综合医院结核病诊断及转诊现状分析

Analysis of current status of diagnosis, treatment and referral of pulmonary tuberculosis in general hospital

目的了解综合医院结核病诊治现状。方法通过北京大学人民医院网上工作统计报表、结核病网上报卡、化验室痰结核菌检查登记本、放射科摄片统计报表、结核病患者转诊单、住院病例等，查询2005年8月至2006年7月间呼吸科门诊量、X线摄片量、痰结核菌检查结果、结核报卡、转诊情况，并对转诊和住院患者的状况进行分析。结果呼吸科X线摄片占门诊量的11．0％（4960／45055）；痰结核菌检查1512例，阳性24例；肺结核病转诊189例，占门诊量的0．4％（189／45055），其中结核病报卡183例，登记率96．8％；住院后确诊为肺结核30例，从人院到确诊〈14d共27例（占90．0％）；转诊26例，转诊率86．7％。结论北京大学人民医院结核病的发现、诊断及转诊工作具有较高水平；有一些环节需要重视，包括进一步提高痰检率及痰检质量，提高放射科医生及呼吸科医生的读片水平；重视气管镜检查及病理诊断在疑难结核病诊断中的价值；痰菌阴性肺结核在肺结核的发病中比例较高，对其诊断应予以重视。

Objective To investigate current status of diagnosis, treatment and referral of pulmonary tuberculosis in general hospital. Methods Statistical reports of hospital work, notification forms of tuberculosis （TB） cases on the intemet, registration book of laboratory sputum mgcobacteria examinations, statistical reports of X-ray examinations for outpatient department, referral forms for mycobacteria patients, medical records for hospitalized patients at the respiratory ward of the People＇s Hospital, Peking University during August 2005 to July 2006 were reviewed and analyzed. Results In outpatient pulmonary department, there were 45 055 visitors during the period of August 2005 to July 2006, and 4960 of them （11.0%） had their chest X-ray examined, 1 512 （3.4%） had sputum mycobacteria examined with smear-positive in 24 cases, 189 （0.4%） were referred to specialized TB dispensaries for further diagnosis and 183 with notification forms with a notification rate of 96. 8%, and 30 （0. 1% ） were finally diagnosed as TB after hospitalization with an interval less than lg days between onset of symptoms and diagnosis in 27 of the 30 （90. 0% ） and 26 were referred to a specialized TB dispensary （86.7%） for treatment. Conclusions On general, detection, diagnosis and referral of TB in People＇s Hospital of Peking University are in a good situation. However, more attention should be paid to the following aspects： ① quantity and quality of sputum mycobacteria examinations for outpatients should be improved further, ②chest radiograph reading by radiologists and clinicians need to be improved, and ③consciousness of early detection for TB need to be enforced in physicians by bronchoscopy and pathological diagnosis, especially in those with complicated and difficultly diagnosed smear-negative TB.