本文選題：布魯氏菌病 + 門診病例��； 參考：《吉林大學(xué)》2013年碩士論文

【摘要】：目的： 了解當(dāng)前布病患者人口學(xué)特征、流行病史、臨床表現(xiàn)、治療過程等情況，探索布病治療效果的影響因素，為改進(jìn)預(yù)防措施和治療方案提供依據(jù)。方法： 在吉林省地方病第一防治研究所布病門診選擇2013年吉林省確診布病病例作為研究對(duì)象。實(shí)驗(yàn)室檢測(cè)方法為平板凝集試驗(yàn)和試管凝集試驗(yàn)。治療方案分別為“頭孢曲松鈉+阿奇霉素”和“利福平+多西環(huán)素”。采用自行設(shè)計(jì)的調(diào)查問卷，首診詢問收集基本信息、臨床癥狀等資料，2個(gè)治療療程和確診后90天分別采用電話隨訪的方式共隨訪3次。療效判定分為治愈、基本治愈、好轉(zhuǎn)、無(wú)效。采用Epidata3.0軟件數(shù)據(jù)錄入，SPSS17.0統(tǒng)計(jì)軟件進(jìn)行描述與分析。 結(jié)果： 1．一般人口學(xué)特征 共隨訪113人，分布在吉林省9個(gè)市（州）的29個(gè)縣（區(qū)），男性90人，女性23人；年齡41.84±12.32歲；已婚占92.04%，漢族93.81%；小學(xué)及以下較多（57.52%），農(nóng)民為主（81.42%），每年家庭收入多為5萬(wàn)元以下（56.64%）。 2．患者就診臨床分期與分型 患者發(fā)病-首次就診時(shí)間間隔14（6,30.5）天，發(fā)病-確診時(shí)間間隔28（11,60）天，首次就診-確診時(shí)間間隔1（1,9.5）天。被調(diào)查者急性期占88.50%，亞急性期11.50%；臨床分型為內(nèi)臟型占21.24%，骨關(guān)節(jié)型63.72%。 3．臨床表現(xiàn)和體力勞動(dòng)能力評(píng)分結(jié)果 首診時(shí)，被調(diào)查者中28.32%出現(xiàn)寒戰(zhàn)，83.19%發(fā)熱，56.64%多汗，27.43%肌肉酸痛，73.45%乏力，15.93%頭暈，35.40%頭痛，76.99%骨關(guān)節(jié)痛。體力（勞動(dòng)能力）進(jìn)行評(píng)分結(jié)果1分占61.95%，2分占31.86%，3分占2.65%和4分占3.54%。 第一療程隨訪時(shí)，5.31%發(fā)熱，12.39%多汗，8.85%出現(xiàn)肌肉酸痛，40.71%乏力，3.54%頭暈，5.31%頭痛，52.21%骨關(guān)節(jié)痛。體力（勞動(dòng)能力）進(jìn)行評(píng)分情況為0分占15.93%，1分占73.45%，2分占8.85%，3分占1.77%。 第二療程隨訪時(shí)，0.00%出現(xiàn)寒戰(zhàn)，0.00%發(fā)熱，2.65%多汗，1.77%出現(xiàn)肌肉酸痛，22.12%乏力，1.77%頭暈，0.88%頭痛，17.70%骨關(guān)節(jié)痛。體力（勞動(dòng)能力）進(jìn)行評(píng)分情況為0分占44.25%，1分占52.21%，2分占2.65%，3分占0.88%。 確診后90天隨訪時(shí)，5.31%發(fā)熱，2.65%多汗，1.77%出現(xiàn)肌肉酸痛，8.85%乏力，，1.77%頭暈，1.77%頭痛，7.08%骨關(guān)節(jié)痛。體力（勞動(dòng)能力）進(jìn)行評(píng)分情況為0分占78.76%，1分占18.58%，2分占1.77%，3分占0.88%。 將首診與確診后90天的體力勞動(dòng)能力評(píng)分進(jìn)行兩樣本秩和檢驗(yàn)，結(jié)果差別有統(tǒng)計(jì)學(xué)意義（P0.001），可見經(jīng)治療，患者體力勞動(dòng)能力有所恢復(fù)。 4．流行病學(xué)結(jié)果 首診時(shí)，38.05%的患者經(jīng)常打掃圈舍，7.96%經(jīng)常屠宰，36.28%經(jīng)常接羔，18.58%經(jīng)常免疫牲畜，0.88%經(jīng)常獸醫(yī)治療，24.78%經(jīng)常皮毛收購(gòu)，2.65%經(jīng)常乳制品加工，2.65%經(jīng)常肉制品加工，13.27%經(jīng)常牲畜運(yùn)輸，14.16%經(jīng)常幼羔放室內(nèi)飼養(yǎng)。 第一療程，11.50%患者經(jīng)常打掃圈舍，2.65%經(jīng)常屠宰，10.62%經(jīng)常接羔，2.65%經(jīng)常免疫牲畜，0.00%經(jīng)常獸醫(yī)治療，6.19%經(jīng)常皮毛收購(gòu)，0.88%經(jīng)常乳制品加工，0.88%經(jīng)常肉制品加工，4.42%經(jīng)常牲畜運(yùn)輸，2.65%經(jīng)常幼羔放室內(nèi)飼養(yǎng)。 第二療程，8.85%的患者經(jīng)常打掃圈舍，2.65%經(jīng)常屠宰，8.85%經(jīng)常接羔，0.88%經(jīng)常免疫牲畜，0.00%經(jīng)常獸醫(yī)治療，4.42%經(jīng)常皮毛收購(gòu)，0.88%經(jīng)常乳制品加工，5.31%經(jīng)常牲畜運(yùn)輸，0.88%經(jīng)常幼羔放室內(nèi)飼養(yǎng)。 確診后90天，11.50%的患者經(jīng)常打掃圈舍，3.54%經(jīng)常屠宰，10.62%經(jīng)常接羔，3.54%經(jīng)常免疫牲畜，0.00%經(jīng)常獸醫(yī)治療，7.08%經(jīng)常皮毛收購(gòu)，0.88%經(jīng)常乳制品加工，0.00%經(jīng)常肉制品加工，7.08%經(jīng)常牲畜運(yùn)輸，1.77%經(jīng)常幼羔放室內(nèi)飼養(yǎng)。 5．治療效果觀察 總體治療效果76.99%治愈，9.73%基本治愈，12.39%好轉(zhuǎn)，0.88%無(wú)效。20.35%的患者出現(xiàn)了不良反應(yīng)。26人接受了方案一（多西環(huán)素+利福平）治療，76.92%治愈，11.54%基本治愈，11.54%好轉(zhuǎn)，0.00%無(wú)效。38.46%出現(xiàn)不良反應(yīng)。87例接受了方案二（頭孢曲松鈉+阿奇霉素）治療，結(jié)果77.01%治愈，9.20%基本治愈，12.64%好轉(zhuǎn)，1.15%無(wú)效。14.94%出現(xiàn)不良反應(yīng)。 6．影響療效因素分析 對(duì)基本情況、臨床表現(xiàn)等4個(gè)方面20個(gè)可能影響患者療效的因素進(jìn)行t檢驗(yàn)、χ~2檢驗(yàn)等單因素分析，結(jié)果患者年齡（30-49歲）是保護(hù)因素、首診體力勞動(dòng)能力評(píng)分（4分）和治療期間從事高危活動(dòng)是危險(xiǎn)因素。結(jié)論： 隨訪在督導(dǎo)布病患者治療和健康教育方面具有優(yōu)勢(shì)。 頭孢曲松鈉+阿奇霉素治療布病的短期療效為治愈率77.01%，不良反應(yīng)率14.94%。 患者年齡（30-49歲）是影響布病療效（治愈率）的保護(hù)因素、首診體力勞動(dòng)能力評(píng)分（4分）和治療期間從事高�；顒�(dòng)是危險(xiǎn)因素。
[Abstract]:Objective:
To understand the demographic characteristics, epidemic history, clinical manifestation, and treatment process of the current disease patients, to explore the influencing factors of the treatment effect of the disease, and to provide the basis for improving the preventive measures and treatment plans.
In the outpatient clinic of the Jilin Institute for the prevention and treatment of endemic diseases, the disease outpatient of Jilin province was selected as the research object in 2013. The laboratory test method was the flat agglutination test and the test tube agglutination test. The treatment scheme was "ceftriaxone sodium + azithromycin" and "rifampin + doxycycline". A self-designed questionnaire was used. The first consultation to collect basic information, clinical symptoms and other data, 2 treatment courses and 90 days after the diagnosis were followed up by telephone 3 times, the curative effect was divided into cure, basic cure, improvement, ineffective. Epidata3.0 software data entry, SPSS17.0 statistical software into the description and analysis.
Result:
1. general demographic characteristics
A total of 113 people were followed up in 29 counties (districts) of 9 cities (States) in Jilin Province, 90 men and 23 women, 41.84 + 12.32 years old, 92.04% married and 93.81% in the Han nationality. Primary and below (57.52%), and farmers were mainly (81.42%), and the annual household income was less than 50 thousand (56.64%).
Clinical staging and classification of 2. patients
The first time interval was 14 (6,30.5) days, the onset time interval was 28 (11,60) days, the first diagnosis time interval was 1 (1,9.5) days, the acute period was 88.50%, the subacute period was 11.50%, the clinical classification was 21.24% of visceral type, and 63.72 of bone joint type.
3. clinical manifestation and physical labor ability score
At the first visit, 28.32% of the subjects were chill, 83.19% fever, 56.64% perspiration, 27.43% muscle soreness, 73.45% fatigue, 15.93% dizziness, 35.40% headache, and 76.99% bone and joint pain. The scores of physical strength (labor ability) were 61.95%, 2, 31.86%, 3, 2.65%, and 3.54%..
During the first course of the follow-up, 5.31% fever, 12.39% sweats, 8.85% muscle soreness, 40.71% fatigue, 3.54% dizziness, 5.31% headache, 52.21% bone joint pain. The physical (labor ability) score was 0, 1, 73.45%, 2, 8.85%, and 3 accounted for 1.77%..
During the second course of follow-up, 0% had chills, 0% fever, 2.65% sweats, 1.77% muscle soreness, 22.12% fatigue, 1.77% dizziness, 0.88% headache, 17.70% bone and joint pain. The score of physical strength (labor ability) was 0 and 44.25%, 1 points accounted for 52.21%, 2 accounted for 0.88%..
90 days after the diagnosis, 5.31% fever, 2.65% perspiration, 1.77% muscle soreness, 8.85% fatigue, 1.77% dizziness, 1.77% headaches, and 7.08% bone and joint pain. The physical (labor ability) score was 0, 78.76%, 1, 18.58%, 2, 1.77%, and 0.88%.
The physical labor ability score of the first 90 days after the first diagnosis and 90 days after the diagnosis was tested with a two sample rank sum test. The difference was statistically significant (P0.001), and the physical labor ability of the patients was recovered.
4. epidemiological results
At the first visit, 38.05% of the patients often clean up the enclosure, 7.96% often slaughtered, 36.28% regular lambs, 18.58% often immunized livestock, 0.88% regular veterinary treatment, 24.78% regular fur purchase, 2.65% regular dairy processing, 2.65% regular meat processing, 13.27% regular livestock transportation, 14.16% often young lambs and indoor rearing.
The first course, 11.50% patients often clean the enclosure, 2.65% often slaughtered, 10.62% regular lambing, 2.65% often immune to livestock, 0% regular veterinary treatment, 6.19% often fur purchase, 0.88% regular dairy processing, 0.88% regular meat processing, 4.42% regular livestock transportation, 2.65% often young lambs indoor breeding 2.65%.
Second courses, 8.85% of the patients often clean up the enclosure, 2.65% often slaughtered, 8.85% regular lambing, 0.88% often immune to livestock, 0% regular veterinary treatment, 4.42% often fur purchase, 0.88% regular dairy processing, 5.31% regular livestock transportation, 0.88% often young lambs indoor feeding.
90 days after the diagnosis, 11.50% of the patients often clean up the enclosure, 3.54% often slaughtered, 10.62% regular lambs, 3.54% often immunized livestock, 0% regular veterinary treatment, 7.08% regular fur purchase, 0.88% regular dairy processing, 0% regular meat processing, 7.08% regular livestock transportation, 1.77% regular young lambs kept indoors.
Observation on the effect of 5. treatment
The overall treatment effect was 76.99% cured, 9.73% basically cured, 12.39% improved, 0.88% ineffective.20.35% patients had adverse reactions,.26 people were treated with regimen 1 (doxycycline + rifampin), 76.92% cured, 11.54% basic cure, 11.54% improved, 0% ineffective.38.46% ungood reaction to receive scheme two (ceftriaxone sodium + azithromycin) Treatment, the results were 77.01% cured, 9.20% basically cured, 12.64% improved, 1.15% invalid.14.94% adverse reactions.
6. influence factors analysis
4 aspects of the basic situation and clinical manifestation were 20 factors that could affect the patient's efficacy by t test, X ~2 test and other single factor analysis. The results showed that the age of the patients (30-49 years old) was a protective factor. The first diagnosis of physical labor ability score (4 points) and the high-risk activities during the treatment were the risk factors.
Follow up has an advantage in supervising the treatment and health education of brucellosis patients.
The short-term curative effect of ceftriaxone sodium plus azithromycin in the treatment of brucellosis was 77.01% and the adverse reaction rate was 14.94%.
The age of the patient (30-49 years old) is a protective factor affecting the curative effect (cure rate) of the disease. The first diagnosis of physical labor ability (4 points) and the high risk activities during the treatment are the risk factors.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R516.7

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