山东省济南市医疗机构百日咳诊断能力调查  

Investigation of the Ability to Diagnose Pertussis in Jinan City Hospitals,Shandong Province

作　　者：宋凯军[1,2] 刘铁诚[2] 张先慧[2] 刘晓雪[2] 宋晓雁[2] 姜宝法[1] 

机构地区：[1]山东大学公共卫生学院,山东济南250017 [2]济南市疾病预防控制中心,山东济南250021

出　　处：《中国疫苗和免疫》2016年第5期533-536,510,共5页Chinese Journal of Vaccines and Immunization

摘　　要：目的掌握济南市医疗机构百日咳诊断标准的执行和实验室诊断方法使用现状。方法利用问卷和访谈的形式调查济南市二级及以上医疗机构医务人员,收集相关数据,结合百日咳监测数据进行分析。结果在49家二级及以上医疗机构中39家（79.59%）开展百日咳临床诊断,其中二级机构占61.54%,三级机构占38.46%。在开展百日咳临床诊断的医疗机构39名医务人员中,百日咳诊断标准中的典型症状选择正确率分别为阵发性痉咳100%、持续咳嗽≥2周94.87%、鸡鸣声87.18%;非典型症状分别为青紫30.77%、心动过缓20.51%、窒息20.51%、反复发作的呼吸暂停15.38%;执行临床诊断病例和确诊病例诊断标准的正确率为35.90%。全市百日咳实验室确诊病例比例从2012年的18.75%上升到2014年的56.88%和2015年的79.46%;排除实验室确诊病例后,2014-2015年疫情依然高发。结论济南市医疗机构百日咳诊断标准执行正确率低,实验室确诊能力不足。实验室诊断技术的采用不能完全解释疫情高发的原因,百日咳疫情仍有可能被低估,尚需进一步研究疫情高发的原因,及时调整免疫策略。Objective To investigate implementation of pertussis diagnostic standards and application of laboratory methods in Jinan. Methods Relevant data were collected from medical staff in 49 secondary or tertiary hospitals by interviews and questionnaires. Data were analyzed in combination with reported pertussis incidences. Results Thirty-nine（ 79. 59%） of 49 hospitals performed clinical diagnosis of pertussis,and among these,61. 54% were secondary hospitals and 38. 46% were tertiary hospitals.Medical staff performing pertussis diagnosis in the 39 hospitals answered questions about typical pertussis symptoms： 100% correct for paroxysmal and spasmodic cough,94. 87% correct for 2-week continuous cough,and 87. 18% correct for crowing voice. Correct answer rates for atypical symptoms were 30. 77%for cyanosis,20. 51% for bradycardia,20. 51% for asphyxia,and 15. 38% for recurrent apnea. The accuracy rate of following diagnostic standards for clinical and confirmed cases was 35. 90%. The proportion of laboratory confirmed pertussis cases in Jinan increased from 18. 75% in 2012 to 56. 88% in 2014,and to 63. 75% in 2015; the incidence in 2014-2015 was higher than in previous years,even when excluding laboratory-confirmed cases. Conclusions The accuracy of performing diagnostic standards of pertussis was low in Jinan,with a lack of laboratory diagnosis. The application of laboratory diagnosis technology cannot fully explain the reason for the pertussis epidemic; pertussis incidences were underestimated. We should further study the causes of increasing pertussis incidence in order to adjust immunization strategy.

关 键 词：百日咳 诊断标准 

分 类 号：R183[医药卫生—流行病学]