發(fā)布時間：2018-06-18 17:52

  本文選題：傷寒 + 副傷寒��； 參考：《昆明醫(yī)科大學(xué)》2014年碩士論文

【摘要】：研究目的 通過在云南省傷寒副傷寒高發(fā)地區(qū)開展診斷現(xiàn)況及危險因素研究,了解各級醫(yī)療機構(gòu)傷寒副傷寒診斷現(xiàn)況,弄清傷寒副傷寒真實發(fā)病水平,了解云南省傷寒副傷寒發(fā)病危險因素,為傷寒副傷寒防控提供科學(xué)依據(jù)。 研究方法 1.診斷現(xiàn)況調(diào)查：采用橫斷面研究方法,選擇云南省傷寒副傷寒發(fā)病率較高的5個縣(市、區(qū)),對轄區(qū)的州(市)級、縣(市、區(qū))級、鄉(xiāng)鎮(zhèn)級醫(yī)療機構(gòu)進行調(diào)查。采用自行設(shè)計的調(diào)查問卷,到相關(guān)科室收集傷寒副傷寒實驗室檢測、診斷、報告、治療等資料。采用率、構(gòu)成比等指標(biāo)描述傷寒副傷寒的診斷現(xiàn)況。 2.危險因素調(diào)查：采用病例對照研究方法,于2013年6月～10月,選擇云南省傷寒副傷寒發(fā)病率較高的彌勒縣,開展以社區(qū)和鄉(xiāng)鎮(zhèn)為基礎(chǔ)的傷寒副傷寒發(fā)病危險因素調(diào)查,病例和對照以1：3配比。病例為彌勒縣人民醫(yī)院血培養(yǎng)陽性的確診病例,對照為與病例在同一自然村、社區(qū)、班級,以年齡、性別、職業(yè)匹配的健康者。用自行設(shè)計的問卷對病例和對照進行調(diào)查。數(shù)據(jù)單因素分析采用x2檢驗或秩和檢驗進行,多因素分析采用Cox回歸進行。 研究結(jié)果 1.診斷現(xiàn)況調(diào)查：調(diào)查20家醫(yī)療機構(gòu),418例傷寒副傷寒報告病例,其中181例病例診斷與報告相符,診斷符合率為43.30%。州(市)級、縣(市、區(qū))級、鄉(xiāng)鎮(zhèn)級醫(yī)院傷寒副傷寒診斷符合率依次為42.86%、47.02%、28.57%。紅河州、版納州、保山市的診斷符合率依次為53.39%、46.38%、20.35%,差異均有統(tǒng)計學(xué)意義。 各級醫(yī)療機構(gòu)診斷傷寒副傷寒病例的部門主要為內(nèi)科門診,占60.00%。所調(diào)查的20家醫(yī)療機構(gòu)均開展了傷寒副傷寒的相關(guān)實驗室檢測。20家醫(yī)療機構(gòu)均開展血常規(guī)檢測,但鄉(xiāng)鎮(zhèn)衛(wèi)生院以三分類法為主(87.50%)；19家醫(yī)療機構(gòu)開展了肥達氏檢測,以玻片法為主(70.00%),檢測試劑來自同一廠家；所有鄉(xiāng)鎮(zhèn)衛(wèi)生院均不能開展血培養(yǎng)。州(市)級、縣(市、區(qū))級醫(yī)院除1家外均能開展血培養(yǎng)檢測,但血培養(yǎng)瓶的廠家不同。 臨床醫(yī)生對傷寒副傷寒的診斷主要依靠流行病學(xué)史、臨床表現(xiàn)、化驗結(jié)果,少部分憑個人臨床經(jīng)驗。診斷標(biāo)準(zhǔn)掌握程度有差異,其中27.78%的醫(yī)務(wù)人員認為流行病學(xué)史包括最近30天有被蚊蟲叮咬史；24.07%的醫(yī)務(wù)人員認為臨床表現(xiàn)包括咳嗽、流涕、呼吸困難。對肥達氏檢測結(jié)果的正確判斷存在差異,其中50.00%的醫(yī)務(wù)人員認為檢測結(jié)果包括肥達反應(yīng)“0”抗體凝集效價≥1：160,“H”抗體凝集效價≥1：80,鄉(xiāng)鎮(zhèn)衛(wèi)生院的醫(yī)務(wù)人員回答錯誤率高于州(市)級和縣(市、區(qū))級醫(yī)院。 查閱紅河州172例傷寒副傷寒住院病人的病歷資料,報告類型以臨床診斷病例為主(占65.70%),血常規(guī)檢測167例(97.09%),肥達氏檢測156例(90.70%),肥達氏檢測陽性率為27.56%,血培養(yǎng)檢測119例(69.19%),血培養(yǎng)陽性率為47.90%。對153例發(fā)熱病人的癥狀進行統(tǒng)計分析,有頭痛(49.67%)、全身不適(37.91%)、畏寒(30.07%)、咳嗽(27.45%)、厭食(24.84%)等癥狀,以及中毒性心肌炎(14.38%)、中毒性肝炎(12.42%)、支氣管炎／肺炎(11.76%)等并發(fā)癥。37.79%的病人治愈出院,僅27.34%的病人在住院期間采取了相應(yīng)的隔離措施。94.19%的病人使用抗生素治療,64.20%病例進行了藥敏試驗,59.62%的病人使用的抗生素與藥敏試驗結(jié)果相符。 2.危險因素調(diào)查：共調(diào)查200人,其中病例50人、對照150人。病例組和對照組在性別、年齡、民族、職業(yè)等方面均衡可比(P0.05)。50例病例均為甲型副傷寒病例,所有病例均發(fā)熱,并伴有頭痛、乏力、畏寒、全身酸痛等癥狀,且均為住院病例,平均住院天數(shù)為(8.28±4.02)天。 單因素分析篩選可疑危險因素：平時在外吃早餐,此前2周早餐吃過米線,此前2周早餐吃過卷粉,早餐中加生蔥,平時中晚餐在外就餐頻率,平時中晚在外就餐點,此前2周在外吃過中晚餐,此前2周在外吃過冷飲或宵夜8個因素差異有統(tǒng)計學(xué)意義。 多因素Cox回歸分析：早餐吃卷粉(OR=11.12,95%CI：1.39-88.75),早餐中加生蔥(OR=15.55,95%CI：1.37-176.87),近2周在外吃中晚餐(OR=5.68,95%CI：1.02-31.62)是彌勒縣甲型副傷寒發(fā)病的危險因素。 結(jié)論 云南省傷寒副傷寒診斷符合率總體較低,尤其是鄉(xiāng)鎮(zhèn)衛(wèi)生院。血培養(yǎng)的結(jié)果表明局部地區(qū)傷寒副傷寒高發(fā)。鄉(xiāng)鎮(zhèn)衛(wèi)生院在醫(yī)務(wù)人員數(shù)量、職稱、學(xué)歷、工作經(jīng)驗以及設(shè)備等方面與州(市)、縣(市、區(qū))級醫(yī)院相比差距大。醫(yī)院對傷寒副傷寒診斷、治療不規(guī)范,療程不足,病人隔離措施和出院標(biāo)準(zhǔn)不嚴格。甲型副傷寒沙門菌已是云南省某些區(qū)域流行的優(yōu)勢菌群；在外就餐,吃生冷食物和食物中加生佐料是云南省部分地區(qū)甲型副傷寒發(fā)病危險因素。
[Abstract]:Purpose of study

The present situation and risk factors of typhoid paratyphoid in the typhoid and paratyphoid region of Yunnan Province were studied . The diagnostic status of typhoid paratyphoid and paratyphoid cold in various medical institutions was investigated . The real morbidity level of typhoid paratyphoid was found . The risk factors of typhoid paratyphoid in Yunnan Province were investigated .

Research Methods

1 . Investigation on the status of diagnosis : A cross - sectional study was used to select five counties ( cities , districts ) with higher incidence of typhoid and paratyphoid in Yunnan Province , and investigated the state ( city ) , county ( city , district ) and township level medical institutions in the district .

2 . Investigation of risk factors : A case - control study was used to investigate the risk factors of typhoid paratyphoid fever in Yunnan Province from June to October 2013 . The case was a case with positive diagnosis of typhoid paratyphoid in the same natural village , community , class , age , gender and occupation .

Results of the study

1 . Investigation of the status of diagnosis : investigation of 20 medical institutions and 418 cases of typhoid paratyphoid fever , of which 181 cases were diagnosed and reported , the diagnostic accuracy rate was 43.30 % . The diagnostic accuracy rate of typhoid paratyphoid was 42.86 % , 47.02 % and 28.57 % in the county ( city , district ) and township level hospitals . The diagnostic accuracy rate of the disease in Honghe Prefecture , Indiana and Baoshan was 53.39 % , 46.38 % and 20.35 % , respectively .

The department of the diagnosis of typhoid paratyphoid in medical institutions at all levels is mainly internal outpatient , accounting for 60.00 % . All the 20 medical institutions surveyed have carried out the related laboratory tests of typhoid and paratyphoid fever . All 20 medical institutions carry out routine tests of blood routine , but the township hospitals are mainly classified by three classifications ( 87.50 % ) ;
In 19 medical institutions , the test was carried out on the basis of slide method ( 70.00 % ) , and the test reagents were from the same manufacturer ;
Blood culture can not be carried out in all township hospitals . Blood culture test can be carried out except 1 in the county ( city ) and county ( city , district ) level hospitals , but the manufacturers of blood culture bottles are different .

The diagnosis of typhoid paratyphoid mainly depends on the history of epidemiology , clinical manifestation , test results , and the rare part by personal clinical experience . The diagnostic standard is different , of which 27.78 % of medical personnel think the history of epidemiology includes the last 30 days with the history of mosquito bite ;
24.07 % of medical personnel considered the clinical manifestation including cough , watery nasal discharge and dyspnea . 50.00 % of medical personnel considered that the results of detection included the agglutination titer 鈮，

本文編號：2036365