上海市嘉定区初治阳性肺结核诊断延误及其影响因素

Study on diagnostic delays and factors influencing accessibility to diagnosis in initially treated smear positive tuberculosis patients in Jiading District,Shanghai

目的了解上海市嘉定区初治阳性肺结核诊断延误情况,分析诊断延误发生的影响因素。方法采用调查表对2008年2月20日~2010年12月31日在嘉定区中心医院结核病专科门诊确诊的244例初治阳性肺结核患者的社会状况、临床症状和就诊经历进行调查。问卷调查64名内科医生,了解其肺结核相关知识及肺结核病例处理情况。结果 244例患者中107人（43.9%）发生就诊延误,有咳嗽症状的人相对于没有出现咳嗽症状的人更容易发生就诊延误。44人（20.8%）确诊延误,其中29人被误诊,首次就医选择不同医疗机构确诊延误发生率差异有统计学意义（P〈0.05）。64名内科医生11人（17.2%）认为咳嗽、咳痰超过1个月可能感染肺结核。结论初治阳性肺结核诊断延误率高,其中就诊延误是诊断延误发生的主要环节,应加大对公众肺结核相关知识宣传力度,降低就诊延误率。同时,要加强医务人员肺结核相关知识培训,减少误诊、诊断延误的发生。

Objective To survey diagnostic delays and factors influencing accessibility to diagnosis in initially treated smear positive tuberculosis（TB）patients in Jiading District,Shanghai.Methods A total of 244 newly diagnosed positive TB patients were registered in the study site from Feb.20,2008 to Dec.31,2010.The subjects were interviewed using a structure questionnaire.Results Among the 244 TB patients 107 cases（43.9%）had the first health seeking delay,those who had cough more prone to the delay than those who didn＇t have cough.44 cases（20.8%）had diagnostic delays,among them 29 had been misdiagnosed,First visiting to different hospitals influenced the rate of diagnostic delay.In the 64 physicians 11（17.2%）thought that cough or sputum more than one month before considering possible tuberculosis.Conclusion Newly diagnosed positive TB patients had a high rate of delayed diagnosis,first health seeking delay is the main one,it is urgent to provide health education on TB knowledge for reduction of first health seeking delay.At the same time strengthen the physicians＇ knowledge of TB be strengthened to reduce the rate of misdiagnosis and delayed diagnosis.