外出务工慢性乙型肝炎患者管理现状及对策研究

Management status quo of migrant workers with chronic hepatitis B and countermeasures research

目的了解外出务工慢性乙型肝炎患者管理现状,探索管理对策,提高生存质量,为健康工程夯实基础。方法采用补充修订的SF-36生存质量量表和一般资料调查表,对300例外出务工慢性乙型肝炎患者进行生存质量评价和服务需求、依从性、经济情况、报销类别及比例调查;对外出务工慢性乙型肝炎患者生存质量的影响因素进行单因素分析和多因素逐步回归分析。结果统计分析发现,外地就医是否方便、报销类别及比例、是否规范抗病毒治疗、是否定期规范检测随访、肝病特有症状是影响外出务工慢性乙型肝炎患者生存质量的因素(P<0.05);外地就医方便、报销比例高、规范抗病毒治疗、定期规范检测随访的患者生存质量显著高于外地就医不方便、报销比例低、未规范抗病毒治疗、未定期规范检测随访的患者(P<0.05);肝病特有症状评分与生存质量评分呈正相关趋势(B=7.657,SD=2.650,t=2.889,P=0.004)。结论改善患者就医需求、报销类别及比例,提高患者定期规范检测随访、规范抗病毒治疗等依从性,从而实现慢性乙型肝炎患者的规范检查治疗,能阻止或延缓疾病进展,避免肝硬化和失代偿肝病,减少肝癌的发生,提高患者生活质量和延长生存期。

Objective To understand the management status quo of migrant workers with chronic hepatitis B （CHB） to explore the management countermeasures and improve the survival quality for tamping the foundation of the healthy project. Methods Totally 300 migrant workers with CHB were performed the living quality evaluation and investigation on the service needs,compliance,economic condition, categories and proportion of reimbursement by adopting the supplementary revision of SF-36 living quality scale and general information questionnaire ; the influencing factors of their living quality were performed the univariate analysis and multivariate stepwise regression analysis. Results The statistical analysis found that whether convenient for outside visiting hospital, categories and proportion of reimbursement, whether normalized antiviral therapy, whether conducting examination and follow up at regular intervals and liver disease specific symptoms were the influencing factors of living quality in the migrant workers with CHB（P〈0.05） ;the living quality in the patients with outside convenient visiting hospital, high reimbursement proportion, normalized antiviral therapy and examination and follow up at regular intervals was significantly higher than that in the patients with inconvenient outside visiting hospital, low reimbursement proportion, non-normalized anti-viral therapy and examination and follow up without regular intervals（P〈0.05） ;the liver disease specific symptom score showed the positive correlation trend with the living quality score （B=7. 657,SD=2. 650,t=2. 889,P=0. 004）. Conclusion It is necessary to improve the patient＇s medical needs,reimbursement type and proportion,increase the compliance of patient＇s normalized examination and follow-up at regular intervals and standard antiviral treatment,thus to realize the standardized examination and treatment in CHB patients,prevent or delay the disease progression,avoid liver cirrhosis and decompensated hepatopathy,reduce the occurrence of HCC,improve the quality of life and prolong the survival period.