骨关节结核耐药的变化、原因分析及应对措施

发布时间：2018-04-05 09:36

本文选题：骨关节结核　切入点：耐药　出处：《新疆医科大学》2015年硕士论文

【摘要】：目的:探讨骨关节结核耐药类型的变化和分析原因及应对措施的疗效和安全性。方法:取2004-2013年自治区胸科医院收集的骨关节结核患者标本行结核分枝杆菌培养和药物敏感试验,分析其耐药类型和耐药率的变化,并分析原因,并在新疆医科大学骨科选取94例患者进行骨关节结核术后的个体化治疗与标准化治疗的疗效和安全性对比。结果1158例标本中,592例培养阳性,阳性率51.1%,其中耐药菌株254例,,总耐药率42.9%,耐多药(MDR-TB)75例,总耐多药率12.7%。各年份总耐药率呈上升趋势,利福平耐药率呈上升趋势,耐单药、耐多药呈上升趋势,耐药顺序为H(异烟肼)S(链霉素)R(利福平)E(乙胺丁醇)。标准化治疗组治愈33例,个体化治疗组治愈41例,标准化治疗组治愈率为70.2%,个体化治疗组治愈率为87.2%,两组治愈率间差异有统计学意义(P0.05)。标准化治疗组和个体化治疗组出现不良反应分别为11例和3例,标准化治疗组不良反应率为23.4%,个体化治疗组不良反应率为6.4%,两组不良反应率间差异有统计学意义(P0.05)结论骨关节结核总体耐药情况呈上升趋势,耐多药结核形势严峻,与不规律用药有关,需做好结核病防控及患者抗结核治疗的督导工作,骨关节结核术后采用个体化治疗具有治愈率高,不良反应小等优点。
[Abstract]:Objective: to investigate the changes of drug resistance in bone and joint tuberculosis and the analysis of the causes and the efficacy and safety of countermeasures.Methods: Mycobacterium tuberculosis culture and drug sensitivity test were carried out in the specimens collected from patients with bone and joint tuberculosis from 2004 to 2013, and the changes of drug resistance types and drug resistance rates were analyzed, and the causes were analyzed.The efficacy and safety of individualized treatment and standardized treatment were compared between 94 patients in orthopedic department of Xinjiang Medical University.Results among the 1158 samples, 592 cases were positive in culture, the positive rate was 51.1%, including 254 strains of drug resistance, 42.9% of total resistance, 75 cases of MDR-TBN, and 12.7% of total multidrug resistance.33 cases were cured in the standardized treatment group, 41 cases in the individualized treatment group, 70.2% in the standardized treatment group and 87.2% in the individualized treatment group. The difference between the two groups was statistically significant (P 0.05).The adverse reactions in the standardized treatment group and the individualized treatment group were 11 and 3, respectively.The adverse reaction rate of the standardized treatment group was 23.4 and that of the individualized treatment group was 6.4. The difference between the two groups was statistically significant (P 0.05). Conclusion the overall drug resistance of bone and joint tuberculosis is on the rise, and the situation of multi-drug resistant tuberculosis is severe.It is necessary to do a good job in the supervision of tuberculosis prevention and control and anti-tuberculosis treatment. The individualized treatment of bone and joint tuberculosis after operation has the advantages of high cure rate and small adverse reaction.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R529.2

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