吉林省布鲁氏菌病门诊病例分析及随访

发布时间：2018-07-09 23:04

本文选题：布鲁氏菌病 + 门诊病例　；参考：《吉林大学》2013年硕士论文

【摘要】：目的：了解当前布病患者人口学特征、流行病史、临床表现、治疗过程等情况，探索布病治疗效果的影响因素，为改进预防措施和治疗方案提供依据。方法：在吉林省地方病第一防治研究所布病门诊选择2013年吉林省确诊布病病例作为研究对象。实验室检测方法为平板凝集试验和试管凝集试验。治疗方案分别为“头孢曲松钠+阿奇霉素”和“利福平+多西环素”。采用自行设计的调查问卷，首诊询问收集基本信息、临床症状等资料，2个治疗疗程和确诊后90天分别采用电话随访的方式共随访3次。疗效判定分为治愈、基本治愈、好转、无效。采用Epidata3.0软件数据录入，SPSS17.0统计软件进行描述与分析。结果： 1．一般人口学特征共随访113人，分布在吉林省9个市（州）的29个县（区），男性90人，女性23人；年龄41.84±12.32岁；已婚占92.04%，汉族93.81%；小学及以下较多（57.52%），农民为主（81.42%），每年家庭收入多为5万元以下（56.64%）。 2．患者就诊临床分期与分型患者发病-首次就诊时间间隔14（6,30.5）天，发病-确诊时间间隔28（11,60）天，首次就诊-确诊时间间隔1（1,9.5）天。被调查者急性期占88.50%，亚急性期11.50%；临床分型为内脏型占21.24%，骨关节型63.72%。 3．临床表现和体力劳动能力评分结果首诊时，被调查者中28.32%出现寒战，83.19%发热，56.64%多汗，27.43%肌肉酸痛，73.45%乏力，15.93%头晕，35.40%头痛，76.99%骨关节痛。体力（劳动能力）进行评分结果1分占61.95%，2分占31.86%，3分占2.65%和4分占3.54%。第一疗程随访时，5.31%发热，12.39%多汗，8.85%出现肌肉酸痛，40.71%乏力，3.54%头晕，5.31%头痛，52.21%骨关节痛。体力（劳动能力）进行评分情况为0分占15.93%，1分占73.45%，2分占8.85%，3分占1.77%。第二疗程随访时，0.00%出现寒战，0.00%发热，2.65%多汗，1.77%出现肌肉酸痛，22.12%乏力，1.77%头晕，0.88%头痛，17.70%骨关节痛。体力（劳动能力）进行评分情况为0分占44.25%，1分占52.21%，2分占2.65%，3分占0.88%。确诊后90天随访时，5.31%发热，2.65%多汗，1.77%出现肌肉酸痛，8.85%乏力，，1.77%头晕，1.77%头痛，7.08%骨关节痛。体力（劳动能力）进行评分情况为0分占78.76%，1分占18.58%，2分占1.77%，3分占0.88%。将首诊与确诊后90天的体力劳动能力评分进行两样本秩和检验，结果差别有统计学意义（P0.001），可见经治疗，患者体力劳动能力有所恢复。 4．流行病学结果首诊时，38.05%的患者经常打扫圈舍，7.96%经常屠宰，36.28%经常接羔，18.58%经常免疫牲畜，0.88%经常兽医治疗，24.78%经常皮毛收购，2.65%经常乳制品加工，2.65%经常肉制品加工，13.27%经常牲畜运输，14.16%经常幼羔放室内饲养。第一疗程，11.50%患者经常打扫圈舍，2.65%经常屠宰，10.62%经常接羔，2.65%经常免疫牲畜，0.00%经常兽医治疗，6.19%经常皮毛收购，0.88%经常乳制品加工，0.88%经常肉制品加工，4.42%经常牲畜运输，2.65%经常幼羔放室内饲养。第二疗程，8.85%的患者经常打扫圈舍，2.65%经常屠宰，8.85%经常接羔，0.88%经常免疫牲畜，0.00%经常兽医治疗，4.42%经常皮毛收购，0.88%经常乳制品加工，5.31%经常牲畜运输，0.88%经常幼羔放室内饲养。确诊后90天，11.50%的患者经常打扫圈舍，3.54%经常屠宰，10.62%经常接羔，3.54%经常免疫牲畜，0.00%经常兽医治疗，7.08%经常皮毛收购，0.88%经常乳制品加工，0.00%经常肉制品加工，7.08%经常牲畜运输，1.77%经常幼羔放室内饲养。 5．治疗效果观察总体治疗效果76.99%治愈，9.73%基本治愈，12.39%好转，0.88%无效。20.35%的患者出现了不良反应。26人接受了方案一（多西环素+利福平）治疗，76.92%治愈，11.54%基本治愈，11.54%好转，0.00%无效。38.46%出现不良反应。87例接受了方案二（头孢曲松钠+阿奇霉素）治疗，结果77.01%治愈，9.20%基本治愈，12.64%好转，1.15%无效。14.94%出现不良反应。 6．影响疗效因素分析对基本情况、临床表现等4个方面20个可能影响患者疗效的因素进行t检验、χ~2检验等单因素分析，结果患者年龄（30-49岁）是保护因素、首诊体力劳动能力评分（4分）和治疗期间从事高危活动是危险因素。结论：随访在督导布病患者治疗和健康教育方面具有优势。头孢曲松钠+阿奇霉素治疗布病的短期疗效为治愈率77.01%，不良反应率14.94%。患者年龄（30-49岁）是影响布病疗效（治愈率）的保护因素、首诊体力劳动能力评分（4分）和治疗期间从事高危活动是危险因素。
[Abstract]:Objective:
To understand the demographic characteristics, epidemic history, clinical manifestation, and treatment process of the current disease patients, to explore the influencing factors of the treatment effect of the disease, and to provide the basis for improving the preventive measures and treatment plans.
In the outpatient clinic of the Jilin Institute for the prevention and treatment of endemic diseases, the disease outpatient of Jilin province was selected as the research object in 2013. The laboratory test method was the flat agglutination test and the test tube agglutination test. The treatment scheme was "ceftriaxone sodium + azithromycin" and "rifampin + doxycycline". A self-designed questionnaire was used. The first consultation to collect basic information, clinical symptoms and other data, 2 treatment courses and 90 days after the diagnosis were followed up by telephone 3 times, the curative effect was divided into cure, basic cure, improvement, ineffective. Epidata3.0 software data entry, SPSS17.0 statistical software into the description and analysis.
Result:
1. general demographic characteristics
A total of 113 people were followed up in 29 counties (districts) of 9 cities (States) in Jilin Province, 90 men and 23 women, 41.84 + 12.32 years old, 92.04% married and 93.81% in the Han nationality. Primary and below (57.52%), and farmers were mainly (81.42%), and the annual household income was less than 50 thousand (56.64%).
Clinical staging and classification of 2. patients
The first time interval was 14 (6,30.5) days, the onset time interval was 28 (11,60) days, the first diagnosis time interval was 1 (1,9.5) days, the acute period was 88.50%, the subacute period was 11.50%, the clinical classification was 21.24% of visceral type, and 63.72 of bone joint type.
3. clinical manifestation and physical labor ability score
At the first visit, 28.32% of the subjects were chill, 83.19% fever, 56.64% perspiration, 27.43% muscle soreness, 73.45% fatigue, 15.93% dizziness, 35.40% headache, and 76.99% bone and joint pain. The scores of physical strength (labor ability) were 61.95%, 2, 31.86%, 3, 2.65%, and 3.54%..
During the first course of the follow-up, 5.31% fever, 12.39% sweats, 8.85% muscle soreness, 40.71% fatigue, 3.54% dizziness, 5.31% headache, 52.21% bone joint pain. The physical (labor ability) score was 0, 1, 73.45%, 2, 8.85%, and 3 accounted for 1.77%..
During the second course of follow-up, 0% had chills, 0% fever, 2.65% sweats, 1.77% muscle soreness, 22.12% fatigue, 1.77% dizziness, 0.88% headache, 17.70% bone and joint pain. The score of physical strength (labor ability) was 0 and 44.25%, 1 points accounted for 52.21%, 2 accounted for 0.88%..
90 days after the diagnosis, 5.31% fever, 2.65% perspiration, 1.77% muscle soreness, 8.85% fatigue, 1.77% dizziness, 1.77% headaches, and 7.08% bone and joint pain. The physical (labor ability) score was 0, 78.76%, 1, 18.58%, 2, 1.77%, and 0.88%.
The physical labor ability score of the first 90 days after the first diagnosis and 90 days after the diagnosis was tested with a two sample rank sum test. The difference was statistically significant (P0.001), and the physical labor ability of the patients was recovered.
4. epidemiological results
At the first visit, 38.05% of the patients often clean up the enclosure, 7.96% often slaughtered, 36.28% regular lambs, 18.58% often immunized livestock, 0.88% regular veterinary treatment, 24.78% regular fur purchase, 2.65% regular dairy processing, 2.65% regular meat processing, 13.27% regular livestock transportation, 14.16% often young lambs and indoor rearing.
The first course, 11.50% patients often clean the enclosure, 2.65% often slaughtered, 10.62% regular lambing, 2.65% often immune to livestock, 0% regular veterinary treatment, 6.19% often fur purchase, 0.88% regular dairy processing, 0.88% regular meat processing, 4.42% regular livestock transportation, 2.65% often young lambs indoor breeding 2.65%.
Second courses, 8.85% of the patients often clean up the enclosure, 2.65% often slaughtered, 8.85% regular lambing, 0.88% often immune to livestock, 0% regular veterinary treatment, 4.42% often fur purchase, 0.88% regular dairy processing, 5.31% regular livestock transportation, 0.88% often young lambs indoor feeding.
90 days after the diagnosis, 11.50% of the patients often clean up the enclosure, 3.54% often slaughtered, 10.62% regular lambs, 3.54% often immunized livestock, 0% regular veterinary treatment, 7.08% regular fur purchase, 0.88% regular dairy processing, 0% regular meat processing, 7.08% regular livestock transportation, 1.77% regular young lambs kept indoors.
Observation on the effect of 5. treatment
The overall treatment effect was 76.99% cured, 9.73% basically cured, 12.39% improved, 0.88% ineffective.20.35% patients had adverse reactions,.26 people were treated with regimen 1 (doxycycline + rifampin), 76.92% cured, 11.54% basic cure, 11.54% improved, 0% ineffective.38.46% ungood reaction to receive scheme two (ceftriaxone sodium + azithromycin) Treatment, the results were 77.01% cured, 9.20% basically cured, 12.64% improved, 1.15% invalid.14.94% adverse reactions.
6. influence factors analysis
4 aspects of the basic situation and clinical manifestation were 20 factors that could affect the patient's efficacy by t test, X ~2 test and other single factor analysis. The results showed that the age of the patients (30-49 years old) was a protective factor. The first diagnosis of physical labor ability score (4 points) and the high-risk activities during the treatment were the risk factors.
Follow up has an advantage in supervising the treatment and health education of brucellosis patients.
The short-term curative effect of ceftriaxone sodium plus azithromycin in the treatment of brucellosis was 77.01% and the adverse reaction rate was 14.94%.
The age of the patient (30-49 years old) is a protective factor affecting the curative effect (cure rate) of the disease. The first diagnosis of physical labor ability (4 points) and the high risk activities during the treatment are the risk factors.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R516.7

【参考文献】