摘要目的 探讨尿不湿的使用对儿童膀胱直肠功能障碍(bladder and bowel dysfunction,BBD)发病率的影响,并对相关因素进行分析.方法 2017年3～9月,采用无记名调查问卷形式在深圳﹑厦门﹑郑州等地随机选取37所小学及幼儿园,对8950名2～8岁儿童进行流行病学调查,了解出生后使用尿不湿的情况及儿童排尿排便现状.每个学校的调查人数在200人以上.通过家长回顾性填写调查问卷,为了保证调查问卷填写的准确性,调查之前对调查人员进行专门培训.问卷主要内容包括:一般资料,出生后是否使用尿不湿、停止使用年龄、每天使用尿不湿的片数,如厕训练开始时间,目前排尿排便状况是否符合BBD诊断标准,是否存在影响排尿排便器质性疾病等.结果对有效问卷8026份数据收集整理,运用t检验及χ2检验等统计学方法进行分析发现:①所调查儿童的BBD调查总体发病率为2.73％;②BBD发病率随年龄增长而减低(P<0.001),从2岁时的4.89％下降到8岁时的0.85％;③随着尿不湿停止使用年龄推迟和每天使用时长(以每天使用片数衡量)的增加,BBD发病率则均呈增高趋势(P<0.05),出生6个月之内停止使用尿不湿的儿童BBD的发病率为0.95％,2岁以后停止使用尿不湿的儿童BBD的发病率为6.11％;④随着把尿把便训练(如厕训练)开始时间的延迟,BBD发病率逐渐增高(P<0.001),出生6个月之内开始如厕训练的儿童BBD的发病率为0.91％,2岁以后开始如厕训练的儿童BBD的发病率为6.47％;⑤将影响BBD发病率多因素Logistic回归分析显示,尿不湿停止使用年龄的增加、每天使用时长的增加、肥胖是儿童BBD发病的危险因素(OR>1,P<0.05),6个月内开始如厕训练是儿童BBD发病的保护因素(OR<1,P<0.05).结论 减少尿不湿的使用和尽早开始如厕训练有利于预防儿童BBD的发生.

abstractsObjective To explore the effect of using disposable diaper (DD) on the prevalence of pediatric bladder and bowel dysfunction (BBD ) and analyze the relevant-factors .Methods From March 2017 to September 2017 ,37 primary schools and kindergartens were randomly selected from the municipalities of Shenzhen , Xiamen and Zhengzhou . An anonymous epidemiological survey of using DD from birth and status of voiding and defecation was conducted for 8950 children aged 2 to 8 years .The number of surveyed students was over 200 at each institution .A retrospective survey was conducted by parents recalling past events and filling out questionnaires .For ensuring the accuracy of questionnaires ,the investigators were specially pre-trained .The main contents of questionnaire include general profiles ,whether using DD from birth ,age of stopped using DD ,duration of daily use (fullday or night-only use) , start time of elimination communication (EC) (including potting training , assistant infant's toilet training ) , whether current status of voiding and defecation fulfilling the diagnostic criteria for BBD and presence or absence of organic diseases affecting voiding and defecation .Results A total of 8026 valid questionnaires were collected and analyzed . Statistical analysis of t-test and chi-square test indicated that the overall prevalence of BBD in children surveyed was 2 .73％ and the prevalence of BBD declined with advancing age from 4 .89％ at age 2 to 0 .85％ at age 8 (P< 0 .001) .With the delayed use of disposable diapers and the prolonged daily use of DD ,the prevalence of BBD showed a rising trend (P< 0 .05) .The prevalence of BBD children stopping using DD within the first 6 months of birth was 0 .95％ and the prevalence of BBD in children stopped using DD after an age of 2 years was 6 .11％ .With a delayed start of elimination communication (EC) ,the prevalence of BBD gradually increased ( P < 0 .001 ) . The prevalence of BBD in children starting elimination communication (EC) within 6 months of birth was 0 .91％ and elimination communication (EC) began after an age of 2 years .The prevalence of childhood BBD was 6 .47％ .The multivariate logistic regression analysis of prevalence of BBD revealed that age of stopping using DD ,whole-day use of DD and obesity were risk factors for an onset of childhood BBD (OR > 1 , P< 0 .05) .Starting toilet training within 6 months was a protective factor for childhood BBD (OR < 1 ,P< 0 .05) .Conclusions Rational usage of DD and early start of EC are effective for preventing BBD in children .