134例复治肺结核患者既往史调查

目的调查复治肺结核既往史信息,为国家制定和调整复治肺结核患者防治政策提供依据。方法使用统一设计的调查问卷,收集2010年9月11-21日期间在北京某两家结核病专科医院经所有住院的134例复治肺结核病患者相关信息,包括患者的基本信息、首次求医行为、首次诊断和治疗等内容并进行整理分析。结果与结核病专科医院等其他机构相比,首次就诊、确诊机构及治疗都是县级以上综合医院比例最高分别为55.22%(74/134)、61.19%(82/134)及53.73%(72/134),首次检查痰涂片检出率为63.43%(85/134);首次治疗个体化方案和标准化方案分别为92.53%(124/134)及7.47%(10/134);有28.36%(38/134)的患者在治疗期间中断治疗,55.26%(21/38)的患者治疗中断原因是自认为治愈而中断治疗;35.82%(48/134)的患者发生了不良反应,因不良反应中断治疗的患者为26.32%(10/38)。结论复治肺结核患者首次就诊转诊不到位,诊疗不规范,应加强多部分合作对转诊工作进行监督,规范诊疗,加强服药监督,提高患者治疗依从性,减少治疗中断,从而减少耐药及提高治愈率。

Survey on history of 134 retreatment pulmonary tuberculosis patients

To investigate history of retreatmeat pulmonary tuberculosis(TB) patients, in order to provide evidence to adjust and develop the policy for retreated tuberculosis prevention and treatment. We used unified questionnaire for collecting treating histories of 134 hospitalized retreated pulmonary tuberculosis patients who had been admitted during 11-21 September 2012, and then carried out analysis. Results showed that compared with specialized tuberculosis hospitals and other health facilities, patients’ first visiting facility, diagnosing and receiving treating facility were mainly general hospitals above county level, the percentages were 55.22% (74/134), 61.19% (82/134) and 53.73% (72/134) respectively. 63.43% (85/134) of patients received sputum bacteria examination on the first visiting. For the first treatment, 92.53% (124/134) patients adopted individualized treatment regimen and 7.47% (10/134) received standardized treatment regimen. Treatment interruption rate was 28.36% (38/134) during treating period, 55.26% (21/38) of them had interrupted treatment because they thought they had been cured. 35.82% (48/134) of patients had adverse drug reactions. 26.32% (10/38) of treatment interrupted patients had interrupted treatment because of adverse reactions. Thus, we concluded that those treatment pulmonary tuberculosis patients were not referring correctly and had not received standardized diagnosis and treatment. We should strengthen the multi-sectoral cooperation to supervise referral work, standardize diagnosis and treatment, strengthen medicine supervision and improve the patients’ treatment compliance, reduce treatment interruption improve the cure rate.