浙江省医疗机构百日咳诊断现状调查  

Investigation of pertussis diagnosis situation in medical institutions in Zhejiang

作　　者：刘铁诚[1] 谢淑云[2] 何寒青[2] 周洋[3] 尹遵栋[3] 张丽杰[4] Liu Tiecheng;Xie Shuyun;He Hanqing;Zhou Yang;Yin Zundong;Zhang Lijie(Institute of Nutrition and Food Safety,Jinan Municipal Center for Disease Control and Prevention,Jinan 250021,China;Zhejiang Provincial Center for Disease Control and Prevention,Hangzhou 310052,China;Department of National Immunization Program,Chinese Center for Disease Control and Prevention,Beijing 100050,China;Chinese Field Epidemiology Training Program,Chinese Center for Disease Control and Prevention,Beijing 100050,China)

机构地区：[1]济南市疾病预防控制中心营养与食品安全风险监测所,250021 [2]浙江省疾病预防控制中心免疫规划所,杭州310052 [3]中国疾病预防控制中心免疫规划中心,北京100050 [4]中国疾病预防控制中心现场流行病学培训项目,北京100050

出　　处：《国际流行病学传染病学杂志》2020年第1期16-20,共5页International Journal of Epidemiology and Infectious Disease

摘　　要：目的了解浙江省各级医疗机构临床医生百日咳诊断能力的现状。方法采用分层系统随机抽样法抽取浙江省6个地市16家医疗机构的150名临床医生。采用问卷调查和小组访谈的方式调查浙江省医疗机构临床医生对百日咳流行病学特征、临床症状、诊断标准掌握的准确率、漏诊原因等诊断现状。结果93.33%的医生自认为掌握百日咳症状,表示见过、诊断过百日咳患者和报送过百日咳病例的医生比例分别为52.67%、38.00%和24.67%。临床医生对传染源、传播途径、易感人群等百日咳流行病学特征掌握正确率分别为35.33%、50.00%和58.67%。对阵发性痉咳、持续咳嗽≥2周者等典型症状掌握正确率较高(88.67%和80.67%),对心动过缓、青紫、窒息、呼吸暂停、间歇性阵发性咳嗽等非典型症状掌握正确率较低(6.67%~42.67%)。对百日咳临床诊断病例和确诊病例的诊断标准掌握的准确率分别为34.67%和33.33%。漏报原因前三位依次为"所在医院缺乏百日咳实验室确诊能力""百日咳病例尤其是青少年和成人症状不典型""临床医生未意识到是百日咳病例"。结论浙江省临床医生对百日咳认知和诊断标准掌握有待提高,医疗机构实验室确诊能力不够充足,当地百日咳疫情可能被低估。Objective To investigate the present diagnostic ability situation of pertussis among clinicians in Zhejiang Province.Methods A total of 150 clinicians from 16 medical institutions in 6 cities of Zhejiang province were selected by stratified systematic random sampling method.The diagnosis status of clinicians including the accuracy rates of epidemiological characteristics,clinical symptoms,diagnostic criteria by clinicians and causes of misdiagnosis were investigated by interviews and questionnaires.Results The proportion of clinicians who consider themselves mastery the clinical symptoms,had ever met pertussis case before,had diagnosed pertussis and delivered report cards were 93.33%,52.67%,38.00%and 24.67%,respectively.The correct rates for clinicians to answer the epidemiological characteristics of pertussis such as source of infection,isolation time and susceptible population were 35.33%,50.00%and 58.67%,respectively.The accuracy rates for paroxysmal and spasmodic cough,≥2-week continuous cough were high(88.67%and 80.67%).However,the accuracy rates for bradycardia,cyanosis,asphyxia,apnea,paroxysmal cough were low with the range of 6.67%to 42.67%.The accuracy rate of following diagnostic standards for clinical and confirmed cases was 34.67%and 33.33%,respectively.The top three reasons for pertussis misdiagnosis were"the hospital lacks the laboratory diagnostic ability of pertussis""cases especially in adolescents and adults are not typical"and"clinicians lack the awareness of pertussis".Conclusions The epidemic situation of pertussis may be underestimated due to the lack of pertussis awareness,inaccurate mastery of diagnostic criteria and inadequate laboratory diagnostic ability of clinicians in Zhejiang Province.

关 键 词：百日咳 临床表现 诊断标准 实验室检测 医疗机构 

分 类 号：R51[医药卫生—内科学]