新发涂阳肺结核病人延误诊断影响因素分析  

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

作　　者：谭云洪 杨华林 刘松山[2] 成诗明[3] 

机构地区：[1]湖南省结核病防治所检验科,长沙410013 [2]湖南省郴州市疾病预防控制中心 [3]中国疾病预防控制中心结核病预防控制中心

出　　处：《中国公共卫生》2009年第6期651-652,共2页Chinese Journal of Public Health

摘　　要：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。Objective To study the delay of diagnosis and treatment and its influencing factors among smear-positive 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 model was 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 factor was 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 seeing medical assistance at drug store, village clinic and the initial consulting in township medical organization. Positive in- fluencing factors on the diagnosis delay were sputum smear, X - ray, CT examinations. The negative influencing factor on the treatment delay was living in rural area and the positive factors was sputum smear at the first medication seeking. Con- dusion The delay of diagnosis and treatment of new smear-positive pulmonary tuberculosis patients are retaled to the unowledge on the disease, the residence, the time of seeking medical counseling of the patients and X-ray check-up, sputum- smear examination at the first time of medication seeking.

关 键 词：结核/肺结核 延误诊断 COX比例风险模型分析 

分 类 号：R521[医药卫生—内科学]