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背景:少数研究已经调查了医院内抗结核治疗不合作的有关因素。目的:确定巴西里约热内卢市住院病人不合作治疗的有关因素。设计:病例对照研究。方法:所有选入研究的病例均在一所教学医院开始抗结核治疗。不合作病例定义为病人中断治疗 60 天仍未返回治疗。经过培训的卫生保健人员采用标准表格对病例组和对照组病人进行随访调查。结果:从 1997 年 1 月 1 日至 12 月 31 日共登记结核病人 228 例。经过查阅病历,剔除了其中的 39 例。对其余 189 例病人进行家庭访视;46 例被确定为病例组,117 例为对照组。在家庭访视以前观察到的抗结核治疗不合作者 66(28.9%)例,家庭访视后不合作治疗者 46 例(20.2%)。多元分析结果显示,治疗不合作的最主要预测指标是:1)没有提供返回治疗卡(OR=0.099;95%CI:0.008-1.2,P=0.07), 2)病人感觉医生服务不周(OR=0.16;95%CI: 0.33-0.015,P=0.001),3)未测血压(OR=0.072; 95%CI:0.036-0.79,P=0.024)。 结论:该医院的抗结核治疗不合作相关因素表明,非常需要系统的结核病控制规划。预计实施此类规划,采取特殊方法,将有助于强化抗结核治疗的完成率和治愈率。何广学 译 贺晓新 校。
Background: A few studies have investigated the related factors of uncooperative anti-TB treatment in hospitals. Purpose: To determine the relevant factors of uncooperative treatment of inpatients in Rio de Janeiro, Brazil. Design: Case-control study. METHODS: All selected study cases started antituberculosis treatment at a teaching hospital. The case of uncooperative patients was defined as discontinuing treatment 60 days after discontinuation of treatment. Trained health-care workers conducted a follow-up survey of patients in the case and control groups using standard forms. Results: A total of 228 TB patients were registered from January 1 to December 31, 1997. After reviewing the medical records, 39 of them were excluded. Family visits were performed on the remaining 189 patients; 46 were identified as case group and 117 as control group. 66 (28.9%) cases of non-partner TB treatment observed prior to family visit and 46 (20.2%) uncooperative follow-up after family visit. Multivariate analysis showed that the most important predictors of treatment uncooperativeness were: 1) no treatment card was returned (OR = 0.099; 95% CI: 0.008-1.2, P = 0.07), 2) poor patient perception = 0.16; 95% CI: 0.33-0.015, P = 0.001), 3) Unmeasured blood pressure (OR = 0.072; 95% CI: 0.036-0.79, P = 0.024). Conclusion: The hospital’s anti-TB treatment non-cooperation related factors indicate that systematic TB control programs are highly needed. It is expected that the implementation of such programs will take special measures and will help to enhance the completion rate and cure rate of anti-tuberculosis treatment. He Guangxue translation He Xiao new school.