“涂阳肺结核病人密切接触者检查”的循证研究

发布时间：2018-06-28 10:51

本文选题：涂阳肺结核 + 密切接触者　；参考：《遵义医学院》2013年硕士论文

【摘要】：研究目的了解痰涂片阳性(以下简称“涂阳”)肺结核病患者的密切接触者检查工作(以下简称“工作”)现状、并分析存在问题及影响该项工作的因素,为提高我国涂阳肺结核病患者密切接触者筛检工作的质量提供参考依据。研究方法 1定性系统评价：检索CNKI,万方,CBM和pubmed4个数据库,最终纳入2007-2012年所有中国涂阳肺结核病患者密切接触者筛检工作的文章共29篇,提取信息进行定性描述。 2调查研究：由统一培训的公卫专业大学生,在2012年8月至9月实地调查。①调查黔北某市结核病防治部门从事肺结核密切接触者筛检工作的专业人员,对其构成比例、年检查接触者的数量、结核病防治专项费用的运行、绩效考核等情况进行了解；②调查当地涂阳肺结核病患者及其密切接触者看病就医、经济状况、结核认知等相关情况；③通过访谈深入了解当地涂阳肺结核病患者接触者筛检工作中存在的实际困难、改进建议,以及涂阳肺结核病病患者和密切接触者对结核病的认知、态度和实际需求。研究结果 1定性系统评价：在纳入的29篇文献中：①有19篇报道的检查流程符合《新登记涂阳肺结核病人密切接触者检查指南》(以下简称“指南”)规定。②对涂阳肺结核病患者密切接触者的接触时间、类型、频率等的量化没有统一方法。③密切接触者受筛检率介于56.8-100%之间,其中接受PPD检查率介于3.3-100%之间；接受X线检查率介于6.2-100%之间；接受痰涂片检查率介于0.4-100%之间。④平均每个涂阳肺结核病患者筛检的密切接触者人数从1.38个到7734个不等。⑤密切接触者中涂片阳性检出率介于0.6-18.0%之间；活动性肺结核的检出率介于0.11-12.9%之间。其中,家庭内接触者的活动性肺结核检出率介于0.3-9.2%之间；家庭内和其他接触者的活动性肺结核检出率介于0.44-3.9%之间；学校内接触者的活动性肺结核检出率介于0.11-12.9%之间。 2调查研究：(1)黔北某市结核病防治机构的人力资源情况：①全市户籍人口约764万,专业结防从业者88人(包括编制外人员共26人),该地结防从业人员与服务户籍人口的比例平均为1：86818。从业人员中医学相关专业者占65.9%,其中临床医学专业占39.8%,预防医学专业占19.3%,医学检验专业占6.8%；中专及以下占42.1%,专科占28.4%,本科占29.5%；中高级职称占15.9%,初级职称占72.8%,无职称占11.3%。②年实际筛检密切接触者2889人,平均每个涂阳肺结核病患者筛检密切接触者1.25个。密切接触者中筛检出的肺结核病人占10.4%。无症状接触者占密切接触者的比例为92.8%,无症状密切接触者中发现的肺结核病人占6.22%。③接受筛检密切接触者补助5-20元；从事筛检的工作人员无补助。(2)对该地区涂阳肺结核病患者及其密切接触者的调查,共发出调查问卷130份,收回有效问卷126份,回收率96.9%,其中涂阳肺结核病患者有效问卷67份,涂阳肺结核病患者密切接触者有效问卷59份。涂阳肺结核病患者及其密切接触者对结核病的认知62.7%来自于亲人朋友之间的口头传播；密切接触者中仅54.2%接受了筛查；未接受检查的主要原因有自觉身体健康认为没必要占44.4%,不知道有免费筛查服务占29.6%,经济困难占18.5%。研究结论 1对于筛检工作,各地执行中存在较大随意性,密切接触者中结核检出率相差较大。 2黔北某市涂阳肺结核病患者密切接触者中肺结核患病率较高,对密切接触者的筛检不容忽视。结核病防治机构的结防从业人员数量较匮乏,人员专业素质有待提高；须加大对该地结核病防治人力财力的投入。加强形式多样、易于被接受的结核病相关知识宣传,增加结核病治疗的医保报销比例。
[Abstract]:research objective
To understand the current situation of the close contacts of sputum smears (hereinafter referred to as "smear Yang") for the close contacts of pulmonary tuberculosis patients (hereinafter referred to as "work"), and to analyze the existing problems and the factors that affect the work, so as to provide reference for the improvement of the quality of the screening workers for the close contacts of the smear positive pulmonary tuberculosis patients.
research method
1 qualitative system evaluation: search CNKI, Wanfang, CBM and pubmed4 database, and finally include 29 articles on the screening work of all Chinese smear positive TB patients in 2007-2012 years, and the extraction information is described qualitatively.
2 investigation and study: the college students who were trained by the United States and the public were investigated in the field from August 2012 to September. Survey local smear positive pulmonary tuberculosis patients and their close contacts for medical treatment, economic status, tuberculosis cognition and other related conditions; thirdly, through interviews, in-depth understanding of the actual difficulties in the screening of local smear positive pulmonary tuberculosis patients in screening work, improvement suggestions, and smear positive pulmonary tuberculosis patients and close contact with the people. The cognition, attitude and actual needs of tuberculosis.
Research results
1 qualitative system evaluation: in the 29 articles included: (1) the inspection process of 19 reports accords with the guidelines for the examination of close contacts of pulmonary tuberculosis patients (hereinafter referred to as the "guide"). (2) there is no unified method for quantifying the contact time, type and frequency of the close contacts of smear positive pulmonary tuberculosis patients. The rate of screening was between 56.8-100%, among which the acceptance rate of PPD was between 3.3-100%; the rate of X-ray examination was between 6.2-100%, and the rate of sputum smear examination was between 0.4-100%. (4) the average number of close contacts between each smear positive pulmonary tuberculosis patients ranged from 1.38 to 7734. The positive rate of positive pulmonary tuberculosis was between 0.6-18.0% and 0.11-12.9%. The detection rate of active pulmonary tuberculosis in family contacts was between 0.3-9.2%; the detection rate of active pulmonary tuberculosis in family and other contacts was between 0.44-3.9% and the detection rate of active pulmonary tuberculosis in school contacts. Between 0.11-12.9%.
2 investigation and study: (1) the human resource situation of tuberculosis prevention and control institution in a city of Northern Guizhou: (1) the population of the city's household registration is about 7 million 640 thousand, and 88 professionals (including 26 people), and the average proportion of the employees and the household registered population of 1:86818. is 65.9%, including the clinical medicine. Study major accounted for 39.8%, preventive medicine accounted for 19.3%, medical examination was 6.8%, secondary school and below accounted for 42.1%, specialist accounted for 28.4%, and undergraduate accounted for 29.5%; middle and senior titles accounted for 15.9%, junior professional titles 72.8%, no titles accounted for 2889 close contact with actual screening in 11.3%., and 1.25 of each smear positive pulmonary tuberculosis patients were in close contact. The proportion of 10.4%. asymptomatic contacts among close contacts was 92.8%, and tuberculosis patients found in the asymptomatic contacts accounted for 5-20 yuan (5-20 yuan) for the close contact of sifting persons, and the staff engaged in screening were not subsidized. (2) TB patients in this area and their density A total of 130 questionnaires were sent out, 126 valid questionnaires were collected, the recovery rate was 96.9%, of which 67 were effective questionnaires for smear positive pulmonary tuberculosis patients and 59 of the effective questionnaires for the close contacts of smear positive pulmonary tuberculosis patients. 62.7% of TB patients and their close contacts were from the mouth of relatives and friends. Only 54.2% of the close contacts were screened; the main reasons for not being examined were self-conscious physical health that was not necessary to account for 44.4%, the free screening service was 29.6%, and the financial difficulties accounted for 18.5%..
research conclusion
1 for screening work, there is a greater degree of randomness in the implementation of each area, and the detection rate of tuberculosis among close contacts is quite different.
2 the prevalence rate of tuberculosis in the patients with pulmonary tuberculosis in a city of North Guizhou is higher. The screening of close contacts should not be ignored. The number of employees in the tuberculosis prevention and control agencies is scarce and the professional quality of personnel needs to be improved; the investment in the manpower and financial resources of tuberculosis prevention and control should be increased. Publicity on tuberculosis related knowledge increased the proportion of reimbursement for TB treatment.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R521

【参考文献】