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目的 分析耐多药肺结核患者实施社区管理后的转归状况及其影响因素,为完善耐多药肺结核患者的社区管理提供依据。方法 采用回顾性调查方法,选择杭州、绍兴、湖州、衢州和丽水市在2009—2012年6月确诊并接受社区治疗管理的患者进行问卷调查,了解患者意愿与需求,并根据患者转归状况,分析不同方式的社区管理对患者治愈率的影响。结果 接受社区管理患者共220例,治愈率为65.91%,其中大专及以上、工人、新患者、药物注射治疗期间无不良反应的患者治愈率相对较高;药物注射治疗地点为家庭的治愈率为86.67%,高于在社区治疗的68.15%和其他地点治疗的54.84%(P=0.03);药物注射治疗地点离家距离≤5km的治愈率为67.74%,高于离家距离>5km的治愈率36.36%(P=0.04);有社区医生/护士随访管理的治愈率为70.39%,高于无随访管理患者的55.88%(P=0.04)。65.91%的患者表示愿意在社区接受药物注射治疗,94.09%的患者选择在家服药治疗。结论 社区管理治疗耐多药肺结核的治愈率丞需提高,应重视患者的意愿和服务需求,不断改进服务方式。
Objective To analyze the prognosis and influencing factors of community-based management of multi-drug-resistant pulmonary tuberculosis patients and provide the basis for improving the community management of multidrug-resistant tuberculosis patients. Methods A retrospective survey was conducted to select patients who were diagnosed and managed by community therapy in Hangzhou, Shaoxing, Huzhou, Quzhou and Lishui from June 2009 to June 2012 for questionnaire survey to understand patients’ wishes and needs. Based on the patient’s prognosis, Analyze the impact of different ways of community management on patient cure rates. Results A total of 220 community-managed patients were recruited, with a cure rate of 65.91%. Among them, college and above, workers, new patients and patients with no adverse reactions during drug injection therapy had a relatively high cure rate. The cure rate of families with drug injection was 86.67%, higher than 68.15% in community treatment and 54.84% in other sites (P = 0.03). The cure rate of distance≤5km from drug injection treatment site was 67.74%, higher than the cure rate of> 5km from home 36.36% (P = 0.04). The cure rate of community doctor / nurse follow-up management was 70.39%, higher than 55.88% (P = 0.04) of those without follow-up management. 65.91% of patients said they were willing to receive drug injections in the community, and 94.09% chose to take home medication. Conclusion The cure rate of MDR-TB in community management should be improved. Patients’ willingness and service needs should be emphasized and the service mode should be continuously improved.