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目的探讨涂阳肺结核病人延误诊断治疗的影响因素,为早期控制传染源提供科学依据。方法以2007年4～10月就诊于湖南省郴州市北湖区、桂阳、宜章、永兴、安仁5县(区)结防机构新发涂阳肺结核患者为研究对象,利用调查表收集相关资料,应用COX比例风险模型进行延误诊断治疗的影响因素分析。结果患者延误、确诊延误、治疗延误、医疗机构延误及总延误时间中位数分别21,29,3,16,62d。患者延误的独立危险因素为不知晓结核病相关知识和首次症状有非肺结核主要症状;确诊延误的独立危险因素为首次就诊未进行痰涂片、X线电子计算机断层扫描(CT)和摄胸片检查;治疗延误的独立危险因素为农村户籍和首次就诊未进行痰涂片检查。医疗机构延误的独立危险因素为首次检查未进行痰涂片、摄胸片和CT检查、首诊医疗机构在村级或乡级医疗机构及首次无咯血症状;总延误的独立危险因素为男性、首次检查未进行胸透或CT检查。结论患者延误诊断、治疗与患者肺结核知识、户口所在地、首诊时间、未进行痰涂片和X线检查有关。
Objective To explore the influencing factors of delayed diagnosis and treatment of smear positive pulmonary tuberculosis patients and provide scientific basis for early control of infectious sources. Methods From April to October 2007, patients with newly diagnosed smear-positive pulmonary tuberculosis in the Beihu district of Chenzhou City, Guiyang, Yizhang, Yongxing and Anren counties (districts) from April 2007 to October 2007 were recruited. Data, the application of COX proportional hazards model for delayed diagnosis and treatment of influencing factors. Results The patients’ delay, the diagnosis delay, the treatment delay, the medical institution delay and the total delay time median respectively were 21, 29, 3, 16 and 62 days. The independent risk factors of delayed patients were unknown TB knowledge and the first symptoms of non-tuberculosis. The independent risk factors of delayed diagnosis were sputum smear, X-ray computed tomography (CT) and chest radiography ; Independent risk factors for delay in treatment for rural household registration and the first visit did not sputum smear. The independent risk factors of delay in medical institutions were the first examination without sputum smear, chest radiography and CT examination, the first visit of medical institutions at village or township medical institutions and the first time without hemoptysis; the independent risk factors of total delay were male, First check No chest X-ray or CT examination. Conclusion The diagnosis and treatment of patients with pulmonary tuberculosis in patients with knowledge, account location, first visit time, without sputum smear and X-ray examination.