發(fā)布時(shí)間：2018-06-28 10:51

  本文選題：涂陽肺結(jié)核 + 密切接觸者��； 參考：《遵義醫(yī)學(xué)院》2013年碩士論文

【摘要】：研究目的 了解痰涂片陽性(以下簡(jiǎn)稱“涂陽”)肺結(jié)核病患者的密切接觸者檢查工作(以下簡(jiǎn)稱“工作”)現(xiàn)狀、并分析存在問題及影響該項(xiàng)工作的因素,為提高我國(guó)涂陽肺結(jié)核病患者密切接觸者篩檢工作的質(zhì)量提供參考依據(jù)。 研究方法 1定性系統(tǒng)評(píng)價(jià)：檢索CNKI,萬方,CBM和pubmed4個(gè)數(shù)據(jù)庫(kù),最終納入2007-2012年所有中國(guó)涂陽肺結(jié)核病患者密切接觸者篩檢工作的文章共29篇,提取信息進(jìn)行定性描述。 2調(diào)查研究：由統(tǒng)一培訓(xùn)的公衛(wèi)專業(yè)大學(xué)生,在2012年8月至9月實(shí)地調(diào)查。①調(diào)查黔北某市結(jié)核病防治部門從事肺結(jié)核密切接觸者篩檢工作的專業(yè)人員,對(duì)其構(gòu)成比例、年檢查接觸者的數(shù)量、結(jié)核病防治專項(xiàng)費(fèi)用的運(yùn)行、績(jī)效考核等情況進(jìn)行了解；②調(diào)查當(dāng)?shù)赝筷柗谓Y(jié)核病患者及其密切接觸者看病就醫(yī)、經(jīng)濟(jì)狀況、結(jié)核認(rèn)知等相關(guān)情況；③通過訪談深入了解當(dāng)?shù)赝筷柗谓Y(jié)核病患者接觸者篩檢工作中存在的實(shí)際困難、改進(jìn)建議,以及涂陽肺結(jié)核病病患者和密切接觸者對(duì)結(jié)核病的認(rèn)知、態(tài)度和實(shí)際需求。 研究結(jié)果 1定性系統(tǒng)評(píng)價(jià)：在納入的29篇文獻(xiàn)中：①有19篇報(bào)道的檢查流程符合《新登記涂陽肺結(jié)核病人密切接觸者檢查指南》(以下簡(jiǎn)稱“指南”)規(guī)定。②對(duì)涂陽肺結(jié)核病患者密切接觸者的接觸時(shí)間、類型、頻率等的量化沒有統(tǒng)一方法。③密切接觸者受篩檢率介于56.8-100%之間,其中接受PPD檢查率介于3.3-100%之間；接受X線檢查率介于6.2-100%之間；接受痰涂片檢查率介于0.4-100%之間。④平均每個(gè)涂陽肺結(jié)核病患者篩檢的密切接觸者人數(shù)從1.38個(gè)到7734個(gè)不等。⑤密切接觸者中涂片陽性檢出率介于0.6-18.0%之間；活動(dòng)性肺結(jié)核的檢出率介于0.11-12.9%之間。其中,家庭內(nèi)接觸者的活動(dòng)性肺結(jié)核檢出率介于0.3-9.2%之間；家庭內(nèi)和其他接觸者的活動(dòng)性肺結(jié)核檢出率介于0.44-3.9%之間；學(xué)校內(nèi)接觸者的活動(dòng)性肺結(jié)核檢出率介于0.11-12.9%之間。 2調(diào)查研究：(1)黔北某市結(jié)核病防治機(jī)構(gòu)的人力資源情況：①全市戶籍人口約764萬,專業(yè)結(jié)防從業(yè)者88人(包括編制外人員共26人),該地結(jié)防從業(yè)人員與服務(wù)戶籍人口的比例平均為1：86818。從業(yè)人員中醫(yī)學(xué)相關(guān)專業(yè)者占65.9%,其中臨床醫(yī)學(xué)專業(yè)占39.8%,預(yù)防醫(yī)學(xué)專業(yè)占19.3%,醫(yī)學(xué)檢驗(yàn)專業(yè)占6.8%；中專及以下占42.1%,�？普�28.4%,本科占29.5%；中高級(jí)職稱占15.9%,初級(jí)職稱占72.8%,無職稱占11.3%。②年實(shí)際篩檢密切接觸者2889人,平均每個(gè)涂陽肺結(jié)核病患者篩檢密切接觸者1.25個(gè)。密切接觸者中篩檢出的肺結(jié)核病人占10.4%。無癥狀接觸者占密切接觸者的比例為92.8%,無癥狀密切接觸者中發(fā)現(xiàn)的肺結(jié)核病人占6.22%。③接受篩檢密切接觸者補(bǔ)助5-20元；從事篩檢的工作人員無補(bǔ)助。(2)對(duì)該地區(qū)涂陽肺結(jié)核病患者及其密切接觸者的調(diào)查,共發(fā)出調(diào)查問卷130份,收回有效問卷126份,回收率96.9%,其中涂陽肺結(jié)核病患者有效問卷67份,涂陽肺結(jié)核病患者密切接觸者有效問卷59份。涂陽肺結(jié)核病患者及其密切接觸者對(duì)結(jié)核病的認(rèn)知62.7%來自于親人朋友之間的口頭傳播；密切接觸者中僅54.2%接受了篩查；未接受檢查的主要原因有自覺身體健康認(rèn)為沒必要占44.4%,不知道有免費(fèi)篩查服務(wù)占29.6%,經(jīng)濟(jì)困難占18.5%。 研究結(jié)論 1對(duì)于篩檢工作,各地執(zhí)行中存在較大隨意性,密切接觸者中結(jié)核檢出率相差較大。 2黔北某市涂陽肺結(jié)核病患者密切接觸者中肺結(jié)核患病率較高,對(duì)密切接觸者的篩檢不容忽視。結(jié)核病防治機(jī)構(gòu)的結(jié)防從業(yè)人員數(shù)量較匱乏,人員專業(yè)素質(zhì)有待提高；須加大對(duì)該地結(jié)核病防治人力財(cái)力的投入。加強(qiáng)形式多樣、易于被接受的結(jié)核病相關(guān)知識(shí)宣傳,增加結(jié)核病治療的醫(yī)保報(bào)銷比例。
[Abstract]:research objective
To understand the current situation of the close contacts of sputum smears (hereinafter referred to as "smear Yang") for the close contacts of pulmonary tuberculosis patients (hereinafter referred to as "work"), and to analyze the existing problems and the factors that affect the work, so as to provide reference for the improvement of the quality of the screening workers for the close contacts of the smear positive pulmonary tuberculosis patients.
research method
1 qualitative system evaluation: search CNKI, Wanfang, CBM and pubmed4 database, and finally include 29 articles on the screening work of all Chinese smear positive TB patients in 2007-2012 years, and the extraction information is described qualitatively.
2 investigation and study: the college students who were trained by the United States and the public were investigated in the field from August 2012 to September. Survey local smear positive pulmonary tuberculosis patients and their close contacts for medical treatment, economic status, tuberculosis cognition and other related conditions; thirdly, through interviews, in-depth understanding of the actual difficulties in the screening of local smear positive pulmonary tuberculosis patients in screening work, improvement suggestions, and smear positive pulmonary tuberculosis patients and close contact with the people. The cognition, attitude and actual needs of tuberculosis.
Research results
1 qualitative system evaluation: in the 29 articles included: (1) the inspection process of 19 reports accords with the guidelines for the examination of close contacts of pulmonary tuberculosis patients (hereinafter referred to as the "guide"). (2) there is no unified method for quantifying the contact time, type and frequency of the close contacts of smear positive pulmonary tuberculosis patients. The rate of screening was between 56.8-100%, among which the acceptance rate of PPD was between 3.3-100%; the rate of X-ray examination was between 6.2-100%, and the rate of sputum smear examination was between 0.4-100%. (4) the average number of close contacts between each smear positive pulmonary tuberculosis patients ranged from 1.38 to 7734. The positive rate of positive pulmonary tuberculosis was between 0.6-18.0% and 0.11-12.9%. The detection rate of active pulmonary tuberculosis in family contacts was between 0.3-9.2%; the detection rate of active pulmonary tuberculosis in family and other contacts was between 0.44-3.9% and the detection rate of active pulmonary tuberculosis in school contacts. Between 0.11-12.9%.
2 investigation and study: (1) the human resource situation of tuberculosis prevention and control institution in a city of Northern Guizhou: (1) the population of the city's household registration is about 7 million 640 thousand, and 88 professionals (including 26 people), and the average proportion of the employees and the household registered population of 1:86818. is 65.9%, including the clinical medicine. Study major accounted for 39.8%, preventive medicine accounted for 19.3%, medical examination was 6.8%, secondary school and below accounted for 42.1%, specialist accounted for 28.4%, and undergraduate accounted for 29.5%; middle and senior titles accounted for 15.9%, junior professional titles 72.8%, no titles accounted for 2889 close contact with actual screening in 11.3%., and 1.25 of each smear positive pulmonary tuberculosis patients were in close contact. The proportion of 10.4%. asymptomatic contacts among close contacts was 92.8%, and tuberculosis patients found in the asymptomatic contacts accounted for 5-20 yuan (5-20 yuan) for the close contact of sifting persons, and the staff engaged in screening were not subsidized. (2) TB patients in this area and their density A total of 130 questionnaires were sent out, 126 valid questionnaires were collected, the recovery rate was 96.9%, of which 67 were effective questionnaires for smear positive pulmonary tuberculosis patients and 59 of the effective questionnaires for the close contacts of smear positive pulmonary tuberculosis patients. 62.7% of TB patients and their close contacts were from the mouth of relatives and friends. Only 54.2% of the close contacts were screened; the main reasons for not being examined were self-conscious physical health that was not necessary to account for 44.4%, the free screening service was 29.6%, and the financial difficulties accounted for 18.5%..
research conclusion
1 for screening work, there is a greater degree of randomness in the implementation of each area, and the detection rate of tuberculosis among close contacts is quite different.
2 the prevalence rate of tuberculosis in the patients with pulmonary tuberculosis in a city of North Guizhou is higher. The screening of close contacts should not be ignored. The number of employees in the tuberculosis prevention and control agencies is scarce and the professional quality of personnel needs to be improved; the investment in the manpower and financial resources of tuberculosis prevention and control should be increased. Publicity on tuberculosis related knowledge increased the proportion of reimbursement for TB treatment.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R521

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