综合医院住院肺结核诊断现状分析

Diagnosis of pulmonary tuberculosis in general hospital

目的了解分析综合医院住院活动性肺结核患者的诊断现状。方法对2002年1月1日—2006年5月31日北京大学人民医院控感科登记的以"肺结核"为主要诊断出院的患者住院病历进行调查并进行回顾性分析,不包括陈旧性肺结核及结核性胸腔积液。结果共统计分析患者74例,其中呼吸内科报告最多,共53例(71.6%),其次为胸外科,共13例(17.6%)。有典型结核中毒症状者仅31例(41.9%),红细胞沉降率明显增快患者者占54.1%,PPD试验阳性仅54.1%。查痰率64.9%,涂阳率54.2%。患者入院至确诊时间平均为13.15 d,≤14 d者48例(64.9%),>14 d者26例(35.1%)。确诊方法主要为痰抗酸杆菌阳性(共26例,占35.1%)。经各种活检确诊共27例(36.7%),其中纤维支气管镜下活检诊断8例(10.9%),经开胸肺活检确诊17例(23.0%),经肺穿刺活检确诊1例(1.4%),淋巴结活检确诊1例(1.4%),除纤维支气管镜下活检阳性率88.9%外,其余方式活检阳性率均为100%。临床诊断20例(27.0%)。结论综合医院呼吸内科处于结核病防治的第一线,目前北京大学人民医院对大部分肺结核患者在住院2周之内确诊。主要诊断方法仍为痰找抗酸杆菌阳性,但相当一部分患者通过各种方式的活检确诊。今后应进一步提高痰菌检查率和阳性率。对于诊断不清的病例应及时进行纤维支气管镜检查(包括镜下活检),必要时行肺穿刺甚至开胸肺活检。

Objective To investigate the diagnosis level of pulmonary tuberculosis of in-patient in general hospital. Methods Senventy-four in-patients with pulmonary tuberculosis reported in people＇s Hospital of Peking University Jan 1, 2002 to May 31, 2006 were retrospectively analyzed. Results Of 74 cases, 71.6 % were reported by respiratory department, 41.9% had typical tuberculosis clinical symptom, 54.1% showed that ESRs were significantly high, 54.1% PPD test were positive. 64.9 % patients took sputum smear examination and 54.2% of them were positive. The average interval from admission to diagnosis was 13.15 days, less than 14 days in 48 cases（64.9% ）, more than 14 days in 26 cases （35.1% ） .26 cases （35.1% ） were diagnosed by spu- tum smear examination. 27 cases （36.7 % ） were diagnosed by biopsy methods （8 cases by biopsy via broncho- scope, 17eases by open-thorax lung biopsy, 1 case by lung-puncture biopsy and 1 case by lymphonode biopsy）. The positive rate was 100% for every biopsy method except bronchoscopic biopsy （88.9%）. 20 cases（27.0%） were clinically diagnosed. Conclusion Respiratory department of general hospital is on the first-line of pulmonary tuberculosis prevention. The detection level of pulmonary tuberculosis in people＇ s Hospital of Peking Uni- versity is satisfactory, and most patients were diagnosed in two weeks. The main diagnostic method is sputum smear examination, but a few parts of cases were diagnosed through biopsy methods