新发涂阳肺结核病人延误诊断影响因素分析

目的 探讨涂阳肺结核病人延误诊断治疗的影响因素,为早期控制传染源提供科学依据。方法 以2007年4～10月就诊于湖南省郴州市北湖区、桂阳、宜章、永兴、安仁5县(区)结防机构新发涂阳肺结核患者为研究对象,利用调查表收集相关资料,应用COX比例风险模型进行延误诊断治疗的影响因素分析。结果 患者延误、确诊延误、治疗延误、医疗机构延误及总延误时间中位数分别21,29,3,16,62d。患者延误的独立危险因素为不知晓结核病相关知识和首次症状有非肺结核主要症状;确诊延误的独立危险因素为首次就诊未进行痰涂片、X线电子计算机断层扫描(CT)和摄胸片检查;治疗延误的独立危险因素为农村户籍和首次就诊未进行痰涂片检查。医疗机构延误的独立危险因素为首次检查未进行痰涂片、摄胸片和CT检查、首诊医疗机构在村级或乡级医疗机构及首次无咯血症状;总延误的独立危险因素为男性、首次检查未进行胸透或CT检查。结论 患者延误诊断、治疗与患者肺结核知识、户口所在地、首诊时间、未进行痰涂片和X线检查有关。

Research on diagnosis and treatment delay and its influencing factors among new smear-positive pulmonary tuberculosis patients in five counties of Hunan province

Objective To study the delay of diagnosis and treahnent and its influencing factors among smearpositive pulmonary tuberculosis in Hunan province.Methods New smear-positive pulmonary tuberculosis patients(SP-PTB)in Beihu district,Guiyang county,Yizhang county,Yongxing county and Anren county in Chenzhou city of Hunan province were selected The data were analyzed with SPSS 13.0 and Cox proportional hazards regression modelwas adopted.Results The study investigated 217 persons in all.The median of patients’delay,the delay of diagnosis treatment,the delay of health care facilities,and total delay was 21,29,3,16,62 days,respectively The positive influencing factor on the patients' delay was health education on TB and the negative influencing factorw as without specific symptom.The positive influencing factors on the health care delay were sputum smear,X-ray,CT examinations and hemoptysis and the negative factors was seeking medical assistance at dmg store,village clinic and the initial consulting in tow nship medical organization Positive influencing factors on the diagnosis delay were sputum smear,X-ray,CT examinations The negative influencing factor on the treatn ent delay was living in rural area and the positive factors was sputum smear at the firstm edication seeking Conclusion The delay of diagnosis and treatment of new sm earpositive puleonary tuberculosis patients are retaled to the unow ledge on the disease,the residence,the tin a of seeking medical counseling of the patients and X-ray check-up,sputum-smear examination at the firsttin a of medication seeking