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目的了解重庆市燃煤型氟中毒病区的防治现状,为燃煤型氟中毒的防治决策提供科学依据。方法采用分层整群抽样的方法,运用统一设计的居民防治现状调查问卷,对抽查的病区村居民进行问卷调查。调查内容包括病区居民的燃料结构、炉灶使用情况和耕种方式等,计算改炉改灶的合格率、改炉改灶的正确使用率、炉灶的报废率。运用Dean’s法检查所有调查村8～12岁儿童氟斑牙患病情况,计算氟斑牙的患病率、氟斑牙指数、缺损率。按照《地方性氟骨症的临床诊断标准》,调查所有病区村16岁及以上的成人,计算氟骨症患病率。结果本次共调查8个病区县9个乡镇12个村4512户,其中使用煤作为燃料的户数为4408户,占97.70%。使用炉灶的户数为4405户,使用率达到97.63%,正确使用率为47.92%。改炉正确使用率为61.77%,报废率为0.38%。改灶正确使用率为46.36%,报废率为0.21%。8～12岁儿童氟斑牙检出率为72.88%,缺损率为8.16%,氟斑牙指数为1.29。16岁及以上氟骨症检出率为1.92%。结论通过20年的以改炉改灶为主的综合性防治,重庆市燃煤型氟中毒病情逐渐减轻,病区类型和数量逐渐减少,说明以改炉改灶为主的综合性防治措施效果较好。今后在地氟病防治工作中,建议在发展经济的同时,加大对改炉改灶项目的投入,加强地氟病的健康教育宣传,完善炉灶的后期管理制度,提高炉灶的正确使用率;在有条件的地区大力推广发展沼气、液化气等新型清洁能源,建立燃煤型氟中毒防治的长效机制。
Objective To understand the status quo of prevention and treatment of coal-burning fluorosis in Chongqing and to provide a scientific basis for prevention and control of coal-based fluorosis. Methods A stratified cluster sampling method was used to investigate the status quo of residents in a unified design by using the questionnaire survey. The survey included the ward inhabitants’ fuel structure, the use of stoves and cultivation methods, etc., to calculate the pass rate of the stove to the stove, the correct utilization of the stove to the stove, and the reject rate of the stove. Dean’s method was used to check the prevalence of dental fluorosis in children aged 8 to 12 years in all surveyed villages. The prevalence of dental fluorosis, dental fluorosis index and defect rate were calculated. In accordance with the “clinical diagnostic criteria of endemic fluorosis,” all villagers aged 16 and above in the ward area were surveyed to calculate the prevalence of skeletal fluorosis. Results A total of 4512 households in 12 villages and 9 townships in 8 ward counties were surveyed. Among them, 4,408 households used coal as fuel, accounting for 97.70% of the total. The number of households using stoves for the 4405 households, the utilization rate reached 97.63%, the correct utilization rate of 47.92%. The correct utilization of the furnace was 61.77%, the rejection rate was 0.38%. The correct utilization of the stove was 46.36% and the rejection rate was 0.21%. The detection rate of dental fluorosis in children aged 8 ~ 12 was 72.88%, the rate of defect was 8.16%, the dental fluorosis index was 1.29, and the detection rate of skeletal fluorosis was 1.92%. Conclusions After 20 years of comprehensive prevention and treatment based on reformer, the situation of coal-fired fluorosis in Chongqing gradually reduced and the type and number of wards gradually decreased, indicating the effect of comprehensive prevention and treatment measures with reformer as main factor better. In the future work on the prevention and treatment of endemic fluorosis, it is suggested that while economic development be carried out, more investment should be made in the project of revamping of furnaces, health education promotion of endemic fluorosis, perfecting the late management system of stoves and improving the correct utilization rate of stoves; We will vigorously promote the development of new clean energy sources such as biogas and liquefied gas in the conditional areas and establish a long-term mechanism for the prevention and control of coal-based fluorosis.