肺结核患者就诊临床表现特征及变化情况调查分析

发布时间：2018-03-14 05:19

本文选题：肺结核　切入点：临床表现　出处：《青岛大学》2012年硕士论文　论文类型：学位论文

【摘要】：目的肺结核(Pulmonary Tuberculosis, PTB)的临床表现可因年龄、或随时间推移有所变化,且各个症状之间存在的关系也有所不同。本文探讨PTB患者就诊临床表现及变化,不同年龄PTB患者临床表现特征及其相关关系,可为提高对PTB的认识和制定有效防控措施提供科学依据。方法收集山东省某七县区2007～2010年PTB患者的有效病历资料共14623份。由经统一培训的工作人员输入病历内容到医院病历管理系统,再导出到数据库进行统计分析。收集的资料内容包括患者的基本情况,如年龄、性别、职业等；临床表现,如咳嗽、咳痰、发热、乏力、咯血、胸痛、食欲减退和盗汗等。结果PTB患者年龄中位数为51岁,男女比例为2.46：1,以农民为主(91.3%)。分析显示,PTB患者就诊时多有咳嗽症状,占97.2%；4年来,咳痰和咯血比率呈明显升高趋势(p均小于0.05),咳嗽、发热、乏力、食欲减退比率则有明显降低趋势(p均小于0.05)；性别比较显示,男性咳嗽、咳痰、咯血和胸痛出现比率明显高于女性(p均小于0.05)。患者中同时出现咳嗽、咳痰(咳嗽+咳痰)的发生率为58.72%,将其他的临床症状和咳嗽+咳痰进行联合分析,发现咳嗽+咳痰伴随乏力为39.22%；次之为咳嗽+咳痰伴随发热,占37.76%。不同年龄患者的临床表现不同,中老年组(51～60岁)咳嗽、发热、乏力和食欲减退症状的性别标化率显著大于青年组(21-30岁)(p0.05)；两组之间的咳嗽程度有显著性差异(p0.05),青年组以咳嗽时间3～8周为最多(40.5%),而中老年组以咳嗽时间8周为最多(50.0%)；咳嗽合并其他临床表现发现分别与发热、胸痛、乏力和食欲减退的组合在两年龄高峰组之间均有显著性差异(p0.05),中老年组的标化率均显著多于青年组。咳嗽与其他临床表现的关联性分析发现,咳嗽分别与发热(r=0.146)、乏力(r=0.138)、咳痰(r=0.132)、盗汗(r=0.096)、食欲减退(r=0.096)以及咯血(r=0.018)之间存在关联性(p0.05)。结论PTB患者中以男性居多,且更易出现各种临床症状。患者就诊时多有长期慢性咳嗽,应重视咳嗽、咳痰等临床特征及变化,提高对于这几种临床表现相关性的认识,避免误诊漏诊,咳嗽、咳痰、发热、乏力这几种联合症状的出现可为早期发现患者起到预警作用,为筛查可疑肺结核人群提供依据。青壮年和中老年对PTB来说是更易感的阶段,但是应根据各自的临床表现区别对待,此外,老年人各种症状的发生情况较青年人更严重,故应提高对老年人的防护措施,为预防控制肺结核提供策略。
[Abstract]:Objective the clinical manifestations of pulmonary tuberculosis tuberculosis (PTBs) may vary with age or over time, and the relationship between the symptoms is different. The clinical manifestations of PTB patients of different ages and their correlation can provide scientific basis for improving the understanding of PTB and making effective prevention and control measures. Methods A total of 14623 valid medical records of PTB patients were collected from seven counties and regions of Shandong Province from 2007 to 2010. The contents of medical records were inputted into the hospital medical records management system by unified training staff. The data collected include the basic information of the patients, such as age, sex, occupation, clinical manifestations, such as cough, expectoration, fever, fatigue, hemoptysis, chest pain, loss of appetite and night sweating. Results the median age of patients with PTB was 51 years old, the ratio of male to female was 2.46: 1, and 91.3% of them were mainly farmers. The analysis showed that the patients with PTB had cough symptoms (97.2%), and the rates of expectoration and hemoptysis were significantly higher than 0.05%, cough, fever, fatigue in the last 4 years, there was a significant increase in the rate of expectoration and hemoptysis. The incidence of cough, expectoration, hemoptysis and chest pain in males were significantly higher than those in females. The incidence of expectoration (cough expectoration) was 58.72. The combined analysis of other clinical symptoms and cough expectoration showed that cough expectoration associated with asthenia was 39.22, followed by cough expectoration with fever, The clinical manifestations of patients of different ages were different. The middle and old age group had cough and fever. The sex-standardized rate of symptoms of fatigue and anorexia was significantly higher than that of the young group (21-30 years old), the cough degree of the two groups was significantly different (p0.05), the cough time of the young group was 38-week and the most of the aged group was 40.5%, while that of the middle-aged group was the most. Cough combined with other clinical manifestations were found to be associated with fever, The combination of chest pain, fatigue and anorexia was significantly different between the two year old peak group (p 0.05), and the standardized rate of the middle and old group was significantly higher than that of the young group. The correlation between cough and other clinical manifestations was found. There was a correlation between cough and fever (0.146), fatigue (0.138), phlegm (0.132), night sweating (0.096), hypoappetite (r0.096) and hemoptysis (0.018). Conclusion the majority of PTB patients are male, and they are more likely to appear various clinical symptoms. Patients with chronic cough should pay attention to the clinical characteristics and changes of cough, expectoration and so on, so as to improve the understanding of the correlation between these clinical manifestations. Avoiding misdiagnosis and misdiagnosis, cough, expectoration, fever and fatigue may serve as a warning for early detection of patients and provide evidence for screening suspected pulmonary tuberculosis. Young and middle-aged people are more susceptible to PTB. However, different treatment should be made according to their clinical manifestations. In addition, the occurrence of various symptoms in the elderly is more serious than that in the young, so the protective measures for the elderly should be improved to provide strategies for the prevention and control of tuberculosis.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R521

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