成都市狂犬病暴露预防门诊犬伤处置能力调查

Medical Staff's Capability of Treating Dog-bitten Out-patients in Rabies Clinics in Chengdu

目的了解成都市主城区狂犬病暴露预防门诊(犬伤门诊)医务人员犬伤处置能力的现状,为规范犬伤暴露后的医学处理工作和提高犬伤处理水平提供参考和依据。方法对成都市21家犬伤门诊医务人员开展现场观察,每个犬伤门诊现场观察1周。观察的主要内容包括犬伤的诊断和处理流程、伤口清洗和消毒、疫苗和狂犬病免疫球蛋白的注射、再暴露和暴露前的免疫预防等。采用Epidata3.02软件建立数据库,SPSS13.0软件进行数据分析。结果市级及以上、区级和社区级犬伤门诊医务人员在伤口冲洗和消毒、再暴露处理或描述、疫苗注射方面差异无统计学意义(P>0.05),操作正确率均在80%以上;而在暴露前免疫处理或描述和对犬伤的诊断和处理流程方面差异有统计学意义(P<0.05),社区级门诊医务人员在这2方面的处理能力最低(正确率分别是70.73%和58.33%)。结论成都市犬伤门诊医务人员的狂犬病处置能力需要提高,特别是社区门诊医务人员,应有针对性的开展更多的规范化犬伤处置技术培训,及时更新犬伤处理知识,促进狂犬病防治工作的完善。

Objective To investigate medical staff＇s capability of treating dog - bitten patients in rabies prevention and control department in Chengdu, and to provide reference for standardizing the medical treatment. Methods Onsite observation was carried out to the medical personnel from the 21 rabies clinics of Chengdu. The investi- gator served as an intern for a week in every se｜ected spot. The observation included diagnosis and treatment processes of dog injury, wound cleaning and disinfection, vaccine and serum injections, re - immunization for injury and before injury etc. Database was established with Epidata3.02 and was analyzed by SPSS13.0. Re- sults No statistical difference was found （ P 〉 0. 05 ） among three levels of clinics （ municipal, district level and community level） concerning the following variables： wound cleaning, vaccine and serum injections, re -treatment for injury among the medical staff; the rate of correct operation was above 80%. Significant differences were found on variables as： treatment or description be- fore dog injury, diagnosis and treatment processes （P 〈 0. 05） ; the lowest correct operation rate was among med- ical staff in community - level （with a correct rate of 70. 73% and 58.33%, respectively）. Conclusion The medical staff＇s capability to treat dog injury in Chengdu needs further improvement, calling for more targeted and standardized technical training.