深圳市大鹏新区综合医院结核病管理现状与评价

Evaluation of tuberculosis management status in general hospital in Dapeng district of Shenzhen

目的 通过探讨深圳市大鹏新区综合医院结核病的管理现状,评估成效、总结经验,为改进医院的结核病管理工作提供借鉴.方法 核对2009 2013年辖区结核病防治机构与综合医院及其他各类型医疗卫生机构4225例疑似肺结核患者的转诊资料;通过现场访谈,了解医院结核病管理制度和程序;抽查胸片了解影像诊断水平等,本研究中的转诊计数资料用率、构成比描述,率的比较采用x2检验,以P＜0.05为差异有统计学意义.结果 2009-2013年综合医院的转诊到位率分别是85.08％ （154/181）、85.56％（160/187）、87.50％（168/192）、90.34％（187/207）、94.29％（198/210）,x2趋势=10.74,P=0.001,说明辖区综合医院重视疑似肺结核患者的转诊工作,转诊到位率逐年提高.其中,46.78％（457/977）转诊的患者诊断为活动性肺结核,占辖区转诊活动性肺结核患者的33.55％ （457/1362）.综合医院转诊的疑似肺结核患者有65.97％（572/867）当天即到位.其中,80.97％（702/867）患者主动就诊;有20.88％（181/867）患者因病情需要由结核病防治机构转回医院.结论 综合医院是发现肺结核患者的重要场所,规范工作流程,是综合医院保证疑似肺结核患者的转诊效率关键.辖区综合医院结核病管理效果显著.

Objective To evaluate tuberculosis （TB） management status and effect in general hospital, and to summarize experience and provide reference for improving the TB management work. Methods The referral information of 4225 suspected pulmonary TB patients in general hospitals, district health care facilities and TB control institutions in 2009-2013 were checked. The TB management system and procedure in general hospitals were gotten by field interviewing and spot-check of X-ray chest films was carried out to evaluate the diagnosis level. Rate and proportion were used to describe the categorical data. Chi-square test was applied for rate comparison. P〈0.05 was set as the criteria for statistical difference. Results The referral arrival rates were 85. 08%（154/181）, 85.56% （160/187）, 87.50% （168/192）, 90.34% （187/207） and 94.29%（198/210） from 2009 to 2013. The referral arrival rate increased significantly year by year （X2trend ： 10. 74, P=0. 001）, which indicated the general hospitals attached great importance to patient referral work. Among them, 46.78% （457/977） of the referral suspected patients from general hospitals were diagnosed as active pulmonary TB, which accounted for 33.55% （457/1362） of the total referral TB cases in the district. Among the suspected pulmonary TB patients, 65.97% （572/867） arrived on the same day, among which 80. 97% （702/867） were arrived actively, 20.88% （181/867） were transferred from the TB control institution to the general hospital because of illness requirement. Conclusion The general hospital plays an important role in TB case finding. The standardization work flow is the key to guarantee the referral efficiency of suspected TB patients in general hospitals. The effect of TB management in district general hospital is good.