發(fā)布時(shí)間：2018-08-01 17:41

【摘要】：研究目的:評(píng)價(jià)不明原因肺炎(PneumoniaofUnkonwn Etiology, PUE)監(jiān)測(cè)系統(tǒng)目前運(yùn)行現(xiàn)狀;分析該監(jiān)測(cè)系統(tǒng)在運(yùn)行過(guò)程中存在的主要問(wèn)題;依據(jù)上述研究發(fā)現(xiàn)與分析,提出針對(duì)該監(jiān)測(cè)系統(tǒng)運(yùn)行的建議。研究方法:采用描述性流行病學(xué)方法對(duì)2004至2016年全國(guó)PUE監(jiān)測(cè)系統(tǒng)病例上報(bào)情況、監(jiān)測(cè)目標(biāo)疾病人感染禽流感等病例報(bào)告途徑進(jìn)行分析;選取4省份醫(yī)療機(jī)構(gòu),采用現(xiàn)況研究方法對(duì)臨床醫(yī)生PUE監(jiān)測(cè)系統(tǒng)的理解和使用情況進(jìn)行調(diào)查;采用現(xiàn)況研究方法對(duì)2家醫(yī)療機(jī)構(gòu)PUE監(jiān)測(cè)系統(tǒng)運(yùn)行現(xiàn)狀進(jìn)行調(diào)查。從監(jiān)測(cè)系統(tǒng)發(fā)現(xiàn)目標(biāo)疾病的陽(yáng)性預(yù)測(cè)值、靈敏度、可接受性、及時(shí)性等指標(biāo)對(duì)PUE監(jiān)測(cè)系統(tǒng)進(jìn)行評(píng)價(jià)。研究結(jié)果:1. PUE監(jiān)測(cè)系統(tǒng)病例上報(bào)情況(1) 2004至2016年,全國(guó)共上報(bào)1666例PUE病例,其中8%(125/1666)為人禽流感病例,包括41例人感染H5N1禽流感病例,81例人感染H7N9禽流感病例,2例人感染H5N6禽流感病例,1例人感染H9N2禽流感病例。監(jiān)測(cè)系統(tǒng)發(fā)現(xiàn)目標(biāo)疾病的陽(yáng)性預(yù)測(cè)值為8%。(2) 2004至2016年全國(guó)報(bào)告PUE病例發(fā)病到診斷的平均間隔為6.0天,診斷到報(bào)告的平均間隔為0.5天,報(bào)告到審核的平均間隔為0.1天。疫情期間發(fā)病到診斷平均間隔長(zhǎng)于非報(bào)告高峰時(shí)段,而疫情期間診斷到報(bào)告、報(bào)告到審核的平均時(shí)間間隔較短。2.人感染禽流感等新發(fā)呼吸道傳染病病例報(bào)告途徑(1) 2004至2016年全國(guó)內(nèi)地共報(bào)告人感染禽流感、歐亞類禽豬流感病例共988例,其中13% (125/988)經(jīng)PUE監(jiān)測(cè)發(fā)現(xiàn),49% (483/988)經(jīng)法定報(bào)告途徑發(fā)現(xiàn),19% (183/988)經(jīng)住院肺炎病例監(jiān)測(cè)發(fā)現(xiàn)。PUE監(jiān)測(cè)發(fā)現(xiàn)目標(biāo)疾病的靈敏度為13%。(2) 2013年人感染H7N9禽流感疫情出現(xiàn)之前,人感染H5N1禽流感疫情時(shí)期的病例均經(jīng)PUE監(jiān)測(cè)系統(tǒng)上報(bào)。2013年人感染H7N9和其他各亞型禽流感疫情出現(xiàn)之后,53% (453/861)人感染禽流感病例經(jīng)法定報(bào)告途徑上報(bào),18%(159/861)經(jīng)住院肺炎病例監(jiān)測(cè)途徑上報(bào),僅9% (78/861)經(jīng)PUE監(jiān)測(cè)上報(bào)。3.臨床醫(yī)生對(duì)PUE監(jiān)測(cè)系統(tǒng)的理解和實(shí)踐調(diào)查(1)調(diào)查的487名臨床醫(yī)生中,83% (403/487)知曉該監(jiān)測(cè)系統(tǒng),知曉該監(jiān)測(cè)系統(tǒng)的臨床醫(yī)生中83% (326/395)接受過(guò)PUE監(jiān)測(cè)相關(guān)培訓(xùn)。知曉該監(jiān)測(cè)系統(tǒng)的醫(yī)生中能完全掌握PUE病例定義者僅占9% (35/395)。(2) 51% (250/487)臨床醫(yī)生自述曾發(fā)現(xiàn)過(guò)符合PUE病例定義的患者,其中55% (139/250)在過(guò)去一年發(fā)現(xiàn)PUE病例數(shù)在1-5例之間,76% (166/220)曾報(bào)告過(guò)符合PUE定義的患者。臨床醫(yī)生報(bào)告病例后,84%以上認(rèn)為報(bào)告程序簡(jiǎn)單易行、報(bào)告后有利于診療、報(bào)告后得到標(biāo)本的檢測(cè)結(jié)果、報(bào)告后得到相關(guān)部門的及時(shí)反應(yīng)。(3)對(duì)臨床醫(yī)生報(bào)告病例的原因進(jìn)行分析,48% (79/166)因病例診斷不明、治療效果不好而報(bào)告;對(duì)臨床醫(yī)生未報(bào)告病例的原因進(jìn)行分析,36%(30/84)因不知曉PUE監(jiān)測(cè)工作,未將符合PUE病例定義的患者上報(bào)。59% (288/487)臨床醫(yī)生認(rèn)為需要關(guān)注病情重的肺炎病例,49% (238/487)臨床醫(yī)生認(rèn)為有傳染性/聚集性的病例需上報(bào)至CDC。4.醫(yī)療機(jī)構(gòu)PUE監(jiān)測(cè)系統(tǒng)運(yùn)行現(xiàn)況(1)調(diào)查期間,兩家醫(yī)院共篩查2619例可能與PUE診斷相關(guān)的急性呼吸道感染病例,其中13% (335/2619)符合PUE病例定義。僅有0.3% (1/335)上報(bào)至當(dāng)?shù)厥屑部刂行摹?2)有病原學(xué)檢測(cè)結(jié)果的311例PUE病例中,6% (18/311)檢測(cè)結(jié)果呈陽(yáng)性,且全部為季節(jié)性流感。其中61%(11/18)為甲型流感病毒陽(yáng)性,39%例(7/18)為乙型流感病毒(Victoria型)陽(yáng)性。(3)管床醫(yī)生未將符合病例定義的病例上報(bào)原因主要為:76%不知道有不明原因肺炎監(jiān)測(cè)這項(xiàng)工作,53%不理解病例定義。隨著工作年限增加,管床醫(yī)生對(duì)這項(xiàng)工作的知曉率也增加。結(jié)論:1. PUE監(jiān)測(cè)系統(tǒng)陽(yáng)性預(yù)測(cè)值為8%。該監(jiān)測(cè)系統(tǒng)往往在人感染禽流感疫情早期的病例發(fā)現(xiàn)及報(bào)告中發(fā)揮主要作用。但隨著人感染禽流感被納入法定傳染病進(jìn)行報(bào)告管理,以及醫(yī)務(wù)人員對(duì)疾病認(rèn)識(shí)的加深,法定傳染病報(bào)告、住院肺炎病例監(jiān)測(cè)等成為病例發(fā)現(xiàn)和報(bào)告的主要途徑,而通過(guò)PUE監(jiān)測(cè)系統(tǒng)發(fā)現(xiàn)和報(bào)告已知人感染禽流感亞型病例的作用逐漸弱化。2.目前醫(yī)院內(nèi)有大量符合PUE定義的病例,但上報(bào)率低,且符合PUE定義的病例中目標(biāo)病原體陽(yáng)性者比例較低,病例定義假陽(yáng)性率高,特異度差。3.臨床醫(yī)生對(duì)該監(jiān)測(cè)系統(tǒng)的接受性尚可,也有意愿利用此監(jiān)測(cè)系統(tǒng)報(bào)告病例,但對(duì)該監(jiān)測(cè)系統(tǒng)的理解掌握程度不理想,培訓(xùn)工作有待進(jìn)一步加強(qiáng)。建議:1.在新版方案下發(fā)之前,加強(qiáng)對(duì)現(xiàn)有PUE監(jiān)測(cè)方案的培訓(xùn),使其發(fā)揮應(yīng)有作用。2.對(duì)PUE監(jiān)測(cè)系統(tǒng)的監(jiān)測(cè)目標(biāo)重新定位,依據(jù)監(jiān)測(cè)目的修改監(jiān)測(cè)病例定義,提高其發(fā)現(xiàn)目標(biāo)疾病病例的特異度,從而提高醫(yī)務(wù)人員按照監(jiān)測(cè)方案報(bào)告的依從性。
[Abstract]:Objective: To evaluate the current operation status of PneumoniaofUnkonwn Etiology (PUE) monitoring system and to analyze the main problems in the operation of the monitoring system. According to the above research findings and analysis, the suggestions for the operation of the monitoring system are proposed. The method of descriptive epidemiology is used for 2004 to 201. The cases reported in the 6 year national PUE monitoring system were reported, and the reports on the cases of avian influenza in the target disease were analyzed. The 4 province medical institutions were selected and the current status research method was used to investigate the understanding and use of the PUE monitoring system for clinicians, and the current status research method was used to run the PUE monitoring system of 2 medical institutions. A survey was conducted. The PUE monitoring system was evaluated from the positive predictive value of the target disease, sensitivity, acceptability and timeliness. The results of the 1. PUE monitoring system reported cases (1) from 2004 to 2016, 1666 cases of PUE were reported nationwide, of which 8% (125/1666) were human cases of avian influenza, including 41 cases of human feeling. There were 81 cases of H5N1 avian influenza, 81 cases of H7N9 avian influenza, 2 cases of H5N6 avian influenza and 1 cases of human H9N2 avian influenza. The monitoring system found that the positive predictive value of the target disease was 8%. (2) from 2004 to 2016. The average septum of PUE cases to the diagnosis was 6 days, and the average interval of the report was 0.5 days. The average interval between the audits was 0.1 days. The average interval between the epidemic period and the diagnosis was longer than the non reported peak period, and the report was diagnosed during the epidemic period. The average time interval of the review was reported, and the average time interval was shorter than the.2. human infection of avian influenza. (1) from 2004 to 2016 the mainland co reported the infectious bird flow. A total of 988 cases of avian and swine influenza, of which 13% (125/988) were detected by PUE, 49% (483/988) was found by legal reporting, 19% (183/988) was detected by hospitalized pneumonia cases, and.PUE monitoring found that the sensitivity of the target disease was 13%. (2) before the outbreak of H7N9 avian influenza epidemic in 2013 and the period of human infection of H5N1 avian influenza. After the PUE monitoring system reported the.2013 infection of H7N9 and other subtypes of avian influenza, 53% (453/861) cases of avian influenza were reported by the legal report. 18% (159/861) was reported through the monitoring of hospitalized pneumonia cases. Only 9% (78/861) was reported to.3. clinicians for the understanding of the PUE monitoring system through PUE monitoring. Of the 487 clinicians surveyed by the practice survey (1), 83% (403/487) knew the monitoring system, and 83% (326/395) of the clinicians in the monitoring system received PUE monitoring training. It was known that only 9% (35/395) of the PUE case definitions were fully mastered among the doctors in the monitoring system. (2) 51% (250/487) clinicians had discovered the character of the monitoring system. In the case of PUE case, 55% (139/250) found the number of PUE cases in 1-5 cases in the past year, 76% (166/220) reported the patient with the PUE definition. After the clinician reported the case, more than 84% thought the report procedure was simple and easy, the report was beneficial to the diagnosis and treatment, the report was obtained after the report, and the report was related. The timely response of the Department. (3) analysis of the causes of the cases reported by clinicians, 48% (79/166) reports of unidentified cases and poor treatment results; analysis of the causes of unreported cases by clinicians, 36% (30/84) because of the unknowing PUE monitoring work, and not reporting to patients defined in PUE cases to.59% (288/487) clinicians. In order to pay attention to severe pneumonia cases, 49% (238/487) clinicians considered infectious / aggregated cases to be reported to the CDC.4. medical institution PUE monitoring system running status (1), the two hospitals were screened for 2619 cases of acute respiratory tract infection associated with PUE diagnosis, of which 13% (335/2619) met the definition of PUE case. Only 0.3% (1/335) was reported to the local CDC. (2) of the 311 cases of PUE with pathogeny test results, 6% (18/311) test results were positive, and all were seasonal influenza. 61% (11/18) was influenza A virus positive, 39% (7/18) was type B virus (Victoria) positive. (3) the doctor of tube bed did not conform to the case definition. The main reasons for the case report were as follows: 76% I did not know the work of unidentified pneumonia monitoring, and 53% did not understand the case definition. As the years of work increased, the awareness rate of the work was also increased. Conclusion: the positive predictive value of the 1. PUE monitoring system is 8%., which is often found in the early cases of human infection with avian influenza and The report plays a major role in the report, but with the report management of the human infection of avian influenza and the deepening of medical personnel's awareness of the disease, the report of the legal infectious disease, the monitoring of the cases of pneumonia in the hospital and so on as the main way of the case discovery and report, the PUE monitoring system found and reported the known people infected with avian influenza. The role of the type case has gradually weakened.2.. There are a large number of cases with PUE defined in the hospital, but the rate of reporting is low, the ratio of the target pathogen positive in the case with the PUE definition is low, the false positive rate of the case definition is high, the specificity poor.3. clinician is acceptable to the monitoring system, and the monitoring system will also have the intention to report the disease by using this monitoring system. For example, the understanding of the monitoring system is not ideal, and the training work needs to be further strengthened. 1. to strengthen the training of the existing PUE monitoring scheme before the new version of the scheme, so that it can play its due role in the repositioning of the monitoring target of the PUE monitoring system, and to modify the definition of the monitoring case according to the monitoring purpose and improve its discovery. The specificity of target disease cases can improve the compliance of medical staff according to the monitoring plan.
【學(xué)位授予單位】：中國(guó)疾病預(yù)防控制中心
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R563.1;R181.3

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4 本報(bào)記者 張藍(lán)飛;將臨床醫(yī)生和研究者融合在一起[N];醫(yī)藥經(jīng)濟(jì)報(bào);2014年

5 ;臨床醫(yī)生非得“攻博”嗎?[N];解放日?qǐng)?bào);2006年

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7 譚嘉;臨床醫(yī)生有時(shí)間做科研嗎？[N];健康報(bào);2005年

8 劉加升;試試臨床醫(yī)生“年薪制”[N];健康報(bào);2012年

9 杜治政;人性化醫(yī)療，，呼喚臨床醫(yī)生的參與[N];健康報(bào);2013年

10 記者 楊秀娟　通訊員 王衛(wèi)忠;我市啟動(dòng)臨床醫(yī)生導(dǎo)師制[N];嘉興日?qǐng)?bào);2010年

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3 白文若;超大規(guī)模風(fēng)電基地風(fēng)電監(jiān)測(cè)系統(tǒng)關(guān)鍵技術(shù)研究[D];天津大學(xué);2015年

4 范允舟;綜合癥狀監(jiān)測(cè)系統(tǒng)預(yù)警性能的評(píng)價(jià)及應(yīng)用研究[D];華中科技大學(xué);2015年

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1 王宇;不明原因肺炎監(jiān)測(cè)系統(tǒng)評(píng)價(jià)[D];中國(guó)疾病預(yù)防控制中心;2017年

2 劉冠軍;烏魯木齊市三級(jí)甲等醫(yī)院臨床醫(yī)生主觀幸福感與職業(yè)緊張的現(xiàn)況調(diào)查研究[D];新疆醫(yī)科大學(xué);2011年

3 王楠;臨床醫(yī)生價(jià)值觀隱性知識(shí)對(duì)工作績(jī)效影響的實(shí)證研究[D];河北聯(lián)合大學(xué);2014年

4 閻曉博;臨床醫(yī)生工作滿意度實(shí)證研究[D];山西醫(yī)科大學(xué);2016年

5 葉強(qiáng);多種學(xué)術(shù)成果評(píng)價(jià)臨床醫(yī)生科研水平的利弊及對(duì)策研究[D];第二軍醫(yī)大學(xué);2016年

6 蘇希;安徽省臨床醫(yī)生職業(yè)壓力源調(diào)查及其與應(yīng)對(duì)方式、心理健康的關(guān)聯(lián)研究[D];安徽醫(yī)科大學(xué);2013年

7 曾波濤;城市公立醫(yī)院臨床醫(yī)生的工作滿意度及其影響因素研究[D];山東大學(xué);2007年

8 魏錚;論誤診風(fēng)險(xiǎn)防范[D];天津醫(yī)科大學(xué);2014年

9 倪榮麗;醫(yī)教研綜合性醫(yī)院臨床醫(yī)生的信息負(fù)擔(dān)研究[D];華中科技大學(xué);2011年

10 黃騰;大型綜合性醫(yī)院不同科室臨床醫(yī)生的生存質(zhì)量比較[D];廣西醫(yī)科大學(xué);2007年

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