论文部分内容阅读
目的探讨初次复治涂阳肺结核患者初治失败原因,为提高肺结核的治愈率及结核病的防治管理工作提供依据。方法收集2014年1月至2015年12月河北省胸科医院收治的第1次复治痰液或支气管肺泡灌洗液浓缩集菌抗酸染色阳性患者的临床病历资料,并对其进行分析。结果共收集病例267例,大部分为农民,123例患者合并其他疾病,其中合并糖尿病、慢性阻塞性肺疾病(COPD)最常见。53.6%患者有不规律治疗史,因主观因素自行停药患者占不规律治疗患者的71.2%,不能耐受药物不良反应者占23.2%,医源性原因占5.6%,药物不良反应以胃肠道反应、肝功能损伤为主,在结核分枝杆菌培养阳性患者中对抗结核药物任一耐药率为45.6%。结论主观因素、药物不良反应、医源性原因、合并基础疾病、细菌耐药、诊断错误是初次复治涂阴肺结核患者初治失败的主要原因。
Objective To investigate the causes of initial failure of patients with initial smear-positive pulmonary tuberculosis and to provide basis for improving the cure rate of tuberculosis and preventing and managing tuberculosis. Methods From January 2014 to December 2015, the clinical records of the first retreatment sputum or bronchoalveolar lavage fluid collected from Hebei Provincial Thoracic Hospital were collected and analyzed. Results A total of 267 cases were collected, most of them were farmers. 123 cases were complicated by other diseases, of which diabetes and chronic obstructive pulmonary disease (COPD) were the most common. 53.6% of the patients had irregular treatment history, 71.2% patients who discontinued due to subjective factors, 23.2% patients who could not tolerate adverse drug reactions, and 5.6% iatrogenic causes. Adverse drug reactions were based on gastrointestinal Road reaction, liver damage, mainly in patients with positive Mycobacterium tuberculosis resistance to any drug resistance rate of TB was 45.6%. Conclusions Subjective factors, adverse drug reactions, iatrogenic causes, combined underlying diseases, bacterial resistance and diagnostic errors are the main reasons for the initial failure of initial smear-negative pulmonary tuberculosis patients.