综合医院住院病人中诊断的活动性肺结核132例分析

目的了解综合医院住院活动性肺结核病人入院前后诊疗情况,探讨肺结核病人诊断延误的原因,以提高综合医院医生对不典型肺结核的诊断水平。方法回顾性分析2002年1月—2006年12月各科活动性肺结核转、出院的132例病例的临床资料,包括临床症状,辅助检查,诊治情况等。结果(1)门诊误诊为其他疾病而收入院29例占22%,以肺炎、肺部阴影待查及肺脓疡为主;因其他疾病收入院而发现合并肺结核的103例占78%,以慢性喘息性支气管炎、胸膜炎为主。(2)以老年人及外地打工或外地农民比例较高。(3)临床症状以发热、咳嗽、纳差、咳痰喘、头痛、憋气、胸痛、咯血、乏力为常见症状,分别占43.9%、37.1%、21.2%、19.7%、11.4%、10.6%、10.6%、9.1%、8.3%。(4)单纯肺结核病例11例,合并其他疾病病例121例,常见合并疾病为脑血管疾病、营养不良、慢性喘息性支气管炎、糖尿病等,2种以上基础疾病的51例。合并肺外结核共21例,占15.9%,以结核性脑膜炎、颅内结核、肠结核多见。(5)入院后CT检查103例,肺结核89例,提示肺结核可能的14例,诊断率86.4%。(6)入院前100%未作痰涂片抗酸杆菌检查,入院后痰涂片检查82例占62.1%,阳性31例占37.8%。结论综合医院门诊是肺结核诊查的第一线,应进一步加强门诊病人结核病的排查工作,怀疑不典型肺结核病人门诊应该进行痰涂片及肺CT检查。

Clinical analysis of 132 active pulmonary tuberculosis in hospitalized patients in a general hospital

Objective In order to investigate the reasons for management delay and to obtain better identification to untypical tuberculosis,a retrospective study was carried out in a general hospital to assess the onset,diagnosis and treatment of active tuberculosis in hospitalized patients.Methods From Jan 2002 to Dec 2006,the data of 132 patients with active pulmonary tuberculosis who were hospitalized in Beijing Tiantan hospital were analyzed,include clinical symptoms,auxiliary examinations,diagnosis,and managements,etc.Results 29 patients(22%) were admitted in hospital as other diseases at out-patient clinic,mostly including pneumonia,bellows shadow and lung Abscess.103 patients(78%) were admitted as other diseases but discovered combination with active tuberculosis,mostly including chronic obstructive pulmonary diseases and pleurisy.The elders,migrate workers and peasants from other area accounted for the big proportion of the total population.The common clinical symptoms included fever(43.9%),cough(37.1%),low appetite(21.2%),wheeze(19.7%),headache(11.4%),breath holding(10.6%),chest pain(10.6%),hemoptysis(9.1%) and debility(8.3%).There were 11 patients with merely pulmonary tuberculosis,and 121 combination with other diseases,mostly including cerebrovascular disease,malnutrition,chronic obstructive pulmonary diseases and diabetes.51 patients had more than two kinds of diseases.There were 21 patients with extrapulmonary tuberculosis,mostly including tuberculous meningitis,intracranial tuberculosis and intestinal tuberculosis.89 patients were diagnosed identified pulmonary tuberculosis by CT,while 14 patients conceivable,Final diagnosis ratio was 86.4% by CT.Sputum smear examination were not be performed before admission.82 patients(62.1%) had sputum smear after admission,among which 31(37.8%) were positive.Conclusions Clinical physicians at out-patient clinic in general hospital must keep an alert dealing with pulmonary tuberculosis patients by sputum smear and chest CT for early identification.