本文關(guān)鍵詞： 傷寒 副傷寒 疾病負(fù)擔(dān)　出處：《中國(guó)疾病預(yù)防控制中心》2010年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：利用云南玉溪市紅塔區(qū)傷寒、副傷寒高發(fā)地區(qū)綜合干預(yù)示范項(xiàng)目發(fā)熱監(jiān)測(cè)系統(tǒng)收集的信息,估計(jì)疾病負(fù)擔(dān),為開展綜合干預(yù),制定符合當(dāng)?shù)貙?shí)際情況的傷寒、副傷寒防治策略提供依據(jù)。方法：1.根據(jù)疾病疾病負(fù)擔(dān)估計(jì)金字塔模型,調(diào)查紅塔區(qū)的發(fā)熱病人就診率(A),就診病人采樣率(B),樣本檢測(cè)率(C),檢測(cè)方法靈敏度(D)和實(shí)驗(yàn)室確診病例報(bào)告率(E),計(jì)算倍數(shù),以此來(lái)校正監(jiān)測(cè)系統(tǒng)2008年5月1日至2009年4月30日一年內(nèi)的實(shí)驗(yàn)室確診病例數(shù)據(jù),估算當(dāng)?shù)氐陌l(fā)病水平。2.問(wèn)卷調(diào)查紅塔區(qū)副傷寒病人各項(xiàng)經(jīng)濟(jì)負(fù)擔(dān),估算分年齡組和全人群經(jīng)濟(jì)負(fù)擔(dān)。3.調(diào)查三家市級(jí)醫(yī)院住院病人抗生素使用及耐藥狀況,按是否使用耐藥抗生素分為耐藥組和非耐藥組,分析抗生素耐藥對(duì)疾病經(jīng)濟(jì)負(fù)擔(dān)的影響。結(jié)果：1.共報(bào)告實(shí)驗(yàn)室確診副傷寒病例354例,估計(jì)紅塔區(qū)副傷寒年總發(fā)病數(shù)為965例(745-2284例),年發(fā)病率為220.33/10萬(wàn)(170.1-521.47)。發(fā)病率最高的年齡組為15-44歲組(318.27/10萬(wàn)),最低的為0-4歲組(18.12/10萬(wàn))。2.紅塔區(qū)副傷寒造成的直接經(jīng)濟(jì)成本為2197222元(1694833-5201962),間接經(jīng)濟(jì)成本為229230元(177120～540540)。經(jīng)濟(jì)負(fù)擔(dān)為2426452元(1871953-5742502)。3.按是否使用過(guò)自身分離菌株耐藥的抗生素,119名住院病人被分成使用過(guò)耐藥抗生素組(耐藥組)和未使用過(guò)耐藥抗生素組(非耐藥組),耐藥組包括23例曾使用過(guò)1種耐藥抗生素的住院病例,和1例曾使用過(guò)2種耐藥抗生素的住院病例,共計(jì)24例。其中有12例使用的耐藥抗生素為克林霉素,占48%,有7例使用的為阿莫西林,占28%,有3例使用的為氨芐西林,占12%,有2例使用的為氧氟沙星,占8%,有1例使用的為頭孢噻肟,占4%。耐藥組住院時(shí)間中位數(shù)為14天,抗生素費(fèi)用中位數(shù)為1241.96元。其余95例未使用過(guò)耐藥抗生素的住院病例進(jìn)入非耐藥組,住院時(shí)間中位數(shù)為14天,抗生素費(fèi)用中位數(shù)為1365.02元。經(jīng)統(tǒng)計(jì)檢驗(yàn),耐藥組和非耐藥組在住院時(shí)間(Z=-0.7014,P=0.4831)和抗生素費(fèi)用(Z=-1.3212,P=0.1864)上的差異均無(wú)統(tǒng)計(jì)學(xué)意義。就此可以認(rèn)為紅塔區(qū)當(dāng)前的抗生素耐藥狀況對(duì)副傷寒疾病經(jīng)濟(jì)負(fù)擔(dān)沒有影響。結(jié)論：1.紅塔區(qū)為副傷寒高流行地區(qū),副傷寒發(fā)病率為220.33(170.10～521.47)。2.紅塔區(qū)副傷寒造成的經(jīng)濟(jì)負(fù)擔(dān)約為2426452元(1871953～5742502)。3.抗生素耐藥未對(duì)紅塔區(qū)副傷寒造成的直接負(fù)產(chǎn)生影響。
[Abstract]:Objective: to estimate the burden of disease by using the information collected by the fever surveillance system of the comprehensive intervention demonstration project in Hongta District, Yuxi City, Yunnan Province, in order to formulate typhoid fever in accordance with the local actual conditions. Paratyphoid fever control strategy provides the basis. Method: 1. Estimate the pyramid model according to the disease burden, To investigate the rate of fever patients in Hongta district, the sampling rate of patients, the rate of sample detection, the sensitivity of detection method and the rate of laboratory confirmed case report were investigated, and the multiple was calculated. This is used to correct the data of laboratory confirmed cases from May 1st 2008 to April 30th 2009 in the surveillance system, and to estimate the local incidence level .2. to investigate the economic burden of paratyphoid fever patients in Hongta District. To estimate the economic burden of age group and the whole population. 3. To investigate the antibiotic use and drug resistance of inpatients in three municipal hospitals, and divide them into drug resistance group and non resistance group according to whether to use resistant antibiotics or not. The effect of antibiotic resistance on the economic burden of disease was analyzed. Results: a total of 354 laboratory confirmed paratyphoid fever cases were reported. It is estimated that the total annual incidence of paratyphoid fever in Hongta District is 965 cases or 745-2284 cases, and the annual incidence rate is 220.33 / 100 000 100.1-521.470.The highest incidence rate is 318.27% -100 000 in the 15-44 age group, and the lowest is 18.12% -100 000 in the 0-4 age group. The direct economic cost caused by paratyphoid fever in Hongta District is 2197222. The indirect economic cost was 229230 yuan / L 177120 / 5405400.The economic burden was 2426452 yuan / 1873 / 5742502N / 3.119 inpatients were divided into two groups according to whether or not they had used their own isolated strains of antibiotics (drug resistance group) or not (drug resistant group). The drug resistance group included 23 inpatients who had used a drug resistant antibiotic. And a total of 24 patients who had used two antibiotic resistant antibiotics, 12 of them used clindamycin (48%), 7 cases used amoxicillin (28%), 3 cases used ampicillin (ampicillin). There were 2 cases using ofloxacin (8 cases) and 1 case of cefotaxime (4%). The median hospitalization time of drug resistant group was 14 days. The median cost of antibiotics was 1241.96 yuan. The other 95 inpatients who had not used antibiotic resistance entered the non-resistant group. The median hospitalization time was 14 days and the median cost of antibiotics was 1365.02 yuan. There was no significant difference between the drug resistant group and the non-resistant group in the hospitalization time of ZHU -0.7014 PnP (0.4831) and the antibiotic cost (ZTX -1.3212P0. 1864). Therefore, it can be concluded that the current situation of antibiotic resistance has no effect on the economic burden of paratyphoid disease in Hongta District. Conclusion: 1) the current situation of antibiotic resistance has no effect on the economic burden of paratyphoid fever. Hongta District is a paratyphoid high endemic area, The incidence of paratyphoid fever was 220.33 / 170.10 / 521.471.2.The economic burden caused by paratyphoid fever in Hongta district was about 2426452 yuan. The antibiotic resistance had no direct negative effect on paratyphoid fever in Hongta district.
【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】：2010
【分類號(hào)】：R516.3;R181.3

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