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目的:通过对衢州市耐多药肺结核患者在诊治和管理过程中的分析,找出建立管理模式的条件因素,评价模式运行效果,为建立适合该市耐多药肺结核管理模式提供科学依据。方法:该研究根据全球基金结核病项目耐多药领域的项目要求,对衢州市耐多药肺结核可疑者进行筛查,并对发现的耐多药患者治疗、管理等情况进行调查分析。结果:衢州市各县级结核病定点医院对耐多药肺结核可疑者的痰标本进行培养,且能保证一个月上送一次阳性菌株,市级定点医院对上送菌株进行药敏试验,但药敏结果周期较长,对患者的及时诊断和治疗有一定影响;发现的耐多药肺结核患者均在专报网上进行登记;纳入治疗的患者先在市级定点医院住院治疗,再门诊治疗,门诊注射点由社区卫生服务中心负责,且90%以上的患者能按时就诊和复查,县级疾控中心安排对在治患者的督导管理,均上门访视,并对督导医生进行经济激励。但因各种原因有一定比例的耐多药患者无法纳入治疗。结论:该模式的运行整合了各部门优势,满足了患者的需求,并为耐多药肺结核患者的坚持治疗提供了充分保障。
Objective: To analyze the condition of diagnosis and management of MDR-TB patients in Quzhou, identify the conditions for establishing management mode and evaluate the effect of mode operation, so as to provide a scientific basis for establishing MDR-TB management model in this city. Methods: According to the project requirements of MDR-TB in the Global Fund TB Project, we screened the suspected MDR-TB patients in Quzhou and investigated the treatment and management of MDR-TB patients. Results: The sputum samples from suspicious patients with multi-drug resistant pulmonary tuberculosis were collected from designated hospitals of TB counties in Quzhou City, and positive samples were sent once a month. Drug-sensitive tests were carried out at designated hospitals in municipal quarantine stations. However, The results of a longer period, the timely diagnosis and treatment of patients have a certain impact; found multidrug-resistant pulmonary tuberculosis patients are reported in the special online registration; included in the treatment of patients at the municipal hospital inpatient treatment, outpatient treatment, outpatient injections Point by the community health service center is responsible for, and more than 90% of patients on time treatment and review, county CDC arrangements for the supervision and management of patients in treatment, home visits, and economic incentives for supervising doctors. However, for a variety of reasons, a certain percentage of MDR patients can not be included in the treatment. Conclusion: This mode of operation integrates the advantages of each department to meet the needs of patients and provides adequate protection for adherence to MDR-TB patients.