对社区流动人口结核病管理的循证评价

Objective To investigate management and treatment to tuberculosis(TB)of floating population in the community,and evaluate systematically,study the effect of TB control management,in order to provide reliable basis for developing the scientific and practical intervention programs specifically for the floating population,and also to further explore and update the governance strategy of the floating population of TB.Hethods The databases of CHKD,WANFANG MED ONLING and CNKI Etc,were searched and analyzed by computer,and related medical journals and monographs were studied by manual searching,getting the issued literature on the treatment,management,nursing intervention of floating population tuberculosis from 1998 to 2010.At the same time we used non-probability purposive sampling method and had on-site interviews after obtaining the interviewee informed of consent.Besults We retrieyed 137 documents that have been published meeting the inclusion criteria,by viewing the full text,9 docunents had been evaluated for the 1 evidence and 15 documents had been evaluated for the 2～3 finally.From the literature with the evaluation and interviews.it showed that:to use a variety ofeffective management measures include health promotion,providing incentives,cross-regional referral tracking,DOTS nanagemerit of patient,had achieved certain effects.But the floating population understood limitedly TB-related knowledge and free treatment policy and had mixed views,that the awareness of TB control is poor,residential instability,lack of effective contact,resulted in difficuhing in supervision and tracking of the floating population.The TB management to floating population patients should be strengthened.Condusion It is necessary to expand the free flow of patient treatment and the corresponding cost of subsidies,to carry out comprehensive and multi-fornKq of community knowledge on TB and the publicity on national TB control policy,to make efforts to improve community supervision OfTB,and carry out individual recycling interactive health education for improving the compliance of TB patient.     

初始耐药肺结核患者近、远期疗效分析

目的分析初始耐药肺结核患者使用2H3R3Z3S3(E3)/4H3R3方案的近、远期治疗效果,分析不同耐药程度对患者疗效的影响。方法回顾分析广州市越秀、荔湾两区1993～2001年登记的初治涂阳培阳并有耐药性结果经复核资料完整的肺结核病人237例,按药物敏感性不同进行近、远期治疗效果分析。结果初治耐药237例病人的第2、3、5、6个月痰菌阴转率分别是78.5%、86.9%、89.5%、93.7%,失败率为6.3%,耐1种药第2个月末痰菌阴转率82.6%、第6个月末96.2%,失败率为3.8%;耐2种药或以上第2个月末痰菌阴转率73.3%、第6个月末90.5%,失败率为9.5%,两者2月末和6月末分别比较差异无显著性(X2=2.958、P=0.085;X2=3.133、P=0.077),耐多药肺结核第2个月末痰菌阴转率58.1%、第6个月末83.7%,失败率为16.3%;非耐多药第2个月末痰菌阴转率83.0%、第6个月末95.8%,失败率为4.2%,两者分别比较差异有非常显著性(X2=12.870、P<0.001;X2=6.718、P=0.010),随访半年非耐多药与耐多药复阳率分别为4.6%、32.6%;随访1年分别为8.2%、37.2%;2年分别为9.3%、53.5%。两者比较差异有非常显著性(X2=28.20、P<0.001;X2=25.27、P<0.001;X2=48.09、P<0.001)。结论在国家结核病防治规划下,采用直接面视下的短程间歇治疗方案(DOTS)是可行的。耐多药会影响痰菌阴转速