“医防合作”模式下实施DOT对耐多药肺结核患者不同治疗转归的分析  

Analysis on the DOT management of multidrug-resistant tuberculosis patients with different treatment outcomes based on the comprehensive programme

作　　者：代晓琦 阮云洲[1] 李仁忠[1] 苏伟[1] 王黎霞[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：《中国防痨杂志》2016年第11期929-933,共5页Chinese Journal of Antituberculosis

基　　金：中国国家卫生和计划生育委员会-盖茨基金会结核病防治合作项目（51914）

摘　　要：目的分析在“医防合作”模式下对耐多药肺结核患者进行直接面视下督导化疗的实施情况，为耐多药肺结核患者的防治服务体系建设提供参考意见。方法选择中国国家卫生和计划生育委员会-盖茨基金会结核病防治合作项目“医防合作子项目”4个调查现场为研究地区，该项目纳入治疗患者172例。排除死亡和接受治疗不满1个月的患者，其余146例患者作为研究对象。2015年1月至2016年6月，由经过培训的调查人员使用统一的个案调查表，对患者进行回顾性调查，共94例患者接受调查。将接受调查的患者分为治疗成功（治愈和完成治疗）和治疗未成功患者（失败、丢失、未评估）两类进行分析。结果接受调查的94例患者完成1个月以上注射期治疗（治疗成功患者60例，63．83％；治疗未成功患者34例，36．17％），治疗成功与未成功患者的注射药物皆主要存放于村卫生室和（或）社区卫生服务站，分别占75．00％（45／60）、55．88％（19／34），差异有统计学意义（X^2=3．65，P=0．056）；口服药物在两类患者中分别主要存放于村卫生室和（或）社区卫生服务站及患者家中，分别占56．67％（34／60）、61．76％（21／34），差异有统计学意义（X^2．95，P=0．086）。治疗成功与未成功的患者中分别有13．33％（8／60）和29．41％（10／34）发生过漏注射药物，差异有统计学意义（X^2=3．62，p=0．057）；分别有13．33％（8／60）和38．24％（13／34）的患者漏服药，差异有统计学意义（X^2=7．76，P=0．005）；88例患者完成注射期治疗并接受1个月以上非注射期治疗（治疗成功患者60例，68．18％；治疗未成功28例，31．82％），两类患者的口服药存放处主要为家里，分别占51．67％（31／60）、71．43％（20／28），差异有统计学意义（X^2=3．06，P：0．080）；11．67％（7／60）的治�Objective To analyze the implementation situation of DOT management of multidrug-resistant tuberculosis based on the comprehensive programme which provided universal access to diagnosis, treatment, and follow-up for MDR-TB in four Chinese cities, and to identify the existing problems and the reasons. Methods The four research sites of the comprehensive programme of China-Gates TB Project were the study sites. One hundred and seventy-two were enrolled in the comprehensive programme. Excluding died patients and patients who undergoing treatment less than 1 month, the remaining 146 patients were the research objects. From January 2015 to June 2016, we designed the questionnaire by expert consultation, and retrospectively investigated MDR-TB patients with standardized ADR questionnaire. A total of 94 patients were investigated. We divided the patients into two categories, patients who were successful/unsuccessful treated. Results Ninety-four patients administrated injectable agent more than 1 months. Injectable drugs were typically preserved in village clinics/community health service sta- tions （75.00%, 45/60; 55.88%, 19/34; Z2 =3, 65, P=0. 056）. Oral medicine of successfully treated patients were typically preserved in village clinics/community health service stations, and at home of unsuccessfully treated patients （56.67%, 34/60; 61.76%, 21/34;X^2 = 2.95, P=0. 086）. 13.33% （8/60） of successfully treated patients and 29.41% （10/34） of others missed the injectable drugs respectively （X^2 =3.62, P=0. 057）. 13. 33% （8/60） of successfully treated patients and 38. 24%（13/34） of others missed the oral drugs respectively （X^2 = 7. 76, P=0. 005）. Eighty-eight patients administrated oral drugs more than 1 months in the continuation phase. Oral drugs were typically preserved at home （51.67%, 31/60; 71.43%, 20/28; X^2=3.06, P=0.080）. 11.67% （7/60） of successfully treated patients and 35.71%（10/28） of others missed the drugs respectively （X^2= 7.08, P= 0. 008）. Patients who misse

关 键 词：结核 肺 结核 抗多种药物性 卫生服务管理 治疗结果 对比研究 

分 类 号：R521[医药卫生—内科学]