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目的研究传染性肺结核病人诊断延迟有关影响因素,为提高涂阳病人发现率,控制结核病传播提供依据。方法设计肺结核流行病学个案调查表,选择5个县的结核病防治专科门诊,对门诊就诊的涂阳肺结核病人进行个案调查,并进行流行病学统计分析。结果148例涂阳病人,就诊延迟117例,就诊延迟率79.1%;确诊延迟84例,确诊延迟率56.8%;发现延迟101例,发现延迟率68.2%。年龄因素中,>60岁年龄组病人,诊断延迟率高于其他年龄组病人。性别因素中,女性高于男性;文化程度因素中,文盲高于其他学历。病人自己不在乎是未就诊的主要原因,乡镇卫生院结核病诊治水平是确诊延迟的重要原因。结论加强政府承诺,改善医疗卫生服务,加大结核病防治宣传力度,增强群体自我保健意识,是降低就诊延迟率的关键。规范和提高结核病诊治能力,落实结核病归口管理,是降低确诊延迟率和发现延迟率的关键。
Objective To study the influencing factors on the delay of diagnosis of infectious pulmonary tuberculosis patients and provide the basis for improving the detection rate of smear-positive patients and controlling the spread of tuberculosis. Methods To design a questionnaire on epidemiology of pulmonary tuberculosis, choose outpatient tuberculosis prevention and treatment clinics in five counties and carry out a case investigation on outpatients with smear positive pulmonary tuberculosis and carry out epidemiological statistical analysis. Results A total of 148 cases of smear positive patients were delayed in treatment for 117 cases and the treatment delay rate was 79.1%. The diagnosis delay was 84 cases and the definite diagnosis delay rate was 56.8%. The delay was found in 101 cases and the delay rate was found to be 68.2%. Age factors,> 60 age group of patients, the diagnostic delay rate higher than other age groups. Among the gender factors, women are higher than men; among literacy factors, illiteracy is higher than other academic qualifications. Patients do not care is not the main reason for treatment, diagnosis and treatment of tuberculosis in township hospitals is an important reason for the delay diagnosis. Conclusion Strengthening the government’s commitment to improve health care services, intensifying publicity on tuberculosis prevention and control and enhancing self-care awareness of the community are the keys to reducing the delay rate of visits. To standardize and improve the ability of diagnosis and treatment of tuberculosis and implement the centralized management of tuberculosis are the keys to reduce the rate of confirmed diagnosis and find the rate of delay.