综合医院住院肺结核诊断现状分析

目的了解分析综合医院住院活动性肺结核患者的诊断现状。方法对2002年1月1日—2006年5月31日北京大学人民医院控感科登记的以“肺结核”为主要诊断出院的患者住院病历进行调查并进行回顾性分析,不包括陈旧性肺结核及结核性胸腔积液。结果共统计分析患者74例,其中呼吸内科报告最多,共53例(71.6%),其次为胸外科,共13例(17.6%)。有典型结核中毒症状者仅31例(41.9%),红细胞沉降率明显增快患者者占54.1%,PPD试验阳性仅54.1%。查痰率64.9%,涂阳率54.2%。患者入院至确诊时间平均为13.15 d,≤14 d者48例(64.9%),>14d者26例(35.1%)。确诊方法主要为痰抗酸杆菌阳性(共26例,占35.1%)。经各种活检确诊共27例(36.7%),其中纤维支气管镜下活检诊断8例(10.9%),经开胸肺活检确诊17例(23.0%),经肺穿刺活检确诊1例(1.4%),淋巴结活检确诊1例(1.4%),除纤维支气管镜下活检阳性率88.9%外,其余方式活检阳性率均为100%。临床诊断20例(27.0%)。结论综合医院呼吸内科处于结核病防治的第一线,目前北京大学人民医院对大部分肺结核患者在住院2周之内确诊。主要诊断方法仍为痰找抗酸杆菌阳性,但相当一部分患者通过各种方式的活检确诊。今后应进一步提高痰菌检查率和阳性率。对于诊断不清的病例应及时进行纤维支气管镜检查(包括镜下活检),必要时行肺穿刺甚至开胸肺活检。

Diagnosis of pulmonary tuberculosis in general hospital

Objective To investigate the diagnosis level of pulmonary tuberculosis of in-patient in general hospital. Methods Senventy-four in-patients with pulmonary tuberculosis reported in people's Hospital of Peking University Jan 1,2002 to May 31,2006 were retrospectively analyzed.Results Of 74 cases,71.6% were reported by respiratory department,41.9% had typical tuberculosis clinical symptom,54.1% showed that ESRs were significantly high,54.1% PPD test were positive.64.9% patients took sputum smear examination and 54.2% of them were positive.The average interval from admission to diagnosis was 13.15 days,less than 14 days in 48 cases(64.9%),more than 14 days in 26 cases(35.1%).26 cases(35.1%) were diagnosed by sputum smear examination.27 cases(36.7%) were diagnosed by biopsy methods(8 cases by biopsy via bronchoscope,17cases by open-thorax lung biopsy, 1 case by lung-puncture biopsy and 1 case by lymphonode biopsy).The positive rate was 100% for every biopsy method except bronchoscopic biopsy(88.9%).20 cases(27.0%) were clinically diagnosed. Conclusion Respiratory department of general hospital is on the first-line of pulmonary tuberculosis prevention.The detection level of pulmonary tuberculosis in people's Hospital of Peking University is satisfactory,and most patients were diagnosed in two weeks.The main diagnostic method is sputum smear examination,but a few parts of cases were diagnosed through biopsy methods.