云南省伤寒副伤寒在高发地区的诊断现状及危险因素研究

发布时间：2018-06-18 17:52

  本文选题：伤寒 + 副伤寒　； 参考：《昆明医科大学》2014年硕士论文

【摘要】：研究目的 通过在云南省伤寒副伤寒高发地区开展诊断现况及危险因素研究,了解各级医疗机构伤寒副伤寒诊断现况,弄清伤寒副伤寒真实发病水平,了解云南省伤寒副伤寒发病危险因素,为伤寒副伤寒防控提供科学依据。 研究方法 1.诊断现况调查：采用横断面研究方法,选择云南省伤寒副伤寒发病率较高的5个县(市、区),对辖区的州(市)级、县(市、区)级、乡镇级医疗机构进行调查。采用自行设计的调查问卷,到相关科室收集伤寒副伤寒实验室检测、诊断、报告、治疗等资料。采用率、构成比等指标描述伤寒副伤寒的诊断现况。 2.危险因素调查：采用病例对照研究方法,于2013年6月～10月,选择云南省伤寒副伤寒发病率较高的弥勒县,开展以社区和乡镇为基础的伤寒副伤寒发病危险因素调查,病例和对照以1：3配比。病例为弥勒县人民医院血培养阳性的确诊病例,对照为与病例在同一自然村、社区、班级,以年龄、性别、职业匹配的健康者。用自行设计的问卷对病例和对照进行调查。数据单因素分析采用x2检验或秩和检验进行,多因素分析采用Cox回归进行。 研究结果 1.诊断现况调查：调查20家医疗机构,418例伤寒副伤寒报告病例,其中181例病例诊断与报告相符,诊断符合率为43.30%。州(市)级、县(市、区)级、乡镇级医院伤寒副伤寒诊断符合率依次为42.86%、47.02%、28.57%。红河州、版纳州、保山市的诊断符合率依次为53.39%、46.38%、20.35%,差异均有统计学意义。 各级医疗机构诊断伤寒副伤寒病例的部门主要为内科门诊,占60.00%。所调查的20家医疗机构均开展了伤寒副伤寒的相关实验室检测。20家医疗机构均开展血常规检测,但乡镇卫生院以三分类法为主(87.50%)；19家医疗机构开展了肥达氏检测,以玻片法为主(70.00%),检测试剂来自同一厂家；所有乡镇卫生院均不能开展血培养。州(市)级、县(市、区)级医院除1家外均能开展血培养检测,但血培养瓶的厂家不同。 临床医生对伤寒副伤寒的诊断主要依靠流行病学史、临床表现、化验结果,少部分凭个人临床经验。诊断标准掌握程度有差异,其中27.78%的医务人员认为流行病学史包括最近30天有被蚊虫叮咬史；24.07%的医务人员认为临床表现包括咳嗽、流涕、呼吸困难。对肥达氏检测结果的正确判断存在差异,其中50.00%的医务人员认为检测结果包括肥达反应“0”抗体凝集效价≥1：160,“H”抗体凝集效价≥1：80,乡镇卫生院的医务人员回答错误率高于州(市)级和县(市、区)级医院。 查阅红河州172例伤寒副伤寒住院病人的病历资料,报告类型以临床诊断病例为主(占65.70%),血常规检测167例(97.09%),肥达氏检测156例(90.70%),肥达氏检测阳性率为27.56%,血培养检测119例(69.19%),血培养阳性率为47.90%。对153例发热病人的症状进行统计分析,有头痛(49.67%)、全身不适(37.91%)、畏寒(30.07%)、咳嗽(27.45%)、厌食(24.84%)等症状,以及中毒性心肌炎(14.38%)、中毒性肝炎(12.42%)、支气管炎／肺炎(11.76%)等并发症。37.79%的病人治愈出院,仅27.34%的病人在住院期间采取了相应的隔离措施。94.19%的病人使用抗生素治疗,64.20%病例进行了药敏试验,59.62%的病人使用的抗生素与药敏试验结果相符。 2.危险因素调查：共调查200人,其中病例50人、对照150人。病例组和对照组在性别、年龄、民族、职业等方面均衡可比(P0.05)。50例病例均为甲型副伤寒病例,所有病例均发热,并伴有头痛、乏力、畏寒、全身酸痛等症状,且均为住院病例,平均住院天数为(8.28±4.02)天。 单因素分析筛选可疑危险因素：平时在外吃早餐,此前2周早餐吃过米线,此前2周早餐吃过卷粉,早餐中加生葱,平时中晚餐在外就餐频率,平时中晚在外就餐点,此前2周在外吃过中晚餐,此前2周在外吃过冷饮或宵夜8个因素差异有统计学意义。 多因素Cox回归分析：早餐吃卷粉(OR=11.12,95%CI：1.39-88.75),早餐中加生葱(OR=15.55,95%CI：1.37-176.87),近2周在外吃中晚餐(OR=5.68,95%CI：1.02-31.62)是弥勒县甲型副伤寒发病的危险因素。 结论 云南省伤寒副伤寒诊断符合率总体较低,尤其是乡镇卫生院。血培养的结果表明局部地区伤寒副伤寒高发。乡镇卫生院在医务人员数量、职称、学历、工作经验以及设备等方面与州(市)、县(市、区)级医院相比差距大。医院对伤寒副伤寒诊断、治疗不规范,疗程不足,病人隔离措施和出院标准不严格。甲型副伤寒沙门菌已是云南省某些区域流行的优势菌群；在外就餐,吃生冷食物和食物中加生佐料是云南省部分地区甲型副伤寒发病危险因素。
[Abstract]:Purpose of study

The present situation and risk factors of typhoid paratyphoid in the typhoid and paratyphoid region of Yunnan Province were studied . The diagnostic status of typhoid paratyphoid and paratyphoid cold in various medical institutions was investigated . The real morbidity level of typhoid paratyphoid was found . The risk factors of typhoid paratyphoid in Yunnan Province were investigated .

Research Methods

1 . Investigation on the status of diagnosis : A cross - sectional study was used to select five counties ( cities , districts ) with higher incidence of typhoid and paratyphoid in Yunnan Province , and investigated the state ( city ) , county ( city , district ) and township level medical institutions in the district .

2 . Investigation of risk factors : A case - control study was used to investigate the risk factors of typhoid paratyphoid fever in Yunnan Province from June to October 2013 . The case was a case with positive diagnosis of typhoid paratyphoid in the same natural village , community , class , age , gender and occupation .

Results of the study

1 . Investigation of the status of diagnosis : investigation of 20 medical institutions and 418 cases of typhoid paratyphoid fever , of which 181 cases were diagnosed and reported , the diagnostic accuracy rate was 43.30 % . The diagnostic accuracy rate of typhoid paratyphoid was 42.86 % , 47.02 % and 28.57 % in the county ( city , district ) and township level hospitals . The diagnostic accuracy rate of the disease in Honghe Prefecture , Indiana and Baoshan was 53.39 % , 46.38 % and 20.35 % , respectively .

The department of the diagnosis of typhoid paratyphoid in medical institutions at all levels is mainly internal outpatient , accounting for 60.00 % . All the 20 medical institutions surveyed have carried out the related laboratory tests of typhoid and paratyphoid fever . All 20 medical institutions carry out routine tests of blood routine , but the township hospitals are mainly classified by three classifications ( 87.50 % ) ;
In 19 medical institutions , the test was carried out on the basis of slide method ( 70.00 % ) , and the test reagents were from the same manufacturer ;
Blood culture can not be carried out in all township hospitals . Blood culture test can be carried out except 1 in the county ( city ) and county ( city , district ) level hospitals , but the manufacturers of blood culture bottles are different .

The diagnosis of typhoid paratyphoid mainly depends on the history of epidemiology , clinical manifestation , test results , and the rare part by personal clinical experience . The diagnostic standard is different , of which 27.78 % of medical personnel think the history of epidemiology includes the last 30 days with the history of mosquito bite ;
24.07 % of medical personnel considered the clinical manifestation including cough , watery nasal discharge and dyspnea . 50.00 % of medical personnel considered that the results of detection included the agglutination titer 鈮，

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