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目的:探索老年肺结核初治菌阳延误诊断的原因,提高肺结核的诊断率和治愈率。方法:对2008年1月—2009年12月常山县人民医院结核门诊诊断治疗125初治菌阳老年肺结核患者进行问卷调查方式。结果:由于各种原因导致延误诊断者,老年组93例,总延误率74.4%;年轻组43例,总延误率41.0%,两组间有统计学意义(P<0.005)。病人延误:老年组61例(65.6%),延误平均32.4天;年轻组28例(65.1%),平均延误14.6天,两组间有统计学意义(P<0.05)。医师延误:老年组32例(34.4%),平均延误21.8天;年轻组15例(34.9%)延误平均16.4天,两组间有统计学意义(P<0.05)。职业以农民为主,107例,占85.6%。结论:病人延误,归根结底是农民患者经济条件差,结核病知识缺乏,医师延误的原因,主要是对肺结核认识不足,早期缺乏呼吸系统疾病之间的鉴别诊断,后期对结核病的中毒症状不够重视,未进行痰涂片检查和肺部CT检查,影响对肺结核的正确诊断。因此,结核病防治工作的重点在农村,加大农村传染病防治知识的宣传力度,提高农民的生活水平,改善农村卫生条件是当前和今后结核病防治的关键所在。
Objective: To explore the causes of delayed diagnosis of senile pulmonary tuberculosis and to improve the diagnosis and cure rate of tuberculosis. Methods: From January 2008 to December 2009, Changshan County People’s Hospital of tuberculosis outpatient diagnosis and treatment of 125 untreated bacilli in elderly patients with pulmonary tuberculosis questionnaire survey. Results: For all kinds of reasons, 93 cases were delayed in diagnosis, the total delay rate was 74.4% in the elderly group and 43 cases in the young group with a total delay rate of 41.0%. There was a significant difference between the two groups (P <0.005). Patient delay: 61 cases (65.6%) in the elderly group, with an average delay of 32.4 days; young group of 28 patients (65.1%), the average delay of 14.6 days, between the two groups was statistically significant (P <0.05). Physician delay: 32 cases (34.4%) in the elderly group, with an average delay of 21.8 days; 15 cases (34.9%) young group delayed an average of 16.4 days, with statistical significance between the two groups (P <0.05). Occupation mainly farmers, 107 cases, accounting for 85.6%. Conclusions: The patient’s delay is due to poor economic conditions, lack of knowledge of tuberculosis and physicians ’delays in peasants’ patients, mainly due to lack of knowledge of tuberculosis and early lack of differential diagnosis of respiratory diseases. In the late stage, the symptoms of tuberculosis are not taken seriously enough. Sputum smear examination and lung CT examination, affecting the correct diagnosis of tuberculosis. Therefore, the focal point of tuberculosis prevention and control work is in the rural areas. It is imperative to intensify publicity on prevention and treatment of infectious diseases in rural areas, improve farmers’ standard of living, and improve rural sanitation, both at present and in the future.