上海某结核病定点医院2005—2015年肺结核诊疗情况分析

姚晶; 顾凯侃; 李智红; 韩志英; 张怀庆

doi:10.19428/j.cnki.sjpm.2019.18710

上海某结核病定点医院2005—2015年肺结核诊疗情况分析

Tuberculosis treatment data from designated hospital in Zhabei District of Shanghai from 2005 to 2015

摘要

摘要:
目的了解上海市闸北区肺结核定点医院患者的主要来源、治疗及转归等信息，为进一步完善结核病定点医院功能提供依据。
方法采用回顾性分析方法，收集2005年1月1日—2015年12月31日定点医院的肺结核患者病案。分析闸北区医疗机构报告及现居住闸北区的疑似肺结核患者到区(市)定点医院归口确诊情况；通过Pearson卡方检验比较不同病情复杂程度患者的治疗转归情况。
结果11年间，闸北区医疗机构报告且现居住闸北区的疑似患者到区定点医院确诊肺结核的共602例，占区定点医院首诊断患者的51.23%(602/1 175)；区定点医院首诊断且闸北区首管理患者数占闸北区首管理患者总数的比例从2005年的67.57%(100/148)下降至2015年的6.57%(18/274)；患者的发现方式主要为转诊(79.27%，742/936)；区(市)定点医院首诊断且闸北区首管理患者的0月序痰培养率为90.38%(70.53%)，培养阳性率为41.37%(55.49%)，重症、合并症、不良反应率分别为15.71%(43.46%)、11.54%(25.15%)、11.54%(18.85%)。根据疾病复杂程度划分等级，区定点及市定点医院首诊断且闸北区首管理患者中，病情相对简单的患者治愈率及完成疗程率分别为79.86%和93.86%，差异有统计学意义(χ² =79.421，P < 0.001)；病情相对复杂患者治愈率及完成疗程率分别为77.12%和83.74%，差异有统计学意义(χ² =4.934，P=0.026)；病情比较复杂的患者治愈率及完成疗程率基本一致(χ² =0.034，P=0.853)，分别为60.00%和56.67%。
结论应提高闸北区结核病定点医院诊疗水平，扩大宣传力度，加强政策支持，引导闸北区肺结核患者到区定点医院就诊治疗。

Abstract:
ObjectiveTo explore the main sources of the pulmonary tuberculosis(PTB)patients and their treatment in TB designated hospital, so as to provide evidence for perfecting TB designated hospital in Zhabei District of Shanghai.
MethodsRetrospective analysis was conducted on the data concerning suspected and diagnosed TB patients in Zhabei District from January 2005 to December 2015, obtained from China Information System for Disease Control and Prevention.The numbers of the suspected TB patients diagnosed with TB in district or municipal TB designated hospital were analyzed, and also were the patients′ basic treatment, laboratory test, radiological results and outcomes of therapy.
ResultsThe number of the suspected TB patients lived in Zhabei District who were diagnosed with TB at the district TB designated hospital was 602, which accounted for 51.23% (602/1 175) of the total. When the patients were managed by Zhabei District centers for disease control, the proportion of the patients that were under treatment in district TB designated hospital was down from 67.57%(100/148)in 2005 to 6.57%(18/274)in 2015: their conditions were mainly discovered by referral, the proportion of the referrals was 79.27%(742/936).The rates of the patients who lived in Zhabei District under treatment in district TB designated hospital(municipal TB designated hospital) and who received sputum specimen culture were 90.38% and 70.53%, the positive rates being 41.37% and 55.49% respectively.The rates of the patients with severe syndromes, complications and side reactions were 15.71%(43.46%), 11.54%(25.15%) and 11.54%(18.85%)respectively.When the patients were under treatment in district TB designated hospital or in municipal TB designated hospital, the successful treatment rates of simple condition TB patients were 79.86% and 93.86% (χ²=79.421, P < 0.001), the rates of relatively complicated condition TB patients 77.12 % and 83.74%(χ²=4.934, P=0.026), rates of complicated condition TB patients 60.00% and 56.67%(χ²=0.034, P=0.853).
ConclusionTB designated hospital in Zhabei District should improve their medical standards and extend publicity with more policy support, guiding the TB patients in Zhabei District to the district designated hospital.

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