目的:通过对某边远地区基层官兵泌尿生殖疾病分析,为做好边远地区官兵泌尿生殖疾病相关医疗保障工作提供依据。方法:2019年10月至2019年11月期间组织巡诊某边远地区基层官兵5600名,收集针对泌尿生殖疾病咨询、就诊的514名基层官兵的病历资料进行统计分析。结果:专科门诊咨询、就诊泌尿生殖疾病官兵514人。其中咨询和初步诊断泌尿生殖疾患分别为328人和186人,占全体官兵比例为5.86%和3.32%。咨询组中官兵对于男性泌尿生殖系统疾病关注度随年龄组分段不同有一定差异,<20岁组对于遗精及手淫,外生殖器认识关注度较高,>30岁组对于优生优育、男性不育关注度高。基层官兵患泌尿生殖疾病前三位是精索静脉曲张、前列腺炎、包皮过长及包茎。官兵随年龄增长在泌尿专科就诊次数及比率增高。结论:驻边远地区基层官兵在泌尿生殖健康方面有明显医疗需要,部分泌尿生殖疾病发病率高,专科就诊率偏低,需要加强关注。 Objective: Through the analysis of genitourinary diseases of officers and soldiers in a remote area, to provide the basis for medical security work related to genitourinary diseases of officers and soldiers in remote areas. Methods: From October 2019 to November 2019, 5600 grass-roots officers and soldiers in a remote area were visited, and the medical records of 514 grass-roots officers and soldiers who consulted and treated for urogenital diseases were collected for statistical analysis. Result: There were 514 officers and soldiers who consulted and visited the specialist clinic for urinary and reproductive diseases. Among them, 328 were consulted and 186 were initially diagnosed, accounting for 5.86% and 3.32% of all officers and soldiers. In the consultation group, the attention of officers and soldiers on male genitourinary system diseases varied with age groups. The awareness of spermatorrhea and masturbation and the awareness of external genitalia of <20-year-old group was higher than that of over 30-year-old group. Varicocele, prostatitis, redundant prepuce and phimosis are the top three diseases of genitourinary and reproductive diseases in grass-roots officers and soldiers. The number and ratio of the officers and soldiers in urology department increased with age. Conclusion: There are obvious medical needs in the reproductive health of the grass-roots officers and men in remote areas. Incidence rate of some genitourinary diseases is high, and specialist attendance rate is low.
目的:通过对某边远地区基层官兵泌尿生殖疾病分析,为做好边远地区官兵泌尿生殖疾病相关医疗保障工作提供依据。方法:2019年10月至2019年11月期间组织巡诊某边远地区基层官兵5600名,收集针对泌尿生殖疾病咨询、就诊的514名基层官兵的病历资料进行统计分析。结果:专科门诊咨询、就诊泌尿生殖疾病官兵514人。其中咨询和初步诊断泌尿生殖疾患分别为328人和186人,占全体官兵比例为5.86%和3.32%。咨询组中官兵对于男性泌尿生殖系统疾病关注度随年龄组分段不同有一定差异,<20岁组对于遗精及手淫,外生殖器认识关注度较高,>30岁组对于优生优育、男性不育关注度高。基层官兵患泌尿生殖疾病前三位是精索静脉曲张、前列腺炎、包皮过长及包茎。官兵随年龄增长在泌尿专科就诊次数及比率增高。结论:驻边远地区基层官兵在泌尿生殖健康方面有明显医疗需要,部分泌尿生殖疾病发病率高,专科就诊率偏低,需要加强关注。
边远地区,基层官兵,泌尿生殖疾病,军事医学
Xinying Fu, Di Zhang, Zhonghua Wang, Zhiqiang Pan, Degui Gong, Yonglian Xia, Haiyan Bao, Yan Wang, Rui Yan, Liming Zhao, Run Ye, Xuqi Shen*
478 Hospital of PLA, Kunming Yunnan
Received: Nov. 2nd, 2020; accepted: Nov. 18th, 2020; published: Nov. 25th, 2020
Objective: Through the analysis of genitourinary diseases of officers and soldiers in a remote area, to provide the basis for medical security work related to genitourinary diseases of officers and soldiers in remote areas. Methods: From October 2019 to November 2019, 5600 grass-roots officers and soldiers in a remote area were visited, and the medical records of 514 grass-roots officers and soldiers who consulted and treated for urogenital diseases were collected for statistical analysis. Result: There were 514 officers and soldiers who consulted and visited the specialist clinic for urinary and reproductive diseases. Among them, 328 were consulted and 186 were initially diagnosed, accounting for 5.86% and 3.32% of all officers and soldiers. In the consultation group, the attention of officers and soldiers on male genitourinary system diseases varied with age groups. The awareness of spermatorrhea and masturbation and the awareness of external genitalia of <20-year-old group was higher than that of over 30-year-old group. Varicocele, prostatitis, redundant prepuce and phimosis are the top three diseases of genitourinary and reproductive diseases in grass-roots officers and soldiers. The number and ratio of the officers and soldiers in urology department increased with age. Conclusion: There are obvious medical needs in the reproductive health of the grass-roots officers and men in remote areas. Incidence rate of some genitourinary diseases is high, and specialist attendance rate is low.
Keywords:Remote Areas, Grass Roots Officers and Soldiers, Urogenital Diseases, Military Medicine
Copyright © 2020 by author(s) and Hans Publishers Inc.
This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).
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边远地区环境艰苦,基层官兵训练任务繁重,医疗资源匮乏,官兵对泌尿生殖健康的诊疗需求日趋增加,而目前对此群体泌尿生殖健康的关注度较低、研究成果较少。本研究回顾性分析2019年10月至2019年11月期间组织巡诊某边远地区基层官兵5600名,收集针对泌尿生殖疾病咨询、就诊的514名基层官兵的病历资料,探究边远地区基层官兵泌尿生殖健康特点,为官兵针对性医疗保障提供依据。
2019年10月至2019年11月期间组织巡诊某边远地区基层官兵5600名,收集泌尿生殖疾病咨询、就诊的官兵共514名。均为男性,年龄范围18~41岁,中位年龄27岁,军龄范围11月~19年,中位军龄8年。数据真实可靠。本研究内的所有病例均签有知情同意书,并通过我院伦理委员会审核。
纳入标准:泌尿生殖疾病咨询、就诊的官兵。
排除标准:合并外伤、既往外科手术病史等疾病咨询、就诊给予排除。
按巡诊要求给予集中授课及科普宣讲,内容涉及基层官兵性思想及常见泌尿生殖系统疾病介绍,开展门诊咨询、查体就诊,辅助泌尿生殖专科B超检查、取尿液及前列腺液初步常规检验,诊断疾病,进行疾病解释、心理疏导并指导下一步专科检查及治疗。
将咨询的328例官兵病历资料按年龄分为4组:<20岁组,125例;20~25岁组,101例;25~30岁组,79例;>30岁组,23例。将确诊泌尿生殖疾病的186例病历资料按年龄分为4组:<20岁组,36例;20~25岁组,52例;25~30岁组,71例;>30岁组,27例。同时对确诊泌尿生殖疾病的官兵进行专科就诊情况分析。
咨询及确诊表格统计中,少数官兵一人有两种及以上泌尿生殖系统疾病者,按主要病因疾病记录。采用spss17.0软件进行统计学处理,组间比较采用方差分析,以P < 0.05为统计学差异。
针对泌尿生殖咨询官兵328名,官兵在遗精及手淫、前列腺炎、精索静脉曲张、男性不育及备孕、优生优育及先天畸形等各年龄组中关注度有统计学差异。遗精及手淫更多受25下官兵关注,前列腺炎、精索静脉曲张更多受20岁以上官兵关注,男性不育及备孕、优生优育及先天畸形在30岁以上官兵关注更多。见表1。
项目 | <20岁(n = 125) | 20~25岁(n = 101) | 25~30岁(n = 79) | >30岁(n = 23) | c2值 | P |
---|---|---|---|---|---|---|
遗精及手淫 | 57 (45.6) | 29 (28.7) | 10 (15.2) | 1 (4.3) | 29.915 | 0 |
前列腺炎 | 1 (0.8) | 12 (11.9) | 25 (31.6) | 9 (39.1) | 49.952 | 0 |
精索静脉曲张 | 2 (1.6) | 18 (17.8) | 20 (25.3) | 2 (8.7) | 27.756 | 0 |
男性外生殖器认识 | 20 (16) | 11 (10.9) | 3 (3.8) | 1 (4.3) | 8.61 | 0.035 |
性病 | 15 (12.0) | 11 (10.9) | 5 (6.3) | 1 (4.3) | 2.681 | 0.444 |
性功能异常 | 16 (12.8) | 10 (9.9) | 5 (6.3) | 1 (4.3) | 3.136 | 0.371 |
男性不育及备孕 | 0 (0) | 1 (1) | 3 (3.8) | 4 (17.4) | 26.23 | 0 |
优生优育及先天畸形 | 0 (0) | 0 (0) | 1 (1.3) | 2 (8.7) | 17.559 | 0.001 |
其它 | 14 (11.2) | 9 (8.9) | 7 (8.7) | 2 (8.7) | 0.479 | 0.923 |
表1. 328名基层官兵泌尿生殖健康问题咨询情况分析[n, (%)]
泌尿生殖疾病确诊中精索静脉曲张、慢性前列腺炎、包皮过长及包茎最常见。而官兵中发生精索静脉曲张、慢性前列腺炎、包皮过长及包茎、弱精症及男性不育、外生殖器丘疹在各年龄组中有统计差异。见表2。
项目 | <20岁(n = 36) | 20~25岁(n = 52) | 25~30岁(n = 71) | >30岁(n = 27) | c2值 | P |
---|---|---|---|---|---|---|
精索静脉曲张 | 6 (16.7) | 20 (38.7) | 31 (43.7) | 9 (33.3) | 7.898 | 0.048 |
前列腺炎 | 0 (0) | 6 (11.5) | 21 (28.2) | 8 (29.6) | 17.595 | 0.001 |
包皮过长、包茎 | 16 (44.4) | 7 (13.5) | 1 (1.4) | 1 (3.7) | 40.779 | 0 |
---|---|---|---|---|---|---|
外生殖器丘疹 | 8 (22.2) | 7 (13.5) | 4 (5.6) | 1 (3.7) | 8.669 | 0.034 |
尿路感染 | 3 (8.3) | 5 (9.6) | 1 (1.4) | 0 (0) | 6.719 | 0.081 |
性功能下降 | 0 (0) | 1 (1.9) | 4 (5.6) | 2 (7.4) | 3.57 | 0.312 |
弱精症及男性不育 | 0 (0) | 0 (0) | 2 (2.8) | 3 (11.1) | 9.758 | 0.021 |
外生殖器包块 | 1 (2.8) | 2 (3.8) | 1 (1.4) | 1 (3.7) | 0.819 | 0.845 |
其它 | 2 (5.6) | 4 (7.7) | 6 (8.5) | 2 (7.4) | 0.291 | 0.962 |
表2. 驻边远地区基层官兵186例确诊泌尿生殖疾病情况分析[n, (%)]
针对初步确诊疾病的186例统计发现,各年龄组在就诊次数上有统计学差异。见表3。
项目 | <20岁(n = 36) | 20~25岁(n = 52) | 25~30岁(n = 71) | >30岁(n = 27) | c2值 | P |
---|---|---|---|---|---|---|
从未就诊 | 31(86.1) | 35(67.3) | 39(54.9) | 5(18.5) | 31.231 | 0 |
就诊一次 | 5(13.9) | 13(25) | 25(35.2) | 14(51.9) | 11.945 | 0.008 |
就诊二次 | 0(0) | 3(5.8) | 6(8.5) | 5(18.5) | 7.935 | 0.047 |
三次以上 | 0(0) | 1(1.9) | 1(1.4) | 3(11.1) | 8.878 | 0.031 |
表3. 驻边远地区基层官兵186例泌尿生殖疾病就诊情况[n, (%)]
基层部队环境特殊,年轻男性聚集,管理严格,获取泌尿生殖健康知识渠道狭窄,官兵容易出现对疾病的认知偏差,甚至合并心理问题 [
本研究中咨询官兵占巡诊总数的5.86%。正常遗精及手淫问题仍是询问最多,占总咨询人数的29.6%;其次为前列腺炎、精索静脉曲张、外生殖器异常(主要包括包皮过长及包茎及少量的阴囊、睾丸发育咨询),分别占该咨询组人数比为14.3%、12.8%、10.7%。咨询内容与年龄组关系明显。在针对遗精及手淫,男性外生殖器认知方面主要集中在20岁以下组,考虑该组战士年龄小,获取知识渠道有限,对于男性正常生理知识缺乏,认知自身性器官存在不足。数据显示慢性前列腺炎关注度随年龄增加呈现上升趋势,30岁以上组占比例最高,符合慢性前列腺炎发病年龄规律,即该病为中青年男性常见疾病,20~60岁均可发病,但以30~40岁年龄发病最多,故在单纯咨询中也表现出相似上升曲线 [
本次巡诊中有186名官兵确诊泌尿生殖相关疾病,占巡诊官兵总数3.32%。前三位分别是精索静脉曲张,慢性前列腺炎、包皮过长及包茎,分别占确诊专科疾病人数比35.5%、18.9%、13.4%。精索静脉曲张20~30岁两组中占比最多,目前索静脉曲张已是部队基层最常见的泌尿生殖疾病 [
本研究显示从未就诊比例最高,占此次确诊人数59.1%。以年龄组统计从小到大看,20岁以下年龄组占86.1%,30岁以上年龄组占18.5%,随年龄增加呈逐渐下降趋势。30岁以上年龄组在专科就诊率及多次就诊比例上均显著高于其余各组。高年龄组专科就诊显著提高,考虑与高年龄组官兵文化程度、社会家庭责任度、健康保健意识高有关系。
近年来,部队持续加大基层医疗投入,很多连队卫生所层面已经明显提高了处理常见泌尿生殖疾病及部分手术的能力,这也可能是部分疾病统计数量下降的原因之一 [
针对巡诊相关结果,我们提出部分建议:(一) 坚持常规泌尿生殖健康、优生优育等方面知识的宣讲,加强官兵卫生知识及泌尿生殖健康保健意识,正确认识男性生理现象及性知识,树立正确性观点,解除心理负担;(二) 指导广大官兵养成良好生活习惯。建立科学训练方式,适当减少诱因作用,对于好发疾病建立定期随诊制度,掌握疾病发展程度及处置的主动性;(三) 继续加强基层部队卫生人员泌尿生殖专业技术培训,切实完善相关基层医疗设备及检查条件。适当增加基层体检常规性,做到疾病早检查、早发现、早治疗;(四) 针对泌尿生殖疾病容易导致心理障碍的特殊性,应加强官兵后期治疗效果观察及重视心理疏导治疗,辅助相关心理课程,提高疾病治疗效果。(五) 上级专科人员的大力帮扶。应加大长期性、常态化巡诊力度,送医下基层形式就是很好的办法。
付歆颖,张 迪,王中华,潘志强,龚德贵,夏永莲,包海燕,汪 雁,严 睿,赵黎明,叶 赟,申旭旗. 某边远地区基层官兵泌尿生殖疾病分析Analysis of Genitourinary Diseases of Officers and Soldiers in a Remote Area[J]. 临床医学进展, 2020, 10(11): 2616-2620. https://doi.org/10.12677/ACM.2020.1011397