论文部分内容阅读
目的对天津市近年来百日咳确诊病例的临床特征及诊断情况进行分析,提高医务人员对百日咳的认知。方法采用描述流行病学方法对在2010-2015年医院被动监测和2010-2012年社区症状主动监测中确诊的百日咳病例的临床症状进行分析。结果百日咳病例咳嗽时间中位数为14 d,咳嗽时间在14 d以下的占46.45%。25.63%的病例只表现为单纯的持续咳嗽,无其他特异的临床症状。具有阵发性痉挛性咳嗽(痉咳)症状的比例最多,占74.37%,其次为咳嗽后呕吐(呕吐)占32.95%,鸡鸣音、青紫、窒息的发生率均低于30.00%。医院监测的发生率均显著高于社区诊所(P<0.05)。1岁以下病例组出现痉咳、鸡鸣音、呕吐、青紫和窒息的发生率均为最高,15岁及以上病例组上述症状的发生率均为最低。未接种疫苗人群中痉咳、鸡鸣音、呕吐及青紫的发生率均高于已接种疫苗的人群(P<0.05)。社区诊所确诊病例在初次就诊时其误诊率高达95.16%,误诊为肺炎的比例最高,占50.00%。结论百日咳临床症状不典型,误诊率高,建议修订现行百日咳监测病例定义,提高百日咳的监测水平。
Objective To analyze the clinical features and diagnosis of pertussis diagnosed in Tianjin in recent years and to improve the cognition of medical staff on whooping cough. Methods Descriptive epidemiological methods were used to analyze clinical symptoms of whooping cough diagnosed in passive hospital surveillance between 2010-2015 and active community symptom monitoring in 2010-2012. Results The median cough time for pertussis cases was 14 days and 46.45% for cough times below 14 days. 25.63% cases showed only simple continuous cough, no other specific clinical symptoms. The patients with paroxysmal spasmodic cough (spastic cough) accounted for 74.37%, followed by cough with vomiting (vomiting) accounted for 32.95%, and the incidence of cocking, bruising and asphyxia were less than 30.00%. The incidence of hospital surveillance was significantly higher than that of community clinics (P <0.05). The incidence of spasmodic cough, cocking, vomiting, bruising and asphyxia were the highest in patients under 1 year of age, and the incidence of these symptoms was the lowest in patients aged 15 and over. The incidences of spasmodic cough, cocking, vomiting and bruising in unvaccinated persons were higher than those in vaccinated groups (P <0.05). The rate of misdiagnosis in community clinics was 95.16% at the time of initial visit, the highest was misdiagnosed as pneumonia, accounting for 50.00%. Conclusions Pertussis clinical symptoms are not typical, the misdiagnosis rate is high, it is recommended to amend the current definition of whooping cough monitoring and improve the level of pertussis monitoring.