论文部分内容阅读
目的掌握济南市医疗机构百日咳诊断标准的执行和实验室诊断方法使用现状。方法利用问卷和访谈的形式调查济南市二级及以上医疗机构医务人员,收集相关数据,结合百日咳监测数据进行分析。结果在49家二级及以上医疗机构中39家(79.59%)开展百日咳临床诊断,其中二级机构占61.54%,三级机构占38.46%。在开展百日咳临床诊断的医疗机构39名医务人员中,百日咳诊断标准中的典型症状选择正确率分别为阵发性痉咳100%、持续咳嗽≥2周94.87%、鸡鸣声87.18%;非典型症状分别为青紫30.77%、心动过缓20.51%、窒息20.51%、反复发作的呼吸暂停15.38%;执行临床诊断病例和确诊病例诊断标准的正确率为35.90%。全市百日咳实验室确诊病例比例从2012年的18.75%上升到2014年的56.88%和2015年的79.46%;排除实验室确诊病例后,2014~2015年疫情依然高发。结论济南市医疗机构百日咳诊断标准执行正确率低,实验室确诊能力不足。实验室诊断技术的采用不能完全解释疫情高发的原因,百日咳疫情仍有可能被低估,尚需进一步研究疫情高发的原因,及时调整免疫策略。
Objective To grasp the implementation of diagnostic criteria of pertussis in medical institutions in Jinan City and the status quo of laboratory diagnostic methods. Methods The questionnaires and interviews were used to investigate the medical staffs in medical institutions of secondary or higher level in Jinan City. The data were collected and analyzed with the pertussis monitoring data. Results Thirty-nine (79.59%) of 49 second-class and above medical institutions carried out the clinical diagnosis of whooping cough, of which 61.54% were secondary institutions and 38.46% were tertiary institutions. Of the 39 medical staff who carried out the clinical diagnosis of whooping cough, the typical symptoms in pertussis diagnostic criteria were 100% for paroxysmal spasm, 94.87% for persistent cough for two weeks and 87.18% for cocking, respectively. Atypical Symptoms were cyanosis 30.77%, bradycardia 20.51%, asphyxia 20.51%, recurrent apnea 15.38%; the implementation of clinical diagnosis and diagnosis of diagnosed cases the correct rate was 35.90%. The proportion of confirmed cases of pertussis in the city rose from 18.75% in 2012 to 56.88% in 2014 and 79.46% in 2015. After excluding laboratory confirmed cases, the epidemic was still high in 2014-2015. Conclusion The diagnostic accuracy of pertussis in medical institutions in Jinan is low and the accuracy of laboratory diagnosis is not enough. The use of laboratory diagnostic techniques can not fully explain the reasons for the high incidence of the epidemic, pertussis may still be underestimated the epidemic, still need to further study the causes of the outbreak, timely adjustment of immunization strategies.