综合医院结核病查痰点痰检工作分析

目的分析综合医院门诊可疑肺结核症状者查痰工作情况,探讨综合医院提高涂阳病人发现的措施。方法根据综合医院和结防机构门诊病人登记本、查痰登记本、转诊登记本及结防机构对综合医院的督导和痰检质量控制情况进行综合分析和评价。结果40所综合医院1年间,共登记可疑肺结核症状者11 303例,发现涂阳肺结核859例,涂阳检出率15.6%,转到结防机构的涂阴及未查痰病人2 094例,在结防机构查痰1 685例,发现涂阳肺结核804例,涂阳检出率47.7%,其中未查痰直接转到结防机构查痰1 026例,发现涂阳肺结核551例,涂阳检出率53.7%,痰阴病人转到结防机构再查痰659例,发现涂阳肺结核253例,涂阳检出率38.4%,结防机构门诊查痰25 238例,涂阳检出率55.7%,与综合医院涂阳检出率比较差异有显著性(P<0.05)。结论在综合医院建立查痰点,加大行政干预力度,加强综合医院与结防机构的合作,医院内相关科室建立协调机制,将痰检工作纳入综合医院临床检查常规项目,加强痰检质量控制和结防专业机构对综合医院相关专业人员的培训和复训,是提高传染源发现水平的有效途径。

Analysis on sputum examination for tuberculosis in general hospital

Objective To analyze the sputum examination of TB suspects in outpatient department in general hospital,and explore the measures to increase case-finding of smear-positive TB in general hospitals. Method Data from case register in the outpatient department,sputum examination register,referral register in general hospital and TB dispensary and data from supervision to general hospital and quality control of sputum examination were collected and evaluated. Result 11,303 TB suspects were registered in 40 general hospitals where the FIDELIS(Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB) project has been implemented for one year,and among them 859 were smearpositive pulmonary tuberculosis(SPTB 15.6%).(2,094) cases referred to TB dispensary were smear-negative TB or without sputum examination. 1,685 cases had sputum examination,and 804 were smear positive TB(47.7%).Among them,551 were from the 1,026 cases without sputum examinations in general hospital(the smearpositive rate was 53.7%) and 253 were from the 659 smear negative TB who were checked by general hospital(the smear-positive rate was 38.4%). 25,238 TB suspects had sputum examinations in TB dispensaries,the smearpositive rate was 55.7% which was significantly different from the rate in general hospitals(P<0.05). Conclusion Many TB suspects seek medical service in general hospital at the first time.However,the case detection is not standardized in general hospital.Thus, it is efficient approach to improve case detection by setting up sputum examination sites in general hospitals,enhancing administration interventions,strengthening the system of cooperation and coordination between TB dispensary and general hospital,and the internal coordination of the general hospital,integrating the sputum examination into the routine examination items in general hospital,and strengthening the quality control,training and retraining the relevant technicians.