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目的了解浙江省绍兴市2013年麻疹发病率突然升高的原因,分析医院就诊情况与麻疹高发之间的病因关联。方法采用病例对照设计,调查实验室诊断麻疹病例166例,并按照1∶3的比例,在每名麻疹病例现住村(社区)选择3名年龄组匹配的共498名作对照。调查持续时间为2013年1-6月,所有调查对象均需完成麻疹传播因素病例对照调查表、入户调查记录表和知情同意书。统计分析方法包括χ2检验(Pearson、Mantel-Haenszel)、两独立样本t检验和Cox比例风险回归分析。结果麻疹潜伏期内有医院就诊史是麻疹发病的危险因素,其关联强度(ORHM)在7月龄以下组为9.08(95%CI:2.58~31.95)、7月龄至14岁组为13.01(95%CI:2.85~59.40)、15岁以上组为16.53(95%CI:8.16~33.47)。多因素Cox比例风险回归分析结果显示,因发热、咳嗽等流感样症状到医院就诊罹患麻疹的可能性是其他原因到医院就诊的36.21倍(95%CI:4.56~289.16);相对于停留在挂号、诊室等空旷的场所,停留在输液室(ORadjust=3.72,95%CI:1.06~13.04)、病房(ORadjust=8.50,95%CI:1.70~42.38)等拥挤场所罹患麻疹的风险更大。结论医院暴露与麻疹发病存在很强的关联,医院预检分诊制度不完善,病房、输液室等场所主动通风工作落实不到位,都可增加麻疹发病的风险。
Objective To understand the reasons for the sudden increase of measles incidence in Shaoxing, Zhejiang Province in 2013 and to analyze the etiological relationship between the hospital treatment and the high incidence of measles. Methods A total of 166 cases of measles were investigated in the laboratory by means of a case-control design. A total of 498 matched 3 age groups were selected as the control group in Xianzhu village (community) in each measles case according to the ratio of 1: 3. The survey duration was from January to June 2013. All respondents were required to complete a case-control survey of measles transmission, household survey records and informed consent. Statistical analysis included χ2 test (Pearson, Mantel-Haenszel), two independent samples t-test and Cox proportional hazards regression analysis. Results The history of hospital visit during the latent period of measles was the risk factor of measles. The correlation strength (ORHM) was 9.08 (95% CI: 2.58 ~ 31.95) in the group of 7 months and 13.01 (95 % CI: 2.85 ~ 59.40), 16.53 (95% CI: 8.16 ~ 33.47) in the group over 15 years old. Multivariate Cox proportional hazards regression analysis showed that the probability of getting flu-like symptoms due to fever and cough to hospital was 36.21 times (95% CI: 4.56-289.16) for hospital visits due to other reasons; (ORadjust = 3.72, 95% CI: 1.06 ~ 13.04), and ward (ORadjust = 8.50, 95% CI: 1.70-42.38) were more likely to have measles in open spaces such as clinics and clinics. Conclusion There is a strong correlation between hospital exposure and the incidence of measles. The imperfect hospital pre-screening and triage system and the inadequate active ventilation in wards and infusion rooms can increase the risk of measles.