本文選題：肺結(jié)核　切入點(diǎn)：臨床表現(xiàn)　出處：《青島大學(xué)》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的肺結(jié)核(Pulmonary Tuberculosis, PTB)的臨床表現(xiàn)可因年齡、或隨時(shí)間推移有所變化,且各個(gè)癥狀之間存在的關(guān)系也有所不同。本文探討PTB患者就診臨床表現(xiàn)及變化,不同年齡PTB患者臨床表現(xiàn)特征及其相關(guān)關(guān)系,可為提高對(duì)PTB的認(rèn)識(shí)和制定有效防控措施提供科學(xué)依據(jù)。 方法收集山東省某七縣區(qū)2007～2010年P(guān)TB患者的有效病歷資料共14623份。由經(jīng)統(tǒng)一培訓(xùn)的工作人員輸入病歷內(nèi)容到醫(yī)院病歷管理系統(tǒng),再導(dǎo)出到數(shù)據(jù)庫(kù)進(jìn)行統(tǒng)計(jì)分析。收集的資料內(nèi)容包括患者的基本情況,如年齡、性別、職業(yè)等；臨床表現(xiàn),如咳嗽、咳痰、發(fā)熱、乏力、咯血、胸痛、食欲減退和盜汗等。 結(jié)果PTB患者年齡中位數(shù)為51歲,男女比例為2.46：1,以農(nóng)民為主(91.3%)。分析顯示,PTB患者就診時(shí)多有咳嗽癥狀,占97.2%；4年來(lái),咳痰和咯血比率呈明顯升高趨勢(shì)(p均小于0.05),咳嗽、發(fā)熱、乏力、食欲減退比率則有明顯降低趨勢(shì)(p均小于0.05)；性別比較顯示,男性咳嗽、咳痰、咯血和胸痛出現(xiàn)比率明顯高于女性(p均小于0.05)�；颊咧型瑫r(shí)出現(xiàn)咳嗽、咳痰(咳嗽+咳痰)的發(fā)生率為58.72%,將其他的臨床癥狀和咳嗽+咳痰進(jìn)行聯(lián)合分析,發(fā)現(xiàn)咳嗽+咳痰伴隨乏力為39.22%；次之為咳嗽+咳痰伴隨發(fā)熱,占37.76%。不同年齡患者的臨床表現(xiàn)不同,中老年組(51～60歲)咳嗽、發(fā)熱、乏力和食欲減退癥狀的性別標(biāo)化率顯著大于青年組(21-30歲)(p0.05)；兩組之間的咳嗽程度有顯著性差異(p0.05),青年組以咳嗽時(shí)間3～8周為最多(40.5%),而中老年組以咳嗽時(shí)間8周為最多(50.0%)；咳嗽合并其他臨床表現(xiàn)發(fā)現(xiàn)分別與發(fā)熱、胸痛、乏力和食欲減退的組合在兩年齡高峰組之間均有顯著性差異(p0.05),中老年組的標(biāo)化率均顯著多于青年組。咳嗽與其他臨床表現(xiàn)的關(guān)聯(lián)性分析發(fā)現(xiàn),咳嗽分別與發(fā)熱(r=0.146)、乏力(r=0.138)、咳痰(r=0.132)、盜汗(r=0.096)、食欲減退(r=0.096)以及咯血(r=0.018)之間存在關(guān)聯(lián)性(p0.05)。 結(jié)論P(yáng)TB患者中以男性居多,且更易出現(xiàn)各種臨床癥狀�；颊呔驮\時(shí)多有長(zhǎng)期慢性咳嗽,應(yīng)重視咳嗽、咳痰等臨床特征及變化,提高對(duì)于這幾種臨床表現(xiàn)相關(guān)性的認(rèn)識(shí),避免誤診漏診,咳嗽、咳痰、發(fā)熱、乏力這幾種聯(lián)合癥狀的出現(xiàn)可為早期發(fā)現(xiàn)患者起到預(yù)警作用,為篩查可疑肺結(jié)核人群提供依據(jù)。青壯年和中老年對(duì)PTB來(lái)說(shuō)是更易感的階段,但是應(yīng)根據(jù)各自的臨床表現(xiàn)區(qū)別對(duì)待,此外,老年人各種癥狀的發(fā)生情況較青年人更嚴(yán)重,故應(yīng)提高對(duì)老年人的防護(hù)措施,為預(yù)防控制肺結(jié)核提供策略。
[Abstract]:Objective the clinical manifestations of pulmonary tuberculosis tuberculosis (PTBs) may vary with age or over time, and the relationship between the symptoms is different. The clinical manifestations of PTB patients of different ages and their correlation can provide scientific basis for improving the understanding of PTB and making effective prevention and control measures. Methods A total of 14623 valid medical records of PTB patients were collected from seven counties and regions of Shandong Province from 2007 to 2010. The contents of medical records were inputted into the hospital medical records management system by unified training staff. The data collected include the basic information of the patients, such as age, sex, occupation, clinical manifestations, such as cough, expectoration, fever, fatigue, hemoptysis, chest pain, loss of appetite and night sweating. Results the median age of patients with PTB was 51 years old, the ratio of male to female was 2.46: 1, and 91.3% of them were mainly farmers. The analysis showed that the patients with PTB had cough symptoms (97.2%), and the rates of expectoration and hemoptysis were significantly higher than 0.05%, cough, fever, fatigue in the last 4 years, there was a significant increase in the rate of expectoration and hemoptysis. The incidence of cough, expectoration, hemoptysis and chest pain in males were significantly higher than those in females. The incidence of expectoration (cough expectoration) was 58.72. The combined analysis of other clinical symptoms and cough expectoration showed that cough expectoration associated with asthenia was 39.22, followed by cough expectoration with fever, The clinical manifestations of patients of different ages were different. The middle and old age group had cough and fever. The sex-standardized rate of symptoms of fatigue and anorexia was significantly higher than that of the young group (21-30 years old), the cough degree of the two groups was significantly different (p0.05), the cough time of the young group was 38-week and the most of the aged group was 40.5%, while that of the middle-aged group was the most. Cough combined with other clinical manifestations were found to be associated with fever, The combination of chest pain, fatigue and anorexia was significantly different between the two year old peak group (p 0.05), and the standardized rate of the middle and old group was significantly higher than that of the young group. The correlation between cough and other clinical manifestations was found. There was a correlation between cough and fever (0.146), fatigue (0.138), phlegm (0.132), night sweating (0.096), hypoappetite (r0.096) and hemoptysis (0.018). Conclusion the majority of PTB patients are male, and they are more likely to appear various clinical symptoms. Patients with chronic cough should pay attention to the clinical characteristics and changes of cough, expectoration and so on, so as to improve the understanding of the correlation between these clinical manifestations. Avoiding misdiagnosis and misdiagnosis, cough, expectoration, fever and fatigue may serve as a warning for early detection of patients and provide evidence for screening suspected pulmonary tuberculosis. Young and middle-aged people are more susceptible to PTB. However, different treatment should be made according to their clinical manifestations. In addition, the occurrence of various symptoms in the elderly is more serious than that in the young, so the protective measures for the elderly should be improved to provide strategies for the prevention and control of tuberculosis.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R521

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