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目的分析肺结核病患者复发的原因,为提高治愈率、减少复发和治疗提供依据,并避免耐药患者的发生。方法对2008─2013年甘肃省民乐县报告地64例复治涂阳肺结核病患者进行复发原因调查,针对复发原因制定个性化的综合治疗,观察治愈情况。结果 64例涂阳肺结核病患者,因化疗方案不合理16例,占复发总数的25.0%;缺乏结核病防治知识14例,占21.8%;不配合治疗48例,占75.0%;自觉症状减轻,自行停止用药36例,占56.3%;社会及经济因素(交通不便、经济困难、外出)不能完成全程治疗18例,占28.1%;药物副作用12例,占18.9%;自身免疫力低下5例,占7.8%;针对上述因素,结合标准复治涂阳治疗方案制定个性化综合治疗方案的治疗组,治愈33例,治愈率97.0%,对照组治愈24例,治愈率80.0%。结论开展肺结核病患者复发因素的调查,制定个性化的综合治疗方案,对提高肺结核病的治愈率、减少结核病的复发和耐药有明显效果。
Objective To analyze the causes of relapse in patients with pulmonary tuberculosis and provide the basis for improving the cure rate, reducing recurrence and treatment, and avoiding the occurrence of drug-resistant patients. Methods A retrospective investigation was conducted on the causes of recurrence of 64 cases of retreated smear-positive pulmonary tuberculosis in Minle county, Gansu Province, from 2008 to 2013. Individualized comprehensive treatment was given according to the cause of recurrence, and the cure was observed. Results Sixty-four patients with positive pulmonary tuberculosis were treated with unreasonable chemotherapy regimens in 16 cases, accounting for 25.0% of the total number of recurrent cases. There was a lack of tuberculosis prevention and control knowledge in 14 cases, accounting for 21.8%; 48 cases were unresponsive, accounting for 75.0%. 36 cases stopped taking drugs, accounting for 56.3%; social and economic factors (inconvenient transportation, economic difficulties, go out) can not complete the full treatment of 18 cases, accounting for 28.1%; drug side effects in 12 cases, accounting for 18.9%; 5 cases of low autoimmune, accounting for 7.8%. According to the above factors, combined with the standard rehabilitation treatment program to develop personalized comprehensive treatment of the treatment group, 33 cases were cured, the cure rate was 97.0%, 24 cases were cured in the control group, the cure rate was 80.0%. Conclusion To carry out the investigation of recurrent pulmonary tuberculosis patients and develop personalized comprehensive treatment programs have obvious effects on improving the cure rate of tuberculosis and reducing the relapse and drug resistance of tuberculosis.