本文選題：肺外結(jié)核病　切入點：結(jié)核性創(chuàng)面　出處：《山西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：初步摸清2010-2012年度北京西北地區(qū)結(jié)核性創(chuàng)面流行病學(xué)數(shù)據(jù)、特點和規(guī)律，填補我國目前在此方面的空白，為后期的臨床研究提供可靠數(shù)據(jù)。 方法：本研究為回顧性調(diào)查研究，收集2010年1月至2012年12月總參謀部總醫(yī)院肺外結(jié)核性創(chuàng)面住院患者，采集性別、年齡、民族、戶籍、治療費別、結(jié)核病類型、全身癥狀、創(chuàng)面情況、診斷方法、確診時間、治療方法及轉(zhuǎn)歸情況等資料，統(tǒng)計分析其規(guī)律及特點。 結(jié)果：總參謀部總醫(yī)院2010-2012年度肺外結(jié)核住院患者中，結(jié)核性創(chuàng)面235例,發(fā)生率為4.0%；男女之比為1.448∶1；平均年齡36.9±17.9歲，中位數(shù)35歲，16-30歲青壯年患者構(gòu)成比最大（42.6%）P0.01。農(nóng)村患者69.4%，城市患者30.6%（P0.05）；治療費別醫(yī)保覆蓋率77%；結(jié)核性創(chuàng)面的原發(fā)病灶中，以周圍淋巴結(jié)結(jié)核為主要原發(fā)病灶，占47.7%（P0.01）；其中又以頸部淋巴結(jié)為主（88.4%）；73.6%的患者全身癥狀不明顯；影像學(xué)檢查提示為肺外結(jié)核病占44.3%，其中，骨關(guān)節(jié)結(jié)核占87.5%；PPD試驗陽性率為80.8％，創(chuàng)面分泌物結(jié)核分枝桿菌培養(yǎng)陽性率為43.8％，活檢病理檢查的陽性率為74.6％；確診平均時間為4.4月（中位數(shù)：3月），確診時間在6個月以上的患者中農(nóng)村居民占85.4%；出現(xiàn)創(chuàng)面的平均時間為8.6月（中位數(shù)：4月）；卡介苗接種率13.6%；抗結(jié)核藥物方面，規(guī)范化用藥率僅有24.7%；耐藥性方面，43.5%不同程度耐藥；耐單藥占26.8%，，耐多藥占16.7%；耐藥率最高的為異煙肼，其次為鏈霉素，耐藥率分別為16.7%和13.4%。創(chuàng)面特性方面，單發(fā)占86.6%，竇道型占54.4%。在治療方法中，傳統(tǒng)換藥治療占54.0%，治愈率4.7%，單純病灶清除術(shù)占20.9%，治愈率89.8%，病灶清除結(jié)合負壓封閉式引流技術(shù)占25.1%，治愈率94.9%；換藥治療組治愈率明顯低于手術(shù)組（P0.001），而單純病灶清除術(shù)與病灶清除結(jié)合負壓封閉式引流技術(shù)治療組在治愈率上并無顯著差異（P=0.265）。遠期療效方面，換藥治療組復(fù)發(fā)率13.4%，單純病灶清除術(shù)治療復(fù)發(fā)率3.3%，病灶清除結(jié)合負壓封閉式引流技術(shù)治療組無復(fù)發(fā)，換藥治療復(fù)發(fā)率遠高于其他治療方式（P0.01）。 結(jié)論：結(jié)核性創(chuàng)面有一定的發(fā)生率，并非罕見；農(nóng)村地區(qū)的男性青壯年患者發(fā)生率高，應(yīng)加強該群體人群的疾病防控；國家醫(yī)保政策尚未完全覆蓋結(jié)核性創(chuàng)面的診治；及時確診仍很困難；原發(fā)病灶以周圍淋巴結(jié)、骨關(guān)節(jié)結(jié)核為主；結(jié)核桿菌抗酸染色和培養(yǎng)陽性率不高，診斷時應(yīng)綜合PPD試驗、影像學(xué)檢查和創(chuàng)面特征，盡早行活體組織病理檢查；卡介苗接種率較低；內(nèi)科抗結(jié)核治療仍存在藥物使用不規(guī)范問題，規(guī)范化抗結(jié)核藥物使用率很低；抗結(jié)核藥物耐藥率高達43.5%；創(chuàng)面以單發(fā)為主；在治療方法上，傳統(tǒng)換藥保守治療治愈率較低，且復(fù)發(fā)率高；外科手術(shù)干預(yù)能顯著性提高治愈率，降低復(fù)發(fā)率。
[Abstract]:Objective: to investigate the epidemiological data, characteristics and rules of tuberculous wound in northwestern Beijing from 2010 to 2012, to fill in the blank in China, and to provide reliable data for later clinical research. Methods: from January 2010 to December 2012, the inpatients with tuberculous pulmonary wounds were collected from January 2010 to December 2012. Sex, age, nationality, household registration, treatment fee, type of tuberculosis, systemic symptoms were collected. The data of wound condition, diagnosis method, diagnosis time, treatment method and prognosis were analyzed statistically. Results: among the patients with extrapulmonary tuberculosis in the General staff General Hospital from 2010 to 2012, 235 cases had tuberculous wound, the incidence rate was 4.0%, the ratio of male to female was 1.448: 1, the average age was 36.9 鹵17.9 years old. The median age was 35 years old and 16-30 years old. The largest proportion of young and middle-aged patients was 42.6% P0.01.The rural patients were 69.44.The urban patients were 30.6% P0.05; the coverage rate of medical insurance was 77%; the primary lesion of tuberculous wound was peripheral lymph node tuberculosis. The percentage of patients with P0.01 was 47.7%, and the percentage of patients with cervical lymph nodes was 88.4%, and 73.6% of the patients had no obvious systemic symptoms, and the imaging examination showed that extrapulmonary tuberculosis accounted for 44.3%, of which, The positive rate of bone and joint tuberculosis was 80.8%, the positive rate of mycobacterium tuberculosis in wound secretion was 43.8%, the positive rate of biopsy and pathology was 74.6%, the average time of diagnosis was 4.4 months (median: March, the time of diagnosis was more than 6 months). Rural residents accounted for 85.4% of the patients, and the average time for wound appearance was 8.6 months (median: April); BCG vaccination rate was 13.6%; anti-tuberculosis drugs, The standardized drug use rate was only 24.7%; the drug resistance was 43.5%; the single drug resistance was 26.8%, and the multidrug resistance was 16.7.The highest drug resistance rate was isoniazid, followed by streptomycin, and the drug resistance rates were 16.7% and 13.40.The wound characteristic, In the treatment, 86.6% were single and 54.4% were sinus type. The cure rate of traditional dressing change treatment was 54.0, the cure rate was 4.7, the cure rate was 89.8, the cure rate was 89.8, and the cure rate was 94.94.The cure rate in the treatment group was significantly lower than that in the operation group (P 0.001), and the cure rate was 94.9 in the control group, while the cure rate in the control group was significantly lower than that in the operation group (89.8%). There was no significant difference in the cure rate between the treatment group and the treatment group with debridement combined with negative pressure closed drainage. The recurrence rate of the treatment group was 13.4%, and the recurrence rate of the treatment group was 3.3.The recurrence rate of the treatment group was significantly higher than that of the other treatment methods (P 0.01a), and no recurrence was found in the treatment group combined with negative pressure closed drainage. Conclusion: the incidence of tuberculous wounds is not rare, the incidence of male young and middle-aged patients in rural areas is high, the disease prevention and control of this group should be strengthened, the diagnosis and treatment of tuberculous wounds have not been completely covered by the national medical insurance policy. It is still very difficult to diagnose in time; the primary focus is peripheral lymph nodes, bone and joint tuberculosis. The positive rate of acid fast staining and culture of Mycobacterium tuberculosis is not high. The diagnosis should be combined with PPD test, imaging examination and wound characteristics. Histopathological examination in vivo was carried out as early as possible; the rate of BCG vaccination was low; the problem of nonstandard drug use was still existed in the treatment of internal medicine and the use rate of standardized antituberculous drugs was very low; the drug resistance rate of antituberculous drugs was as high as 43.5%; In the treatment, the cure rate of the traditional conservative treatment is low, and the recurrence rate is high; the surgical intervention can significantly improve the cure rate and reduce the recurrence rate.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R52

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