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目的了解未纳入当地诊治管理的耐多药肺结核(MDR-TB)患者的基本状况及未纳入当地诊治管理的原因。方法采用问卷调查的方法,对衢州市所有未纳入当地诊治管理的MDR-TB患者进行调查,探索其治疗现状及原因。结果未纳入当地诊治管理的MDR-TB 14例中,中断治疗6例、未纳入治疗5例、异地治疗3例。未纳入治疗组平均年龄(72.2±12.9)岁,高于中断治疗组(58.0±16.2)岁和异地治疗组(39.3±13.6)岁(P<0.05)。引起6例中断治疗涉及的因素有药物不良反应(6例)、低收入(5例)、独居(2例)。5例未纳入治疗涉及的因素有独居(3例)、无收入来源(3例)、因高龄未纳入治疗仅随访观察(3例)、不能组成有效化疗方案(1例)、拒治(1例)。3例去异地治疗涉及的因素有病情重且当地医疗水平有限(2例)、为获取更好医疗资源转异地治疗(1例)。结论 MDR-TB患者未纳入当地治疗管理的原因与患者治疗出现不良反应等因素有关,因此需要制定针对性的MDR-TB诊疗管理办法,有效提高患者治疗依从性。
Objective To understand the basic condition of patients with multi-drug resistant tuberculosis (MDR-TB) that is not included in local diagnosis and management and the reasons for not being included in the management of local diagnosis and treatment. Methods A questionnaire survey was conducted to investigate all patients with MDR-TB who did not participate in the local diagnosis and treatment in Quzhou City and to explore their treatment status and causes. The results were not included in the local diagnosis and management of MDR-TB in 14 cases, interrupted treatment in 6 cases, not included in the treatment of 5 cases, 3 cases of remote treatment. Not included in the treatment group average age (72.2 ± 12.9) years, higher than interrupted treatment group (58.0 ± 16.2) years old and off-site treatment group (39.3 ± 13.6 years old (P <0.05. Six of the factors that led to the discontinuation of treatment were adverse drug reactions (6 cases), low income (5 cases) and single living (2 cases). The five factors that were not included in the treatment were living alone (3 cases), no source of income (3 cases), advanced age without treatment only follow-up observation (3 cases), no effective chemotherapy (1 case), no treatment example). Three of the factors involved in the treatment in different places were serious illness and limited local medical treatment (2 cases), and the treatment was better (1 case) in order to obtain better medical resources. Conclusion The reasons why MDR-TB patients are not included in local treatment management are related to the adverse reactions of patients’ treatment. Therefore, it is necessary to formulate targeted MDR-TB diagnosis and management methods to effectively improve the treatment compliance of patients.