诸暨市因症就诊新发肺结核患者延误诊疗及影响因素分析  

Analysis of delayed diagnosis and affecting factors among new tuberculosis patients due to symptoms in Zhuji City

作　　者：蒋扬莹 陈深侠[1] JIANG Yangying;CHEN Shenxia(Zhuji Center for Disease Control and Prevention,Zhuji,Zhejiang 311800,China)

机构地区：[1]诸暨市疾病预防控制中心,浙江诸暨311800

出　　处：《中国农村卫生事业管理》2024年第9期679-684,共6页Chinese Rural Health Service Administration

摘　　要：目的分析肺结核患者就诊延误、确诊延误和发现延误情况及影响因素,为诸暨市结核病防控工作提供数据支持。方法对2023年4月—10月诸暨市因症就诊新发肺结核患者进行问卷调查,进行描述性分析、卡方检验和Logistic回归多因素分析。结果诸暨市因症就诊新发肺结核患者就诊天数、确诊天数和发现天数中位数分别为15d、11d和37.5d;就诊延误率、确诊延误率和发现延误率分别为50.9%、37.7%和60.5%。多因素Logistic回归显示:合并糖尿病会增加就诊延误,有其他症状会减少就诊延误;男性和首诊时被转诊至结核门诊可减少确诊延误;常住主城区、退休或家务待业、合并呼吸系统疾病和糖尿病是发现延误的危险因素;有咯血血痰、有其他症状和私家车就诊是发现延误的保护因素。结论诸暨市应重视女性、主城区、患有呼吸系统疾病或糖尿病、退休或家务待业人群的结核病健康宣传教育,重点宣传“咳嗽咳痰超过两周就要怀疑有肺结核可能”的核心知识。加强医务人员对肺结核的警惕性,树立转诊意识。Objective To analyze the delay in health seeking,diagnosis and discovery of pulmonary tuberculosis patients and its influencing factors,so as to provide data support for tuberculosis prevention and control in Zhuji City.Methods A questionnaire survey was conducted among the newly diagnosed pulmonary tuberculosis patients seeking treatment due to symptoms in Zhuji City from April to October 2023.Descriptive analysis,chi-square test and logistic regression analysis were performed.Results The median number of days of health seeking,diagnosis and discovery of patients in Zhuji were 15 d,11 d and 37.5 d,respectively.The delay rates of health seeking,diagnosis and discovery were 50.9%,37.7%and 60.5%,respectively.Multivariate logistic regression analysis results showed that comorbid diabetes mellitus would increase the delay rate of health seeking,while other symptoms would reduce the rate;male and being referred to tuberculosis clinic at the first visit could reduce diagnosis delay;the risk factors for discovery delay were permanent residence in the main urban area,retirement or unemployment at home,and comorbid respiratory diseases and diabetes mellitus;hemoptysis and phlegm,other symptoms and private car visit were the protective factors for discovery delay.Conclusions Zhuji city should attach importance to tuberculosis health education among women,urban residents,people with comorbid respiratory diseases or diabetes mellitus,retirement or unemployment at home,and focus on the publicity of core knowledge of“if you cough and expectorate for more than two weeks,you should suspect the possibility of tuberculosis”.We should strengthen the vigilance of medical staff in health institutions at all levels against tuberculosis and establish their awareness of referral.

关 键 词：肺结核 因症就诊 就诊延误 确诊延误 发现延误 影响因素 

分 类 号：R186[医药卫生—流行病学]