患者关怀对利福平耐药肺结核患者门诊随访痰标本送检水平的影响分析

doi:10.3969/j.issn.1000-6621.2021.10.013

摘要/Abstract

摘要：

目的评价患者关怀对利福平耐药肺结核(RR-PTB)患者门诊随访痰标本送检情况的影响。方法以西安市胸科医院耐药结核科门诊随访的RR-PTB患者作为研究对象。观察组1为2019年7—9月接受第一阶段3项关怀服务的门诊随访RR-PTB患者(249例),观察组2为2020年7—9月接受第二阶段6项关怀服务的门诊随访RR-PTB患者(239例),对照组为2018年7—9月接受常规门诊留痰指导的门诊随访RR-PTB患者(127例)。比较接受关怀服务前后3组患者痰标本送检率的变化。结果对照组、观察组1和观察组2患者总体痰标本送检率为35.8%(77/215)、51.7%(209/404)和78.6%(276/351),差异有统计学意义(χ²=111.249,P<0.001)。观察组1第1次接受关怀后的痰标本送检率(47.0%,117/249)和观察组2第1次接受关怀后的痰标本送检率(73.6%,176/239)均明显高于对照组第1次痰标本送检率(29.9%,38/127),差异有统计学意义(χ²值分别为10.110和65.278,P值均<0.017);且观察组2第1次接受关怀后的痰标本送检率明显高于观察组1,差异有统计学意义(χ²=36.106,P<0.001)。观察组1接受第1次关怀、第2次关怀和第3次关怀后的痰标本送检率分别为47.0%(117/249)、 57.4%(78/136)、 73.7%(14/19),差异有统计学意义(χ_趋势²=7.448,P=0.006)。观察组2接受第1次关怀和第2次关怀后的痰标本送检率分别为 73.6%(176/239)和89.3%(100/112),差异有统计学意义 (χ²=11.111,P=0.001)。结论患者关怀可以提高门诊随访RR-PTB患者痰标本送检率,且开展6项关怀服务的效果优于3项关怀服务的实施效果。

关键词: 结核, 抗多种药物性, 利福平, 病人医护管理, 痰, 患者关怀, 对比研究

Abstract:

Objective To assess the effect of the patients care on the level of sputum specimens submitted for examination among the outpatient follow-up of rifampicin-resistant pulmonary tuberculosis (RR-PTB) patients. Methods The RR-PTB outpatients followed-up in Drug-Resistant TB Department of Xi’an Chest Hospital were taken as objects. The RR-PTB outpatients followed-up from July to September 2019 were taken as the intervention group 1 (249 cases) who received 3 care services in the first phase. The intervention group 2 (239 cases) were the RR-PTB outpatient followed-up from July to September 2020 who received 6 care services in the second-phase. Meanwhile, RR-PTB outpatients who followed-up from July to September 2018 received routine outpatient expectoration guidance were retrospectively analyzed as the control group (127 cases). The changes of the rate of sputum specimens submitted for examination of the 3 groups were compared. Results The overall rate of sputum specimens submitted for examination in the control group, intervention group 1 and intervention group 2 were 35.8% (77/215), 51.7% (209/404) and 78.6% (276/351) separately, the difference was statistically significant (χ²=111.249, P<0.001). The rate in the intervention group 1 received the first intervention (47.0%, 117/249) and the group 2 received the first intervention (73.6%,176/239) were significantly higher than that of control group (29.9%, 38/127), the difference was statistically significant (χ²=10.110, 65.278;P<0.017). The rate of the intervention group 2 was significantly higher than the group 1 (χ²=36.106, P<0.001). The rates of intervention group 1 after receiving the first intervention, the second intervention and third intervention were 47.0% (117/249), 57.4% (78/136) and 73.7% (14/19), respectively, and the differences were significant (χ_trends²=7.448, P=0.006). The rates of the intervention group 2 received first intervention and the second intervention were 73.6% (176/239) and 89.3% (100/112) respectively, and the difference was significant (χ²=11.111, P=0.001). Conclusion Patient care services can increase the rate of sputum specimens submitted for examination among the followed-up RR-PTB outpatients, and the effects of 6 care services were better than that of 3 care services.

Key words: Tuberculosis, multidrug resistance, Rifampicin, Patient care management, Sputum, Patient care, Comparative study

罗卉, 阮云洲, 赵阿利, 袁荣, 何小谋, 李仁忠. 患者关怀对利福平耐药肺结核患者门诊随访痰标本送检水平的影响分析[J]. 中国防痨杂志, 2021, 43(10): 1046-1051. doi: 10.3969/j.issn.1000-6621.2021.10.013

LUO Hui, RUAN Yun-zhou, ZHAO A-li, YUAN Rong, HE Xiao-mou, LI Ren-zhong. Analysis of the effect of patients care on the level of sputum specimens submitted for examination among outpatient follow-up of rifampicin-resistant pulmonary tuberculosis patients[J]. Chinese Journal of Antituberculosis, 2021, 43(10): 1046-1051. doi: 10.3969/j.issn.1000-6621.2021.10.013

图/表 4

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参考文献 14

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一般特征	对照组(127例)	观察组1(249例)	观察组2(239例)	χ²值	P值
性别				2.428	0.297
男性	80(63.0)	176(70.7)	159(66.5)
女性	47(37.0)	73(29.3)	80(33.5)
年龄组(岁)				7.560	0.109
<18	7(5.5)	7(2.8)	2(0.8)
18~59	108(85.1)	214(86.0)	213(89.2)
≥60	12(9.4)	28(11.2)	24(10.0)
文化程度				1.937	0.747
小学及以下	9(7.1)	15(6.0)	16(6.7)
初中及高中	95(74.8)	195(78.3)	175(73.2)
大专及以上	23(18.1)	39(15.7)	48(20.1)
并发糖尿病				0.481	0.786
有	12(9.4)	26(10.4)	28(11.7)
无	115(90.6)	223(89.6)	211(88.3)
居住地				4.922	0.085
西安市	64(50.4)	147(59.0)	149(62.3)
西安市以外	63(49.6)	102(41.0)	90(37.7)
医疗费用支付方式				3.219	0.200
医疗保险	103(81.1)	206(82.7)	209(87.4)
自费	24(18.9)	43(17.3)	30(12.6)

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