)(qu)(qu)(qu)(qu)(qu)常住兒(er)(er)童(tong)和流(liu)動(dong)兒(er)(er)童(tong)，百(bai)白(bai)破(po)疫(yi)(yi)苗(miao)(miao)基(ji)(ji)(ji)(ji)礎(chu)和加強免(mian)(mian)疫(yi)(yi)，報(bao)(bao)告(gao)接(jie)(jie)(jie)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)率(lv)(lv)都(dou)(dou)(dou)達(da)(da)(da)到(dao)(dao)了(le)99％以(yi)(yi)(yi)上(shang)；2014年(nian)(nian)(nian)全(quan)(quan)區(qu)(qu)(qu)(qu)(qu)(qu)百(bai)白(bai)破(po)疫(yi)(yi)苗(miao)(miao)第(di)一(yi)劑(ji)次(ci)(ci)(ci)（DTP1）實(shi)(shi)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)3702人(ren)(ren)，2015年(nian)(nian)(nian)DTP1實(shi)(shi)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)3383人(ren)(ren)，2016年(nian)(nian)(nian)DTP1實(shi)(shi)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)3947人(ren)(ren)，以(yi)(yi)(yi)2016年(nian)(nian)(nian)DTP1實(shi)(shi)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)人(ren)(ren)數減去(qu)2014年(nian)(nian)(nian)DTP1實(shi)(shi)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)人(ren)(ren)數，得到(dao)(dao)的(de)(de)差值除以(yi)(yi)(yi)2014年(nian)(nian)(nian)DTP1實(shi)(shi)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)人(ren)(ren)數，得到(dao)(dao)全(quan)(quan)區(qu)(qu)(qu)(qu)(qu)(qu)百(bai)白(bai)破(po)疫(yi)(yi)苗(miao)(miao)接(jie)(jie)(jie)種(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)(zhong)的(de)(de)變化趨(qu)勢為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)6．62％，該項(xiang)(xiang)(xiang)(xiang)評(ping)(ping)(ping)(ping)分(fen)(fen)(fen)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)0分(fen)(fen)(fen)（表(biao)1）。2．2．3AFP病(bing)(bing)(bing)例(li)(li)(li)(li)的(de)(de)脊灰(hui)疫(yi)(yi)苗(miao)(miao)免(mian)(mian)疫(yi)(yi)情(qing)況(kuang)2012－2016年(nian)(nian)(nian)全(quan)(quan)區(qu)(qu)(qu)(qu)(qu)(qu)共報(bao)(bao)告(gao)完成(cheng)(cheng)(cheng)調查(cha)了(le)12例(li)(li)(li)(li)本(ben)(ben)地(di)AFP病(bing)(bing)(bing)例(li)(li)(li)(li)，其中(zhong)(zhong)無(wu)(wu)“0”劑(ji)次(ci)(ci)(ci)免(mian)(mian)疫(yi)(yi)史病(bing)(bing)(bing)例(li)(li)(li)(li)，無(wu)(wu)未全(quan)(quan)程免(mian)(mian)疫(yi)(yi)（少于(yu)3劑(ji)次(ci)(ci)(ci)）病(bing)(bing)(bing)例(li)(li)(li)(li)，該項(xiang)(xiang)(xiang)(xiang)評(ping)(ping)(ping)(ping)分(fen)(fen)(fen)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)0分(fen)(fen)(fen)（表(biao)1）。2．2．4麻(ma)疹發(fa)病(bing)(bing)(bing)情(qing)況(kuang)2014－2016年(nian)(nian)(nian)，全(quan)(quan)區(qu)(qu)(qu)(qu)(qu)(qu)麻(ma)疹1～14歲(sui)人(ren)(ren)群發(fa)病(bing)(bing)(bing)率(lv)(lv)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)依次(ci)(ci)(ci)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)0，0．56／10萬(wan)(wan)，0。3年(nian)(nian)(nian)平(ping)(ping)均(jun)(jun)發(fa)病(bing)(bing)(bing)率(lv)(lv)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)0．18／10萬(wan)(wan)。無(wu)(wu)麻(ma)疹暴發(fa)疫(yi)(yi)情(qing)發(fa)生(sheng)(sheng)，該項(xiang)(xiang)(xiang)(xiang)評(ping)(ping)(ping)(ping)分(fen)(fen)(fen)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)0分(fen)(fen)(fen)（表(biao)1）。2．3AFP病(bing)(bing)(bing)例(li)(li)(li)(li)監(jian)測情(qing)況(kuang)2．3．115歲(sui)以(yi)(yi)(yi)下兒(er)(er)童(tong)AFP病(bing)(bing)(bing)例(li)(li)(li)(li)報(bao)(bao)告(gao)發(fa)病(bing)(bing)(bing)率(lv)(lv)2014－2016年(nian)(nian)(nian)全(quan)(quan)區(qu)(qu)(qu)(qu)(qu)(qu)報(bao)(bao)告(gao)本(ben)(ben)地(di)15歲(sui)以(yi)(yi)(yi)下兒(er)(er)童(tong)AFP病(bing)(bing)(bing)例(li)(li)(li)(li)報(bao)(bao)告(gao)發(fa)病(bing)(bing)(bing)率(lv)(lv)依次(ci)(ci)(ci)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)1．35／10萬(wan)(wan)、4．37／10萬(wan)(wan)、4．29／10萬(wan)(wan)，全(quan)(quan)區(qu)(qu)(qu)(qu)(qu)(qu)整個(ge)(ge)監(jian)測系統保持(chi)了(le)較高(gao)的(de)(de)敏感性，該項(xiang)(xiang)(xiang)(xiang)評(ping)(ping)(ping)(ping)分(fen)(fen)(fen)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)0分(fen)(fen)(fen)（表(biao)2）。2．3．2樣(yang)品采(cai)集和及(ji)時(shi)送達(da)(da)(da)情(qing)況(kuang)2014－2016年(nian)(nian)(nian)全(quan)(quan)區(qu)(qu)(qu)(qu)(qu)(qu)完成(cheng)(cheng)(cheng)調查(cha)的(de)(de)本(ben)(ben)地(di)AFP病(bing)(bing)(bing)例(li)(li)(li)(li)，14天(tian)內雙份(fen)合格便采(cai)集率(lv)(lv)3年(nian)(nian)(nian)均(jun)(jun)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)100％；7天(tian)內送達(da)(da)(da)省(sheng)(sheng)級(ji)脊灰(hui)實(shi)(shi)驗室，及(ji)時(shi)送達(da)(da)(da)率(lv)(lv)3年(nian)(nian)(nian)均(jun)(jun)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)100％，該項(xiang)(xiang)(xiang)(xiang)評(ping)(ping)(ping)(ping)分(fen)(fen)(fen)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)0分(fen)(fen)(fen)（表(biao)2）。2．3．3高(gao)危病(bing)(bing)(bing)例(li)(li)(li)(li)全(quan)(quan)區(qu)(qu)(qu)(qu)(qu)(qu)2014－2016年(nian)(nian)(nian)無(wu)(wu)高(gao)危AFP病(bing)(bing)(bing)例(li)(li)(li)(li)及(ji)聚集性高(gao)危病(bing)(bing)(bing)例(li)(li)(li)(li)發(fa)生(sheng)(sheng)，該項(xiang)(xiang)(xiang)(xiang)評(ping)(ping)(ping)(ping)分(fen)(fen)(fen)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)0分(fen)(fen)(fen)（表(biao)2）。2．4輸入風險。我區(qu)(qu)(qu)(qu)(qu)(qu)存在勞務人(ren)(ren)員(yuan)前往新(xin)疆(jiang)、西藏、青(qing)海高(gao)風險地(di)區(qu)(qu)(qu)(qu)(qu)(qu)從事經商(shang)、采(cai)棉、建筑等工(gong)(gong)作，該項(xiang)(xiang)(xiang)(xiang)評(ping)(ping)(ping)(ping)分(fen)(fen)(fen)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)1分(fen)(fen)(fen)（表(biao)2）。2．5評(ping)(ping)(ping)(ping)估結果青(qing)白(bai)江區(qu)(qu)(qu)(qu)(qu)(qu)總分(fen)(fen)(fen)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)11分(fen)(fen)(fen)，被判定為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)中(zhong)(zhong)級(ji)風險地(di)區(qu)(qu)(qu)(qu)(qu)(qu)。

3討論

根據《市衛(wei)健(jian)委(wei)市發(fa)(fa)改委(wei)市財政局市醫(yi)(yi)保局關于印發(fa)(fa)市推進“互(hu)聯(lian)網(wang)+醫(yi)(yi)療健(jian)康”建設(she)意見(jian)的(de)通(tong)知》（衛(wei)規劃〔2020〕69號）和《縣深化(hua)醫(yi)(yi)藥衛(wei)生(sheng)體(ti)(ti)制改革領導小組(zu)關于學習借鑒“三(san)明經(jing)驗”深化(hua)醫(yi)(yi)藥衛(wei)生(sheng)體(ti)(ti)制改革的(de)通(tong)知》（醫(yi)(yi)改組(zu)〔2020〕3號），經(jing)研(yan)究同意，為充分(fen)發(fa)(fa)揮信(xin)息技術在深化(hua)醫(yi)(yi)改中的(de)支撐作用，全面推進縣“互(hu)聯(lian)網(wang)+醫(yi)(yi)療健(jian)康”建設(she)，現就(jiu)我縣推進“互(hu)聯(lian)網(wang)+醫(yi)(yi)療健(jian)康”建設(she)意見(jian)通(tong)知如下：

一、完善(shan)區域平(ping)臺便民惠(hui)民應用

（一）完(wan)善公(gong)眾健康(kang)(kang)(kang)服(fu)(fu)務平臺。推廣(guang)“12320熱線服(fu)(fu)務平臺”，完(wan)善“健康(kang)(kang)(kang)”微(wei)信公(gong)眾服(fu)(fu)務平臺，為公(gong)眾提(ti)供基于(yu)電子健康(kang)(kang)(kang)卡的預約掛號、在線報告(gao)、健康(kang)(kang)(kang)檔案查詢、移(yi)動(dong)支(zhi)付等便民(min)惠民(min)服(fu)(fu)務應(ying)用，提(ti)高醫療健康(kang)(kang)(kang)服(fu)(fu)務的可及(ji)性。到2022年，公(gong)眾通過(guo)平臺可實現各類醫療健康(kang)(kang)(kang)便民(min)惠民(min)“一站式(shi)”服(fu)(fu)務。

（二）建設(she)“多(duo)碼(ma)融合”應(ying)用(yong)(yong)(yong)平臺。建設(she)縣電子健(jian)(jian)康卡(ka)“多(duo)碼(ma)融合”應(ying)用(yong)(yong)(yong)平臺，推廣使用(yong)(yong)(yong)全(quan)國統一標準的電子健(jian)(jian)康卡(ka)（虛(xu)擬卡(ka)），貫穿就(jiu)醫(yi)診(zhen)(zhen)(zhen)療、預防接種、婦幼保(bao)健(jian)(jian)、信息查詢(xun)、健(jian)(jian)康管(guan)理等各類(lei)場景，逐步減少(shao)院內臨(lin)時(shi)(shi)就(jiu)診(zhen)(zhen)(zhen)卡(ka)發(fa)放，推動“e點通”應(ying)用(yong)(yong)(yong)，保(bao)證(zheng)實(shi)名制就(jiu)診(zhen)(zhen)(zhen)和“先診(zhen)(zhen)(zhen)療、后(hou)付費”服務模式有效落地。到2022年(nian)，實(shi)現“多(duo)碼(ma)融合”應(ying)用(yong)(yong)(yong)在(zai)縣鄉醫(yi)療機構(gou)覆(fu)蓋使用(yong)(yong)(yong)。二級醫(yi)院臨(lin)時(shi)(shi)就(jiu)診(zhen)(zhen)(zhen)卡(ka)就(jiu)診(zhen)(zhen)(zhen)率應(ying)低于(yu)20%。

（三）建設區域醫(yi)(yi)學(xue)(xue)影(ying)(ying)像(xiang)(xiang)共(gong)享(xiang)平臺。建設縣(xian)區域醫(yi)(yi)學(xue)(xue)影(ying)(ying)像(xiang)(xiang)共(gong)享(xiang)平臺，推進同(tong)級醫(yi)(yi)療機構、醫(yi)(yi)聯(lian)體(ti)內醫(yi)(yi)學(xue)(xue)影(ying)(ying)像(xiang)(xiang)資料共(gong)享(xiang)；實(shi)施數字影(ying)(ying)像(xiang)(xiang)“云膠片”服務，實(shi)現個人醫(yi)(yi)學(xue)(xue)影(ying)(ying)像(xiang)(xiang)查詢調閱(yue)。到2022年，實(shi)現轄區內醫(yi)(yi)療機構醫(yi)(yi)學(xue)(xue)影(ying)(ying)像(xiang)(xiang)共(gong)享(xiang)互認(ren)，患(huan)者隨時隨地(di)查看個人影(ying)(ying)像(xiang)(xiang)資料和(he)診斷報告。

（四）建設(she)區域互(hu)聯(lian)(lian)網(wang)醫(yi)(yi)院(yuan)(yuan)平臺(tai)。建設(she)縣互(hu)聯(lian)(lian)網(wang)醫(yi)(yi)院(yuan)(yuan)平臺(tai)，為轄區內醫(yi)(yi)療機(ji)構開(kai)(kai)展(zhan)互(hu)聯(lian)(lian)網(wang)醫(yi)(yi)療服(fu)務(wu)提供統一、規范的(de)平臺(tai)支撐。縣醫(yi)(yi)院(yuan)(yuan)要(yao)開(kai)(kai)展(zhan)互(hu)聯(lian)(lian)網(wang)醫(yi)(yi)院(yuan)(yuan)業務(wu)。到2022年(nian)，二級以(yi)上醫(yi)(yi)療機(ji)構普遍開(kai)(kai)展(zhan)互(hu)聯(lian)(lian)網(wang)診療服(fu)務(wu)。

根(gen)據黨中央(yang)、國(guo)務(wu)院決策部署，在(zai)繼續(xu)做好重點人(ren)群(qun)(qun)疫(yi)(yi)苗(miao)(miao)(miao)接種(zhong)工(gong)作(zuo)基礎上(shang)，國(guo)務(wu)院聯防聯控機制決定擴大人(ren)群(qun)(qun)接種(zhong)范圍、分階段做好各類人(ren)群(qun)(qun)疫(yi)(yi)苗(miao)(miao)(miao)接種(zhong)工(gong)作(zuo)，結合《中華人(ren)民共和國(guo)疫(yi)(yi)苗(miao)(miao)(miao)管理法》、《省衛生健康(kang)委(wei)員(yuan)會關于做好二級以上(shang)公立(li)醫療(liao)機構設立(li)疫(yi)(yi)苗(miao)(miao)(miao)接種(zhong)點工(gong)作(zuo)的通知(zhi)》（衛醫政發(fa)明電〔2021〕66號(hao)）和《市病毒感(gan)染(ran)肺炎防控工(gong)作(zuo)領導小組(zu)關于印發(fa)<市疫(yi)(yi)苗(miao)(miao)(miao)接種(zhong)實施方案>的通知(zhi)》等文件要(yao)求，為確(que)保我街疫(yi)(yi)苗(miao)(miao)(miao)接種(zhong)工(gong)作(zuo)有序開展，特制定本方案。

一、基本原則

堅持(chi)區(qu)分輕重(zhong)(zhong)緩急。從4月1日(ri)起(qi)對(dui)符(fu)合接(jie)種(zhong)人群實行全(quan)民免(mian)費(fei)接(jie)種(zhong)。根據外防(fang)輸入、內防(fang)反彈的防(fang)控策(ce)略和疫(yi)情防(fang)控形(xing)勢(shi)要求，按(an)照重(zhong)(zhong)點地區(qu)優(you)先、重(zhong)(zhong)點行業優(you)先、重(zhong)(zhong)點單位優(you)先的原則。對(dui)不(bu)同崗(gang)位、年齡(ling)、人群等排出先后順序，初期(qi)要考慮必要性(xing)、需求性(xing)，先慢后快，不(bu)斷總結經驗，扎實穩妥推進(jin)。現階段疫(yi)苗實施(shi)居民免(mian)費(fei)接(jie)種(zhong)政策(ce)，疫(yi)苗接(jie)種(zhong)服務費(fei)用由醫(yi)保基金負擔。

二、工作目標和(he)階段任務(wu)

按照“知情同(tong)意(yi)、免費接種、應接盡接”的原則，符合(he)接種條件的人(ren)群(qun)盡可(ke)能實現全民接種，目前(qian)疫苗接種人(ren)群(qun)年齡范圍(wei)18-59周(zhou)歲(sui)，確保在6月(yue)底(di)之前(qian)完成常(chang)住(zhu)人(ren)口的40%即18456人(ren)的接種任務(wu)。

主要分三個階段：

為確保(bao)重大(da)動(dong)物疫(yi)病口(kou)蹄疫(yi)、禽流(liu)感、豬瘟、新城(cheng)疫(yi)等已被(bei)國(guo)家(jia)列入動(dong)物的一(yi)類(lei)傳染病和已被(bei)國(guo)際動(dong)物衛生(sheng)組(zu)織（OIE）列入的A類(lei)傳染病緊急疫(yi)情(qing)發(fa)(fa)生(sheng)時，能夠及時、迅(xun)速、高(gao)效、有序地進行應(ying)急處理(li)，確保(bao)我縣動(dong)物飼養業(ye)持續健康發(fa)(fa)展，促進進出口(kou)貿易和社會經濟發(fa)(fa)展，保(bao)護人(ren)類(lei)健康，維護社會安定(ding)，根據《中華人(ren)民共和國(guo)動(dong)物防疫(yi)法》及農業(ye)部、市政府等有關(guan)法律(lv)法規(gui)的規(gui)定(ding)，制定(ding)本(ben)預案。

一(yi)、重大動物疫病防治原則

（一）口蹄疫(yi)(yi)、豬瘟、新城疫(yi)(yi)堅持以封(feng)鎖、撲殺(sha)、無害化處理和免疫(yi)(yi)、消毒、監測、檢疫(yi)(yi)為主。

（二）疫情的分級

1、一級(ji)疫(yi)(yi)(yi)(yi)情：縣境內(nei)2個以(yi)(yi)上(shang)鎮（鄉）、街道(dao)辦事處發(fa)生重大動物疫(yi)(yi)(yi)(yi)病(bing)時；或(huo)(huo)在30日內(nei)發(fa)生5個以(yi)(yi)上(shang)疫(yi)(yi)(yi)(yi)點；或(huo)(huo)在30日內(nei)發(fa)病(bing)畜(chu)200頭（規模(mo)500頭）以(yi)(yi)上(shang)，禽400只（規模(mo)場1000只）以(yi)(yi)上(shang)；特殊(shu)情況(kuang)需要劃分為一級(ji)疫(yi)(yi)(yi)(yi)情的。

2、二級疫(yi)情：縣境內(nei)(nei)在(zai)1個鎮(zhen)（鄉）、街(jie)道辦(ban)事處區(qu)域(yu)內(nei)(nei)發生口(kou)蹄疫(yi)、禽流感病例；或(huo)在(zai)30日內(nei)(nei)發生豬(zhu)瘟30頭（規(gui)模(mo)(mo)場100頭）或(huo)新城疫(yi)50只(zhi)（規(gui)模(mo)(mo)場200只(zhi)）以上。

2014年全(quan)市衛生工(gong)作的總(zong)體思路是：認真學(xue)習貫徹黨的十八大(da)和(he)十八屆三中(zhong)全(quan)會精神，以維護群(qun)眾(zhong)健康為(wei)(wei)中(zhong)心，以深化醫(yi)改(gai)(gai)為(wei)(wei)動力(li)，以開展黨的群(qun)眾(zhong)路線教育實(shi)踐活動為(wei)(wei)抓手，實(shi)施“居民(min)健康促(cu)進(jin)工(gong)程”，落實(shi)各項(xiang)民(min)生保障措施，加(jia)強基本(ben)醫(yi)療(liao)(liao)和(he)公共衛生工(gong)作，推進(jin)公立醫(yi)院改(gai)(gai)革，不斷(duan)強化能(neng)力(li)建(jian)設和(he)作風轉變，著力(li)提高醫(yi)療(liao)(liao)衛生服務(wu)能(neng)力(li)和(he)管理水平，努力(li)建(jian)設人(ren)民(min)滿意的衛生事業，為(wei)(wei)加(jia)快(kuai)建(jian)設“幸福”作出更大(da)貢(gong)獻。

一、深(shen)化醫藥衛生體制改革，抓好民生實(shi)事(shi)項目(mu)

（一）加快構建(jian)濟萊衛生一體化(hua)(hua)發展格局。深化(hua)(hua)聯合辦醫，充分利(li)用省級綜(zong)合醫院的技術(shu)優(you)勢、人才(cai)優(you)勢、管理優(you)勢和品牌優(you)勢，帶動全市(shi)醫療水(shui)平(ping)和服務能力的提升，努力實現資源(yuan)互補、優(you)勢共用、共同發展。推動疾病預(yu)防控制、醫療急救(jiu)、傳染(ran)病救(jiu)治(zhi)、婦幼保健(jian)等公共衛生服務合作(zuo)，提升服務能力。

(二)全(quan)力完(wan)(wan)成為(wei)(wei)民辦(ban)實(shi)事項目(mu)。按照全(quan)市統一(yi)管理和(he)屬(shu)地(di)組織管理相結合、資質準入(ru)和(he)劃片包干服務的原則，為(wei)(wei)6-8歲適(shi)齡兒童免費實(shi)施窩(wo)溝(gou)封閉，使目(mu)標兒童口(kou)腔衛生常(chang)識知曉率(lv)達(da)85％以上，口(kou)腔疾病篩查(cha)率(lv)、口(kou)腔健康檔案建檔率(lv)均達(da)90%以上，第一(yi)恒磨牙(ya)窩(wo)溝(gou)封閉完(wan)(wan)好率(lv)達(da)85%以上。繼續加快推進市醫院擴建工(gong)程建設，年(nian)內完(wan)(wan)成主要安裝工(gong)程。

（三）鞏固完善基本藥(yao)(yao)物制(zhi)度(du)和(he)基層(ceng)運行新(xin)機制(zhi)。有序推進非(fei)政(zheng)府辦基層(ceng)醫療衛(wei)生機構和(he)村衛(wei)生室(shi)實施基本藥(yao)(yao)物制(zhi)度(du)。規(gui)范處方行為，引(yin)導合理用藥(yao)(yao)。建立基本藥(yao)(yao)物制(zhi)度(du)實施績效(xiao)考核(he)評價(jia)體系，嚴(yan)格執(zhi)行基本藥(yao)(yao)物中標企業(ye)誠信記(ji)錄(lu)和(he)市場清退制(zhi)度(du)，強化(hua)基本藥(yao)(yao)物貨(huo)款統一(yi)支付監管。落實基層(ceng)醫療衛(wei)生機構穩定(ding)長效(xiao)的(de)多(duo)渠道補(bu)償(chang)(chang)政(zheng)策，完善績效(xiao)考核(he)和(he)人事(shi)分配制(zhi)度(du)，提高(gao)獎勵性績效(xiao)工資(zi)比例，合理拉開(kai)收入差距(ju)。強化(hua)基層(ceng)醫療衛(wei)生人才隊伍建設，規(gui)范鄉村醫生執(zhi)業(ye)管理，落實多(duo)種形(xing)式的(de)補(bu)償(chang)(chang)政(zheng)策，積極探(tan)索養老保障政(zheng)策措施。配合做好新(xin)農合和(he)城鎮居民醫保整合工作(zuo)。

（四）加(jia)快推進(jin)公立(li)醫(yi)(yi)院改(gai)革(ge)。認真學習試(shi)點(dian)縣公立(li)醫(yi)(yi)院綜(zong)合(he)改(gai)革(ge)經驗(yan)，積極落(luo)實價(jia)格調整、財政補(bu)償、醫(yi)(yi)保支付等改(gai)革(ge)政策，同(tong)步推進(jin)人事分配(pei)制(zhi)度(du)(du)改(gai)革(ge)，完善績效考核和(he)科(ke)學薪(xin)酬(chou)制(zhi)度(du)(du)。改(gai)革(ge)縣級公立(li)醫(yi)(yi)院藥(yao)品招標采購(gou)辦法，實行(xing)招采合(he)一、量價(jia)掛鉤、雙信封制(zhi)。建(jian)立(li)二級及以(yi)上(shang)公立(li)醫(yi)(yi)院藥(yao)品優先(xian)配(pei)備使用(yong)制(zhi)度(du)(du)。開(kai)展高值(zhi)(zhi)醫(yi)(yi)用(yong)耗材集中采購(gou)，規范醫(yi)(yi)療(liao)機構高值(zhi)(zhi)醫(yi)(yi)用(yong)耗材使用(yong)管理。推進(jin)醫(yi)(yi)療(liao)服務價(jia)格改(gai)革(ge)，提高技術勞務價(jia)格，嚴格控制(zhi)醫(yi)(yi)療(liao)費用(yong)不合(he)理過快增長。探索建(jian)立(li)分級診療(liao)模式，加(jia)快緊密型醫(yi)(yi)聯(lian)體建(jian)設，年(nian)底前全市(shi)至(zhi)少建(jian)立(li)2個緊密型醫(yi)(yi)聯(lian)體。