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目的用结核病患病率、死亡率等指标监测新密市结防服务体系运行30年效果,评价现有体系的可行性。方法 1.颁布地方性防痨法规,落实结核病归口管理;2.设立结核病转诊有奖制度,鼓励转诊医生的积极性;3.实施结核病控制项目,对患者免费提供抗痨药治疗;4.建立防痨协会,搭建医防合作平台;5.将可疑结核病推荐转诊和患者健康管理纳入公卫服务项目;6.实施“6岁防痨工程”、对入学新生进行结核病预防性体检、建立学校结核病4级应急响应和结核病高危人群预防性治疗等综合措施,加强学生结核病防治工作。结果1.可疑结核病患者登记率由1985年的146/10万增长到2015年的560/10万,年递增率4.60%,各区间年度对比有统计学意义(χ2=6399.55,P<0.05)。2.活动性肺结核新登记率由1985年的11.6/10万增长到2015年的65.5/10万,年递增率5.90%,各区间年度对比有统计学意义(χ2=509.964,P<0.05)。3.涂阳肺结核患者新登记率由1990年的19.0/10万下降到2015年的12.1/10万,年递降率1.80%,各区间年度对比有统计学意义(χ2=233.269,P<0.05)。4.14岁以下儿童结核病新登记率由1990年的7.7/10万下降到2015年的2.5/10万,年递降率4.40%,各区间年度对比有统计学意义(χ2=9.428,P<0.05)。5.15岁以上人群结核病患病率由1979年的1256/10万下降到2010年的254/10万,年均递降5.00%,两个年度患病率对比有统计学意义(χ2=9.782,P<0.05)。6.结核病死亡率由1992年的3.95/10万下降到2015年的0.90/10万,年递降率6.20%,各区间年度对比有统计学意义(χ2=31.457,P<0.05)。结论新密市实行的以市结防所“诊断治管”为龙头、以市直综合医院和乡镇卫生院“发现转诊”为中枢、以村卫生所“推荐管理”为基础的“三位一体”结核病防治服务体系已能满足县级结核病防治工作需求,体系运行良好,疫情下降平稳,患者负担减轻,群众比较满意,应在现有服务体系的基础上继续巩固和发展。
Objective To monitor the 30-year effect of the anti-altruistic service system in Xinmi City on the basis of the prevalence of tuberculosis and mortality, and to evaluate the feasibility of the existing system. Methods 1. Promulgation of local anti-tuberculosis laws and regulations, implementation of centralized management of tuberculosis; 2. Establishment of a referral system for tuberculosis referrals to encourage referrals of physicians; 3. Implementation of tuberculosis control programs to provide anti-tuberculosis treatment to patients free of charge; The establishment of anti-tuberculosis Association, set up a platform for cooperation in medical prevention; 5 suspicious TB referral and patient health management into public health services; 6 implementation of “6-year-old anti-tuberculosis project”, freshmen tuberculosis preventive medical examination , Establish a comprehensive response to school level 4 emergency response and preventative treatment for TB at high risk and strengthen TB prevention and control among students. Results 1. The registration rate of suspicious TB patients increased from 146.1 million in 1985 to 560.10 million in 2015, with an annual increment rate of 4.60%. The annual comparison between the two groups was statistically significant (χ2 = 6399.55, P <0.05). 2. The new registration rate of active tuberculosis increased from 11.6 / 100,000 in 1985 to 65.5 / 100,000 in 2015, with an annual increment rate of 5.90%. The annual comparison between the two groups was statistically significant (χ2 = 509.964, P <0.05). The new registration rate of smear positive pulmonary tuberculosis patients dropped from 19.0 / 100000 in 1990 to 12.1 / 100000 in 2015, the annual decline rate was 1.80%, and the annual comparison between each interval was statistically significant (χ2 = 233.269, P <0.05) . 4. The new registration rate of tuberculosis in children under 14 dropped from 7.7 / 100,000 in 1990 to 2.5 / 100,000 in 2015, and the annual decline rate was 4.40%. The annual comparison between the two groups was statistically significant (χ2 = 9.428, P <0.05). The prevalence of tuberculosis among people over 5.15 years old dropped from 1256/10 million in 1979 to 254/10 million in 2010, with an average annual decline of 5.00%. The prevalence of tuberculosis in the two years was statistically significant (χ2 = 9.782, P < 0.05). 6. The mortality rate of tuberculosis dropped from 3.95 per 100 000 in 1992 to 0.90 per 100,000 in 2015, with an annual decline rate of 6.20%. The annual comparison between the two groups was statistically significant (χ2 = 31.457, P <0.05). Conclusion Xinmi City, the implementation of the municipal end of the prevention and treatment of “diagnosis and management ” as a leader to the city straight hospitals and township hospitals “found referral ” as the center, the village health clinic “recommended management The basic ”Trinity " tuberculosis prevention and treatment service system has been able to meet the needs of tuberculosis prevention and control at the county level. The system is in good condition with a steady decline in the outbreak and a reduction in the burden on patients, and the masses are more satisfied. They should continue to consolidate and develop on the basis of the existing service system .