论文部分内容阅读
目的了解县级医疗机构儿童结核病诊疗工作现状,为儿童结核病防治工作提供理论依据。方法招募5所结防机构和5家县级医院中参与儿童结核病防治工作的相关人员进行焦点小组访谈。结果 10家县级医疗机构中,PPD覆盖了5家结防机构和1家医院;X线覆盖了10家单位,CT仅覆盖了5个医院;病原学检查覆盖了5家结防机构和4家医院,通过自然痰收集标本,仅3家医院还采用吸痰等方式。医生未诊断过婴幼儿期和学龄前期结核病患儿,部分医生依靠影像学检查和临床症状诊断过学龄期结核病患儿,多数疑似结核病患儿初筛后转诊,但无转诊沟通渠道;治疗的结核病患儿以学龄期为主,仅1家单位治疗过1例结核病婴儿,医院监测患儿的服药情况、处理不良反应及治疗方面优于结防机构;结防机构以成人方式对患儿进行管理。结论县级医疗机构对儿童结核病的诊断工具缺乏和经验不足,诊断能力有限,应指定儿童结核病定点医院,建立分级诊疗制度,完善单位之间的联系制度。
Objective To understand the status quo of diagnosis and treatment of childhood tuberculosis in county-level medical institutions and to provide a theoretical basis for tuberculosis prevention and treatment in children. Methods Five focus groups and five related county-level hospitals were recruited to interview the key personnel involved in the prevention and treatment of childhood tuberculosis. Results Of the 10 county-level medical institutions, PPD covered 5 prevention and treatment institutions and 1 hospital; X-ray covered 10 units, CT covered only 5 hospitals; etiological examination covered 5 prevention and treatment institutions and 4 Home hospital, collecting samples through natural sputum, only 3 hospitals also use suction and other means. The doctor did not diagnose infants and children with pre-school-age tuberculosis, some doctors rely on imaging studies and clinical symptoms diagnosed in children with school-age TB, the majority of suspected TB patients after screening screening, but no referral channels of communication; treatment Of tuberculosis patients were mainly school-age, only 1 unit treated 1 case of tuberculosis infants, the hospital monitored the children’s medication, treatment of adverse reactions and treatment is superior to the antisense mechanism; antistress mechanism of adult children Manage. Conclusion County-level medical institutions lack of diagnostic tools for childhood tuberculosis and lack of experience, diagnostic capacity is limited, designated TB children’s hospitals should be designated to establish a hierarchical diagnosis and treatment system, improve the contact between the system.