结核病定点医院肺结核诊断治疗管理现况分析  

Status of the diagnosis,treatment and management of tuberculosis in TB specialized hospitals

作　　者：赵津[1] 李仁忠[1] 

机构地区：[1]中国疾病预防控制中心结核病预防控制中心,北京102206

出　　处：《中国健康教育》2011年第1期13-17,共5页Chinese Journal of Health Education

基　　金："艾滋病和病毒性肝炎等重大传染病防治"科技重大专项资助项目(2008ZX10003-007)

摘　　要：目的评价结核病定点医院肺结核诊断、治疗和管理的现状。方法采用多阶段分层随机抽样方法,在全国选择5个地区的5家结核病定点医院,对2009年8月之前曾经在结核病定点医院住院治疗的新发涂阳非耐药肺结核患者进行问卷调查和病案回顾,收集患者住院期间诊治、管理情况及出院后治疗管理情况。结果痰涂片检查是定点医院最常使用的细菌学诊断,为95.0%,痰培养和药敏试验分别为37.8%和16.0%。78.1%的患者在方案中使用了多种二线抗结核药品,特别是左氧氟沙星使用比例高达69.7%。住院期间接受医生面视下服药的比例为6.3%,出院后为3.6%;10.8%的患者转诊到结核病防治机构进行督导。84.0%的患者医疗费属于灾难性支出,医疗保险报销后仍有65.8%的患者属于灾难性医疗支出。结论目前定点医院肺结核诊断、治疗和管理都存在不规范的现象,医疗费造成患者经济负担重,不利于患者依从治疗,这些因素都会导致耐药肺结核的产生。Objective To evaluate the current status of diagnosis,treatment,and management of TB specialized hospitals.Methods Five TB specialized hospitals in 5 cities were selected,and 132 non-resistant new smear positive patients who were in hospital before August 2009 in those hospitals were investigated by questionnaire and case review.The information on diagnosis,treatment and management of inpatient treatment was analyzed.Results Sputum smear test（95.0%） was commonly used for TB diagnosis in all hospitals.Due to limitation of lab condition,only 37.8% of patients received sputum specimen culture,and even less for drug susceptibility test（16.0%） of first line drugs.78.1% of patients received second line drugs for treatment,especially levofloxacin up to 69.7%.Only 6.3% of the patients received DOT by health staff,and only 3.6% for outpatient treatment.10.8% of the participants were transferred to county TB dispensary.84.0% of the patients paid for medication and hospitalization more than 40% of their family non-food income,which was called catastrophe expense,even after health insurance reimbursement,this indicator was still 65.8%.Conclusion Irregular diagnosis,treatment and management still happened in TB specialized hospitals,medication fee was a heavy burden for most patients and their family,and these phenomena might lead to incompliance and also drug resistance TB.

关 键 词：结核病 定点医院 诊断 治疗 管理 经济负担 

分 类 号：R193[医药卫生—卫生事业管理] R521[医药卫生—公共卫生与预防医学]