论文部分内容阅读
1997、1998年对云南省、山西省、贵州省、广西壮族自治区、新疆维吾尔自治区报告的187例急性弛缓性麻痹（AFP）病例进行了神经学诊断方面的追踪调查，同时对监测工作的质量予以评价．诊察结果为；临床脊髓灰质炎（脊灰）的24例，其余为其它麻痹性疾病。麻痹性疾病的发病率存在着地理性差异，在中国南方地区非脊灰脊髓炎（脊髓炎）病例很多，而西北地区脊髓炎较少，则以格林-巴利综合征（GBS）为多．在追踪临床诊断为脊灰的24例中，仅有3例接脊灰病例报告；在当地诊断为脊灰23例中，追踪诊断为脊灰的仅3例。本次追踪调查在AFP病例监测方面发现以下问题：①对有无后遗症的判定不正确；②由于在家中采集粪便标本，使得粪便标本不能妥善保存；③发病日期的记录不正确等。另外，通过从这些AFP病例中分离出的脊灰病毒均为疫苗株可以判定，存在着在采集粪便标本前给患者服用脊灰疫苗（OPV）的情况。建议省专家诊断小组在对病例进行最终诊断时，有必要慎重地研究临床经过。特别是对高危病例应亲自诊察。对病例的调查不能仅由县级人员进行，应争取地区级和省级神经学专家的协助。在判定临床经过时，不能仅依赖个案调查表，也应查阅医院的病案记录．另外，为防止因主观因素影响到采集粪便标本质量，造成实验室误诊
In 1997 and 1998, 187 cases of acute flaccid paralysis (AFP) cases reported in Yunnan Province, Shanxi Province, Guizhou Province, Guangxi Zhuang Autonomous Region and Xinjiang Uygur Autonomous Region were investigated for neurological diagnosis, and the quality of the monitoring work was also Evaluation. The results of the examination were: 24 cases of clinical polio (polio) and the rest were other paralytic diseases. There are geographical differences in the incidence of paralytic diseases. There are many cases of non-poliomyelitis (myelitis) in southern China, while there are fewer cases of myelitis in northwestern China. Guillain-Barre Syndrome (GBS) is more. Of the 24 cases that track clinically diagnosed polio, only 3 cases were reported with polio cases; of the 23 cases with local polio diagnoses, only 3 were polio cases. This follow-up investigation found the following problems in the monitoring of AFP cases: 1 Incorrect determination of the presence or absence of sequelae; 2 The collection of faecal specimens at home prevented proper preservation of fecal specimens; 3 Inaccurate recording of date of onset. In addition, it can be determined that all the polioviruses isolated from these AFP cases are vaccine strains, and there is a case where a polio vaccine (OPV) is administered to patients before the fecal samples are collected. It is recommended that the provincial expert diagnostic team carefully examine the clinical course when making final diagnosis of the case. Especially for high-risk cases should be personally examined. The investigation of cases cannot be performed only by county-level personnel, and regional- and provincial-level neurological experts should be encouraged. In determining the clinical course, it is not possible to rely solely on the case questionnaire, but also the hospital’s medical record. In addition, in order to prevent the subjective factors from affecting the quality of collected fecal specimens, the laboratory is misdiagnosed.