新疆维吾尔自治区喀什地区肺结核就诊及确诊延迟调查分析  

Analysis of pulmonary tuberculosis patient health seeking delay and diagnosis delay in Kashgar in Xinjiang

作　　者：杨太华[1] 瓦哈甫.沙力 扬津民[2] 邰新蓉[1] 

机构地区：[1]新疆维吾尔自治区疾病预防控制中心结核病防治中心,乌鲁木齐830002 [2]新疆维吾尔自治区青河县疾病预防控制中心

出　　处：《中国防痨杂志》2011年第12期803-805,共3页Chinese Journal of Antituberculosis

摘　　要：目的分析新疆喀什地区肺结核患者就诊与确诊延迟的原因,为提高就诊和确诊的措施提供依据。方法对喀什地区除塔什库尔干县(高海拔偏远小县)外其他所有11个县(市)2005年1月1日至2010年9月30日登记的所有活动性肺结核患者43 832例(其中有7622例因出现症状至初次就诊日期填写不详而无法评价,占17.39%)就诊延迟和确诊延迟进行统计,结合每个县面对面问卷调查不少于20例2010年结束疗程的肺结核患者对防治结核病知识的认知、就医行为等进行调查分析;同时对被调查乡卫生院及村卫生室的状况进行调查了解。结果患者出现症状到第一次就诊平均间隔106.5d,91.98%(33 305/36 210)就诊延迟;就诊前了解相关信息者延迟率为51.43%(18/35),而不了解者为98.11%(52/53),差异有统计学意义(χ2=28.24,P<0.01);患者初诊至确诊平均间隔80.1d,33.25%(12 102/36 393)确诊延迟;乡医院痰菌检出率为13.15%(43/327)、诊断符合率93.58%(306/327);X线胸片合格率72.64%(146/201)、诊断符合率76.03%(111/146);村医无诊断结核病的能力。结论就诊延迟和确诊延迟现象在喀什地区农村中普遍存在。强化少数民族人口结核病防治策略和措施的宣传,提高乡村级诊断能力和转送意识,是当前喀什地区亟待解决的问题。Objective To analyze the reasons of PTB patient health seeking delay and diagnosis delay in order to provide evidence for improving.Methods Except Taxkorgan County（a high altitude remote small county）,all 43 832 cases of active PTB（of which,7622 cases could not be evaluated due to lack of interval information between symptoms onset to initial health care seeking,accounting for 17.39%） registered from January 1,2005 to September 30,2010 in remaining 11 counties in Kashgar were analyzed for health seeking delay and diagnosis delay.In combination with the face-to-face questionnaire investigation for more than 20 cases of PTB patients who completed treatment in 2010 in each county,patient＇s TB cognition and health seeking behaviors were analyzed.Meanwhile,the status of township and village hospitals were investigated.Results The average interval from symptom onset to initial health seeking was an average of 106.5 days.The overall health seeking delay was 91.98%（33 305/36 210）;51.43%（18/35） for patients who understood the relevant information before seeking health care,and 98.11%（52/53） for those who did not understand,the difference was statistically significant（χ2 = 28.24,P0.01）;The average interval from initial health seeking to TB confirmation was an average of 80.1 days.The overall diagnosis delay was 33.25%（12 102/36 393）;In township hospital,the sputum smear detection rate was 13.15%（43/327）,93.58%（306/327） of diagnosis rate;72.64%（146/201） of X-ray quality passing rate,76.03%（111/146） of diagnostic accuracy rate;village doctor had no ability in TB diagnosis.Conclusion Health seeking delay and diagnosis delay are common in local rural areas.Therefore,to strengthen the publicity of TB control strategies and measures for minority population,improve the diagnostic capacity and consciousness of TB referral is the current pressing problems in Kashgar.

关 键 词：结核 肺/诊断 误诊 新疆[维吾尔自治区 

分 类 号：R521[医药卫生—内科学]