贵阳市花溪区传染性肺结核发现工作现状分析

为了提高传染性肺结核的发现工作 ,现将花溪区 1998～ 2 0 0 2年传染性肺结核发现工作的现状报告如下。1　资料与方法1.1　资料来源　 1998～ 2 0 0 2年我所门诊初诊登记本、结核病人登记本、治疗管理卡。1.2　病人发现　以因症就诊为主要方式 ,重点是传染性肺结核 ,即痰涂片阳性病人。1.3　按照《全国结核病防治工作手册》对病人发现工作指标汇总、统计、分析现状。2　结　果2 .1　基本情况　 1998～ 2 0 0 2年接诊可疑肺结核者4 30 4例 ,胸部X光片检查 4 2 81例 (99.5 % )、查痰2 919例 (6 7.8% ) ,发现活动性肺结核 12 2 3例(2 8.4 % ) …     

平川区2002-2009年实施结核病控制项目效果分析

目的调查平川区2002-2009年实施结核病控制项目后的预防效果。方法对2002-2009年门诊初诊登记本、结核患者登记本、痰检登记本、季年度报表中的结核患者进行流行病学统计分析。结果本次调查共发现活动性肺结核患者980例,其中涂阳肺结核598例(61.02%)。598例涂阳肺结核患者中,初治涂阳509例,复治涂阳89例,初治涂阳登记比例呈逐年上升趋势,而复治涂阳登记比例逐年下降。初治涂阳肺结核患者男、女之比为1.61:1,发病年龄以青壮年为主。初治涂阳肺结核患者治愈率由2002年的88.89%提高至2009年的100.00%,复治涂阳肺结核病治愈率由2002年的66.67%提高至2009年的90.00%。结论实施结核病控制项目对结核病的防治具有重要作用。     

肺结核患者发现成本效果分析

目的探讨成本效果好的肺结核患者发现方法,提高肺结核患者发现率。方法对永城市结防所结核病门诊2005年1月至2005年12月《初诊结核病人登记本》登记的初诊患者资料进行成本效果分析。结果A(咳嗽咳痰>=3周)、B(咯血或血痰)、C(咳嗽咳痰<3周)、D(其它)四种不同症状者构成比分别为58.7%、8.7%、12.4%、20.2%;A、B、C、D四种不同症状中涂阳肺结核患者构成比分别为74.7%、16.2%、6.1%、9.0%;A、B、C、D四种不同症状中涂阳肺结核患者检出率分别为16.1%、26%、6.9%、10%;A、B、C、D四种不同症状中发现涂阳肺结核患者成本效果(CER)分别为185元/例、115元/例、437元/例、484元/例,成本效果最好的为咯血或血痰60岁以上者(88元/例)。结论应加强对有咳嗽、咳痰≥3周或咯血或血痰症状患者的结核病发现工作,对就诊的老年可疑肺结核患者应作为结核患者发现的重点。     

平川区2002-2009年实施结核病控制项目效果分析

目的 调查平川区2002-2009年实施结核病控制项目后的预防效果.方法 对2002-2009年门诊初诊登记本、结核患者登记本、痰检登记本、季年度报表中的结核患者进行流行病学统计分析.结果 本次调查共发现活动性肺结核患者980例,其中涂阳肺结核598例(61.02%).598例涂阳肺结核患者中,初治涂阳509例,复治涂阳89例,初治涂阳登记比例呈逐年上升趋势,而复治涂阳登记比例逐年下降.初治涂阳肺结核患者男、女之比为1.61:1,发病年龄以青壮年为主.初治涂阳肺结核患者治愈率由2002年的88.89%提高至2009年的100.00%,复治涂阳肺结核病治愈率由2002年的66.67%提高至2009年的90.00%.结论 实施结核病控制项目对结核病的防治具有重要作用.     

奉贤区综合医院网络报告肺结核患者追踪不到位情况调查

目的:分析奉贤区综合医院在结核患者发现中的作用以及网络报告肺结核患者追踪不到位的原因。方法:对奉贤区3所综合医院2009年1月～2011年12月传染病网络直报系统上报的疑似肺结核患者报告卡资料和同期结核病疫情登记管理卡、结核患者初诊登记本,疫情追踪登记本等相关资料进行统计分析。结果:奉贤区综合医院传(直)报疑/确诊肺结核患者1040例,占辖区内各医疗机构传(直)报总数73.6%,1040例患者中确诊涂阳肺结核患者150例,占辖区内各医疗机构传报确诊涂阳肺结核患者总数72.5%。总体到位的885例,到位率85.0%;不到位的155例,不到位率15.0%。追踪不到位的因素有返乡85例,占8.2%;查无此人30例,占2.9%;地址不详18例,占1.7%;其他16例,占1.5%;死亡4例,占0.4%;拒绝就诊2例,占0.2%。结论:综合医院是发现肺结核患者的重要来源。提高网络直报资料的准确性和加强流动人口管理是提高肺结核患者追踪到位率的重要措施。     

老年结核病46例误诊分析

老年结核病指年龄在60岁以上的结核患者。我院1998—2006年就诊患者中,属延误诊断的老年结核病共46例,现报告如下。1临床资料1.1一般情况:46例患者中,男性29例,女性17例,年龄60~78岁,平均67·5岁,误诊时间2个月~1·5年。1.2临床表现:46例患者中,发热35例(76.2%),其中高热11例,中等度热17例,低热7例。咳嗽、咯痰25例(54%),咯血7例(15.3%),心悸、胸憋、气短22例(46%),食欲不振29例(63%),体重减轻33例(70%),腹痛、腹泻8例(20%),尿频、尿急、尿血10例(21.7%),头痛、头晕8例(19%),无症状9例(20%)。1·3辅助检查:血常规:白细胞(WBC)(3·9~19)×1…     

苏州地区2011年-2017年间9528例肺结核患者合并症的原因分析及其分布趋势

目的:分析苏州地区住院肺结核患者的合并症原因及其分布趋势,为改善结核病的诊断和治疗提供参考。方法:收集2011年-2017年间收治的肺结核患者9 528例病历资料,并发症6 927例,其中肺外结核和咯血患者设为青少年组(n=4 389例),糖尿病、耐药、药物反应患者设为中老年组(n=2 538例);分析其肺结核合并症谱、时间和年龄分布的趋势。结果:6 927例住院肺结核并发症患者占肺结核患者的72.70%;肺结核合并症如肺外结核3 453例、糖尿病1 075例、咯血936例、耐药389例和药物反应1 074例;青少年组并发症例数(3 380例)低于中老年组(3 547例))P<0.05);肺外结核患者占肺结核患者(PTB)比例为36.24%,糖尿病占11.28%,药物不良反应占11.27%,咯血占9.82%和耐药占4.08%;并发症的患病比例总体呈上升趋势(χ~2=23.503,P<0.01)。结论:苏州地区肺结核患者主要合并症为肺外结核、糖尿病;患者年龄小于40岁的人群合并肺外结核概率为最高,大于60岁易出现耐药、药物反应,应规范肺结核患者合并症的诊疗,以提高对复杂肺结核病的诊断治疗水平。     

广州市学生肺结核患病情况调查分析

目的 探讨学生肺结核病患病情况及影响因素.方法 将1993～2004年我广州市结核病肺部肿瘤防治所学生登记的肺结核患者,查阅<世界银行贷款中国结核病控制项目肺结核病人管理登记卡>,必要时查阅病人病历资料,从而对学生肺结核患者的患病情况进行性分析.结果 1993～2004年全市新登记肺结核患者45353例,其中学生肺结核患者2550例,占4.37%(涂阳患者801例,占学生肺结核患者31.41%,涂阴患者1749例,占68.59%);学生结核发现方式上以因症就诊( 0.78%)最多见,其次是健康体检(18.27%);学生结核初复治比例为29.7:1;临床表现中以咳嗽(67.25%)最为多见.     

20例结核病家庭病房随访分析

我们医院对20例初治涂阴、涂阳肺结核并胸膜炎病人，建立了家庭病房，采用2SRHZ/4RH短程化疗方案，在医护人员全监下进行规律用药，随访1~2年无复发，疗效显著报道如下。 1 一般资料 患者来源：20例病人系1998-11~1999-11，是本桃山区的职工、家属，均在本结核科因症就诊而发现。 患者情况：20例中男16例，女4例，年龄17~25岁4例，26~35岁5例，36~45岁4例，46~55岁7例，按我国分类法，20例中II型2例，占10%，III V型4例(单侧)，占20%。V型1例(左侧)，占5%，III型12例占60%，其中有2例为支气管播散型。 各病例在治疗前后做胸片对照，…     

肺结核瘤35例临床及X线分析

肺结核瘤是临床常见的肺部良性肿瘤样病变之一,因缺乏特异性临床表现,不易与肺癌及其他良性肿瘤相鉴别。本文分析报告我院1995年6月至1998年5月间经手术切除病理证实的35例肺结核瘤的临床和Ｘ线特点,以提高对本病的认识和诊断水平。临床资料11　一般资料　本组男27例,女8例,男女之比34:1。年龄20～71岁,在≥40岁的17例患者中,男性14例(40%)。平均年龄422岁。病程1月至5年。有26例因以下表现而就诊:咳嗽19例(543%),胸痛14例(40%),咯血5例(143%),气促3例(86%),发热2例(57%)。9例(257%)在体检作Ｘ线检查时发现肺内肿块,经抗感染及结核治疗肿块…     

武汉市硚口区2003～2007年登记肺结核治疗结局分析

目的:了解武汉市硚口区2003～2007年登记肺结核治疗结局及其影响因素,为提高治愈率提出可行性措施。方法:回顾性分析武汉市硚口区2003～2007年肺结核患者登记资料,并查阅患者病历资料。结果:5年平均治疗成功率为90.6%,多因素logistic回归分析发现性别、诊断延误、治疗分类、依从性及诊断结果是影响治疗结局的主要因素,其相应的OR(95%CI)分别为1.859(95%CI:1.169～2.955)、0.396(95%CI:0.264～0.593)、2.673(95%CI:1.655～4.319)、26.648(95%CI:17.661～40.208)、0.595(95%CI:0.396～0.893)。结论:减少肺结核患者的诊断延误和提高患者的依从性是提高治疗成功率的关键因素。     

Assessment of hypothyroidism in patients with chronic heart failure

STUDY OBJECTIVE: To determine whether appropriate thyroid function measurements were being conducted in patients receiving care at a multidisciplinary heart failure clinic. DESIGN: Retrospective chart review. SETTING: University-affiliated outpatient clinic. PATIENTS: One hundred ninety-three patients with heart failure. INTERVENTION: Patients enrolled in the heart failure clinic at the Medical University of South Carolina from January 2000-April 2003 were identified. Their medical records were reviewed for demographics, New York Heart Association (NYHA) functional classification, laboratory data, and date of most recent heart failure clinic appointment. MEASUREMENTS AND MAIN RESULTS: The records of 193 patients (43% women) were reviewed. Overall and subgroup analyses were performed based on patient characteristics such as presence of thyroid-stimulating hormone (TSH) level, interval since last heart failure clinic appointment, presence of thyroid replacement therapy, amiodarone use, NYHA functional class, and attending physician. Of the 193 patients, 77 (40%) had appropriate TSH monitoring, whereas 10 (32%) of 31 patients receiving amiodarone had appropriate monitoring. Forty-four (27%) patients not receiving amiodarone had no record of a TSH level. In 22 patients (11%), hypothyroidism was diagnosed and treated, whereas 16 patients (8%) had an abnormal TSH level but received no therapy. CONCLUSION: Forty percent of the 193 patients at this outpatient heart failure clinic received appropriate TSH monitoring. An opportunity exists for protocol implementation and education of pharmacists, nurse practitioners, and physicians concerning appropriate thyroid function monitoring in the heart failure population.     

A case of infectious tuberculosis on two long-haul aircraft flights: contact investigation

AIM: During a five-week period in 1996, a passenger with highly infectious tuberculosis travelled on five long-haul aircraft flights. We investigated passengers and crew on two of these flights to identify whether transmission of Mycobacterium tuberculosis had occurred. METHODS: Crew and passengers were identified from airline and immigration records. Contacts were notified of their exposure and invited to attend their local public health clinic. At the clinic, a questionnaire was administered by a public health worker, and a Mantoux skin test was performed. When indicated, a second test was carried out twelve weeks later. Test positivity and conversion were defined according to the 1996 New Zealand tuberculosis control guidelines. RESULTS: Data were obtained on 206 (87%) of the 238 contacts. Twenty four contacts had a positive Mantoux test result, four of which were conversions. All of these contacts had at least one other major risk factor for a positive result, such as a previous BCG vaccination (n=17) or having lived in a country in which tuberculosis is endemic (n=15). To our knowledge, no contacts have subsequently developed tuberculosis disease. CONCLUSIONS: The investigation produced inconclusive evidence about the hypothesis that Mycobacterium tuberculosis was transmitted on one or both of these flights.     

肺外结核80 例临床病理特征及几种常见结核分枝杆菌检测技术对比分析

目的探究肺外结核的临床病理特征,比较几种常见结核分枝杆菌检测技术在肺外结核诊断中的价值。方法回顾性分析2018年8月至2019年8月就诊于安徽省胸科医院经病理确诊的80例肺外结核病人的临床病理资料。结果肺外结核病人主要集中在19～84岁年龄段。80例病人中有基础疾病的8例(10.0%),合并肺结核的45例(56.3%)。肺外结核可发生在多器官、组织,其中发生在淋巴结44例(55.0%),鼻、咽、喉、声带、声门11例(13.8%),骨、关节9例(11.2%),泌尿、生殖系统8例(10.0%),消化道4例(5.0%),腹膜2例(2.5%),皮肤2例(2.5%)。多数病人首发症状以局部表现为主,结核全身中毒症状少见。不同部位的肺外结核,其常见病理改变存在差异:淋巴结结核病理改变以坏死性肉芽肿常见,32/44例(72.7%)。鼻、咽、喉、声带、声门结核病理改变以渗出性病变常见,6/11例(54.6%)。骨、关节结核病理改变以坏死性肉芽肿常见,4/9例(44.4%)。泌尿、生殖系统结核病理改变以坏死性肉芽肿常见,4/8例(50.0%)。腹膜结核和皮肤结核病理改变均以坏死性肉芽肿常见(100%)。相关实验室检查中,80例福尔马林固定-石蜡包埋(FFPE)标本中结核分枝杆菌荧光PCR法的阳性率高于分枝杆菌菌种鉴定、血液T-SPOT和血清学结核抗体检测,差异有统计学意义(P<0.001)。结论肺外结核在性别、年龄分布、临床表现方面缺乏特异性,组织学病理改变结合FFPE标本结核分枝杆菌荧光PCR检测可提高诊断效率。     

老年抑郁症用药和不良反应调查及护理对策

目的:了解老年抑郁症患者抗抑郁药物使用情况及不良反应,并提出相应的护理措施。方法:调查了183例老年抑郁症患者的病历资料,对采用的抗抑郁药物种类、药物不良反应及护理措施进行分析。结果:老年抑郁症患者单一用药者175例,占95.63%,合并用药有8例,占4.37%;在单一用药的175例中使用第一代抗抑郁药的8例,占4.57%,使用第二代抗抑郁药167例,占95.43%。用药后的不良反应主要有:震颤(17例,占9.29%)、镇静、嗜睡(18例,占9.84%)、焦虑(17例,占9.29%)、口干(29例,占15.85%)、视物模糊(17例,占9.29%)、头晕(21例,占11.48%)、心动过速(19例,占10.38%)、心电图QT间期异常(24例,占13.11%)、食欲减少(24例,占13.11%)、恶心(49例,占26.78%)、肝功损害(谷丙转氨酶ALT>40U.L-1,41例,占22.40%)等。第一代抗抑郁药导致的抗胆碱不良反应多于第二代抗抑郁药(P<0.05)。采用了预防性护理、针对性护理、心理护理相结合的方法,减少了患者对抗抑郁药的不良反应。结论:老年抑郁症患者多单一用药,绝大多数采用第二代抗抑郁药;但仍有较多的不良反应。对于老年抑郁症用药不良反应宜采用综合护理措施。     

Comprehensive antenatal care and education of young adolescents: beneficial effects on pregnancy and outcome

Fifty-five consecutive adolescents, aged sixteen years or under at delivery, were cared for at a special antenatal clinic by one nurse and doctor and educated about pregnancy, health and reproduction. A philosophy of self-care and respect was engendered in these adolescents by the nurse and doctor. The effects of such care on the pregnancy and outcome were compared with a group of 55 consecutive patients (of similar age and background) cared for by the general clinic immediately prior to the introduction of the special care clinic. Urinary tract infection, anaemia, premature labour, fetal distress, operative delivery, primary postpartum haemorrhage, low birth weight infants, infant admission rate to neonatal unit and artificial feeding, were all significantly less common in the special clinic patients who also rarely missed outpatient appointments.     

Prevalence of excessive or problem drinkers among patients attending somatic outpatient clinics: a study of alcohol related medical care.

The prevalence of alcohol related morbidity was studied among 2038 patients attending somatic outpatient clinics. A further 76 patients had refused the study, giving an overall drop out rate of 3.6%. Several methods were combined so as to detect as many patients with problem drinking as possible. According to the criteria and definitions employed 17% of men (confidence interval 15% to 19%) and 4% of women (confidence interval 3% to 5%) were excessive consumers of alcohol or problem drinkers. The highest proportion of such patients--that is, 17%--was noted in the emergency rooms (27% of men, 8% of women). At other clinics the proportions varied from 11% to 17% of men and from 2% to 4% of women. The strongest relations between overconsumption of alcohol and consultation at the clinic were among patients attending the medical outpatient clinic and the emergency rooms; in 86% (confidence interval 75% to 97%) and 88% (confidence interval 81% to 95%) of problem drinkers attending these clinics, respectively, alcohol was related to the consultation. Consultations were related to alcohol in 82% of women with excessive or problem drinking and 73% of men defined in this way. There was a tendency to a higher proportion of men with excessive or problem drinking in the age group 40-49 years. These findings show that among patients classified as excessive or problem drinkers attending somatic outpatient clinics there was a close relation between alcohol consumption and utilisation of medical resources, especially in women.     

Lipid-lowering treatment in coronary artery disease: a survey in an ambulatory outpatient clinic.

OBJECTIVES: In controlled trials, HMG-CoA reductase inhibitors (statins) effectively reduced cardiovascular events in patients with coronary artery disease (CAD). However, recent pharmacoepidemiological studies indicate an underuse of statins in the target population. The objective of this study was to examine the extent to which CAD patients in Germany actually received statins under field conditions. METHODS: We evaluated the medical records of 296 patients referred to the cardiology outpatient clinic of the Frankfurt University Hospital by their general practitioner (GP) in the period 1995 to 1998. All patients had symptomatic, angiographically proven CAD, 142 had previous myocardial infarction. A diagnosis of dyslipidemia was taken from the records. Most patients were visited on more than 1 occasion. In all, we were able to access 296 records for a 1st visit, 76 records for a 2nd visit and 29 records for a 3rd visit and 16 records for > 3 visits. RESULTS: According to the entry criteria of the 4S Trial (total cholesterol 5.5-8.0 mmol/l or 212-311 mg/dl), 108 patients were deemed as eligible for lipid-lowering treatment, criteria of the LIPID Trial (4.0-7.0 mmol/l or 154-270 mg/dl) gave a yield of 190 patients. The actual treatment rate with a statin at the 1st visit was 34% (LIPID Group) and 40% (4S Group). At later visits, the treatment rates with statins increased to 63% (LIPID Group) and 79% (4S Group), due to advice given to the GP by the outpatient clinic. When the observation period was devided into 2 periods (04/95 - 01/97; 02/97 - 09/98), actual treatment rates (all visits) for the 4S Group were 43% and 38%, respectively, indicating no further "penetration" of the 4S Study in the therapy decision-making of the GPs. CONCLUSIONS: The data indicate that necessary treatment with a HMG-CoA reductase inhibitor is often withheld in the ambulatory setting.     

Tuberculosis at Green Lane Hospital 1980-1982

An audit of tuberculosis management at Green Lane Hospital was undertaken by review of the case records of 235 cases of adult tuberculosis. There were 135 men and 100 women (mean age 47 years). Important findings include the large proportion of nonEuropeans (66%) and the frequency of drug resistance. Drug resistance was present in 29% of isolates from nonEuropean immigrants who had resided in New Zealand for a year or less. The adequacy of current medical screening of Pacific Island and South-east Asian visitors and immigrants is discussed in the context of these findings. Treatment regimens used were in accordance with accepted recommendations, although the duration (14 months in uncomplicated disease) was longer than is now thought necessary. Of the 205 patients who completed treatment under our care 186 (91%) were cured, 14 (6.8%) died, 3 (1.5%) relapsed and two defaulted. The median in hospital stay was 32 days and together with the somewhat high relapse rate (1.5%) reflects the absence of facilities for closely supervised outpatient tuberculosis treatment in Auckland.