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目的评价目前徐州市耐多药结核病管理模式的运行效果,探讨适合徐州市控制耐多药结核病(MDR-TB)的发现、治疗与管理模式。方法收集2009年10月至2014年6月项目执行期间耐多药患者的发现、治疗与管理数据,对徐州市当前的耐多药结核病患者的筛查、治疗和管理情况进行调查分析。结果徐州市耐多药结核病患者的筛查工作由县级和市级共同承担。耐多药肺结核可疑者的痰标本的培养工作由各县级疾病预防控制中心(结核病定点诊疗机构)、徐州市传染病院承担。各县培养阳性菌株送至市疾病预防控制中心进行药敏试验。市传染病院对该院培养的阳性菌株直接进行药敏试验。徐州市目前使用的是传统培养和传统药敏,培养及药敏试验周期均较长,对患者的及时诊断和治疗有一定的影响。纳入治疗的患者采取住院(2个月)与门诊治疗相结合的管理方式,病人出院后注射期由患者所在地社区卫生服务中心或乡镇卫生院负责,非注射期由患者所在地社区卫生服务站或村卫生室负责。90%以上的患者能按时就诊和复查,县级疾控中心负责对在治患者的督导管理工作,定期上门访视,督促患者按时随访复查。部分确诊的耐多药结核病患者因各种原因无法纳入治疗。结论徐州市耐多药结核病管理模式,有效衔接了市、县、镇、村四级,能够为耐多药结核病患者的坚持治疗提供基本保障。
Objective To evaluate the operational effect of multidrug-resistant tuberculosis (MDR-TB) management in Xuzhou and to find out the suitable methods for the detection, treatment and management of multi-drug resistant tuberculosis (MDR-TB) in Xuzhou. Methods The data of the discovery, treatment and management of MDR-TB patients during the project implementation period from October 2009 to June 2014 were collected. The current screening, treatment and management of MDR-TB patients in Xuzhou were investigated. Results The screening of MDR-TB patients in Xuzhou was shared by the county level and municipal level. Sputum specimens of multi-drug resistant TB suspects were cultivated by all county-level CDC (TB sentinel clinics) and Xuzhou Infectious Diseases Hospital. Positive strains were cultivated in all counties and sent to the Municipal Center for Disease Control and Prevention for susceptibility testing. City Infectious Hospital hospital positive strains cultured directly susceptibility test. Xuzhou currently uses the traditional culture and traditional drug susceptibility, culture and susceptibility testing cycles are longer, the timely diagnosis and treatment of patients have a certain impact. Patients admitted into the hospital should be managed by a combination of hospitalization (2 months) and outpatient treatment. Patients should be discharged from the community health service center or township hospitals at the time of discharge after discharge from the community health service station or village The clinic is responsible. More than 90% of patients can be treated and reviewed on time. The CDC of the county is responsible for supervising the management of patients under treatment, visiting regularly and urging patients to follow up on time. Some confirmed MDR-TB patients can not be included for a variety of reasons. Conclusion The multidrug-resistant tuberculosis management model in Xuzhou effectively links up with the four levels of cities, counties, towns and villages and provides a basic guarantee for adherence treatment of patients with multidrug-resistant tuberculosis.