论文部分内容阅读
目的探讨家庭成员短程督导化疗对提高新涂阳肺结核患者治疗依从性的效果。方法采用流行病学实验性研究方法,家庭成员督导组(Ⅰ组)为实验组,村医督导组(Ⅱ组)为对照组。2006年6月—2007年4月,湖北省汉川市、宜都市、咸丰县、秭归县和建始县等5个县(市)登记的新涂阳肺结核病人为研究对象,用SAS软件随机分成2组,分别在家庭督导员或村医督导下实施短程督导化疗,比较2组治疗依从性和治疗效果;采用EpiData V3.02软件录入数据,EpiData AnalysisV2.0.3.129软件汇总分析,SAS 8.0软件进行x~2分析。结果5县(市)共登记新涂阳肺结核病人532例,其中Ⅰ组270例,Ⅱ组262例;Ⅰ组2、5、6个月末随访查痰率分别为95.9%,93.0%和92.6%,村医督导组为95.8%,89.7%和88.9%。Ⅰ组6个月末随访查痰率明显高于Ⅱ组(x~2=6.935 0,P<0.05)。Ⅰ组应服药24 300次,实际用药23 126次,规则服药率为95.2%。Ⅱ组应服药23 580次,实际服药22 045次,规则服药率为93.5%。Ⅰ组规则服药率明显高于Ⅱ组(x~2=63.163 6,P<0.01);Ⅰ组2个月末痰菌阴转率、治愈率分别为95.6%和92.6%。Ⅱ组2个月末痰菌阴转率、治愈率分别为95.4%和88.9%。2组2个月末痰菌阴转率和治愈率差异无统计学意义。结论在推广全程督导化疗有困难的边远山区和贫困农村,鼓励具有一定文化程度,经过培训的结核病患者家庭成员或志愿者担任家庭督导员,监督病人按时服药及复查,可以弥补医务人员督导治疗在部分农村地区应用的不足,从而提高患者治疗依从性和DOTS实施质量。
Objective To investigate the effect of short-range superficial chemotherapy of family members on improving the treatment compliance of patients with newly smear-positive pulmonary tuberculosis. Methods Epidemiological experimental research methods, family member supervision group (Ⅰ group) as experimental group, village medical supervision group (Ⅱ group) as control group. From June 2006 to April 2007, new smear-positive TB patients registered in 5 counties (cities) of Hanchuan, Yidu, Xianfeng, Zigui, and Jianshi were enrolled in this study. They were randomly divided into 2 groups, respectively, under the supervision of family supervisors or village doctors to implement short-course supervision and chemotherapy, treatment adherence and treatment of two groups were compared; using EpiData V3.02 software input data, EpiData AnalysisV2.0.3.129 software summary analysis, SAS 8.0 software Perform x ~ 2 analysis. Results A total of 532 new smear-positive pulmonary tuberculosis patients were enrolled in 5 counties (including 270 cases in group Ⅰ and 262 cases in group Ⅱ). The sputum acquisition rates at the end of 2,5,6 months in group Ⅰ were 95.9%, 93.0% and 92.6% , Village medical supervision group was 95.8%, 89.7% and 88.9%. At the end of 6 months, the sputum acquisition rate in group Ⅰ was significantly higher than that in group Ⅱ (x ~ 2 = 6.935 0, P <0.05). Group Ⅰ should take 24 300 times, the actual use of medicine is 23 126 times, and the regular medication rate is 95.2%. Group Ⅱ should take 23,580 times, the actual taking 22,045 times, the rule of taking rate was 93.5%. The prescription medication rate of group Ⅰ was significantly higher than that of group Ⅱ (x ~ 2 = 63.163 6, P <0.01). The sputum negative conversion rates at the end of two months in group Ⅰ were 95.6% and 92.6%, respectively. At the end of 2 months in group Ⅱ, the sputum negative conversion rate was 95.4% and 88.9% respectively. No significant difference was found in the rate of sputum negative conversion and the cure rate between the two groups at the end of 2 months. Conclusion In promoting remote monitoring and chemotherapy in remote mountainous areas and poor rural areas, family members or volunteers of tuberculosis patients with a certain educational level and training are encouraged to serve as household supervisors and to supervise the timely taking and review of patients so as to make up for the medical staff supervision and treatment. Inadequate application in some rural areas, thereby improving patient compliance with treatment and the quality of DOTS implementation.