合肥市2004-2009年结防机构肺结核病人发现方式研究

The analysis of ways to find TB case in TB dispensaries from 2004 to 2009 in Hefei

目的了解结防门诊肺结核病人发现的主要方式,建立可持续病人发现模式,同时为针对不同的人群采取不同的健康教育方式提供理论依据。方法对2004-2009年的初诊登记本资料进行分析。结果 2004-2009年结防机构共登记初诊病人8 191例,确诊肺结核病人4 601例,涂阳病人1 677例;其中转诊、就诊和其他三种方式发现的肺结核病人分别占肺结核病人总数的64.7%、30.4%和4.9%;三种方式来源的病人中肺结核病人和涂阳病人的检出率分别为54.5%、57.1%和54.3%(χ2=5.175,P=0.075),35.5%、37.5%和28.0%(χ2=8.973,P=0.011),不同来源病人中两种检出率均无明显差异;不同级别医疗机构转诊到位病人中肺结核病人和涂阳病人的检出率有明显差异。结论转诊仍是结防机构发现肺结核病人的主要方式,尤其是市级及以上医疗机构,但就诊也占一定的比例。因此在病人发现上,除了加强对医疗机构进行归口管理外,对大众人群结防政策和知识的宣传仍不可松懈。

Objective To understand the major ways to find TB patients in the TB dispensaries,establish sustainable patterns of finding patients and provide a theoretical basis for health education of different groups of people with different approaches.Methods The registered data of the suspicious and newly diagnosed TB patients from 2004 to 2009 were analyzed.Results 8 191 cases of suspicious patients were registered in TB dispensaries from 2004 to 2009,among them 4 601 cases were confirmed TB patients,1 677 cases of smear-positive patients.The rates of diagnosed TB patients were 64.7%,30.4% and 4.9% from referrals,active treatments,and others respectively.The detection rate of conformed TB patients and smear-positive patients were 54.5%,57.1% and 54.3%（χ2=5.175,P=0.075）,35.5%,37.5% and 28.0%（χ2=8.973,P=0.011） in the three sources of patients,and without significant difference among them,but significant difference were found in different rank hospitals of the referral patients in the detection rate of TB patients and smear-positive TB patients.Conclusions The major way of finding TB patients was referral,especially the medical institutions of municipal level and above,but active treatment also account for a certain proportion.Therefore,in terms of finding patients,the advocacy of knowledge and TB control policy for the right people must be maintained besides strengthening the centralized management of medical institutions.