耐多药结核病患者管理模式的系统综述

Systematic review on the management model for multi-drug resistant tuberculosis

目的系统回顾国际上不同国家和地区耐多药结核病患者的管理模式,探讨适合我国的患者管理模式。方法全面搜索了PubMed、ProQuest、中国医院知识仓库(CHKD)和万方数据资源系统等数据库中发表于2000—2010年的文章,以及相关出版物、会议资料汇编等材料。共检索到文献1151篇,排除观点性文章、信件、新闻、社论、评论、文献目录、会议摘要等,对符合条件的14篇文献和3个出版物进行分析。结果目前各国采取的耐多药结核病患者管理模式主要有4种:以住院治疗为基础的管理模式,主要在美国、法国等经济发达国家实施,要求患者接受住院治疗(共3篇文献);以门诊治疗为基础的管理模式,要求患者定期到门诊进行检查和领取药品(1篇文献);以住院和门诊治疗相结合的管理模式,规定患者强化期或细菌学检查阴转前在医院接受治疗,尔后在门诊继续接受治疗(共4篇文献);以社区关怀为基础的管理,为中低收入国家采取的主要方法,是以门诊治疗为基础管理模式的升级,更为强调结核病防治规划的覆盖(共6篇文献)。结论耐多药结核病患者管理模式的选择与当地的疫情、经济、结核病防治规划和医疗卫生体系的覆盖程度相关,我国应进一步完善住院治疗和社区关怀相结合的患者管理模式。

Objective Systematic review on different international management model for multi-drug resistant tuberculosis and explore the strategies tailored to China.Methods Related publications,conference information and other materials were searched in PubMed,ProQuest,CHKD and WANFANG DATA（2000—2010）,1151 studies were retrieved,except view articles,letters,news,editorials,reviews,bibliography and conference summary,14 full-text studies and 3 published documents were included and analyzed.Results The results showed that there are mainly 4 kinds of management model：inpatient-based model,mainly implemented in the United States,France and other developed countries,patients are asked for receiving inpatient treatment（3 studies）,outpatient-based model,patients are required to take examination and receive drug regularly in outpatient（1 studies）,inpatient-outpatient based model,patients need to receive inpatient treatment throughout the intensive phase or until sputum bacteriological conversion,and then continued outpatient treatment（4 studies）,and community-based model,mainly adopted in low and middle income countries,upgrades from the outpatient-based model and with emphasis on the NTP coverage（6 studies）.Conclusion The model selection should base on the TB epidemic,economy,the covera-ge of NTP and the health care system.The inpatient-community-based management model should be developed for the management of drug resistant TB in China.