马拉维一家中心医院收治的肺结核疑似患者的诊断管理及结果
Diagnostic management and outcomes of pulmonary tuberculosis suspects admitted to a central hospital in Malawi.
作者信息
Gawa L G, Reid T, Edginton M E, Van Lettow M, Joshua M, Harries A D
机构信息
Dignitas International, Zomba, Malawi ; Zomba Central Hospital, Zomba Ministry of Health, Zomba, Malawi.
Operations Research Unit, Médicins Sans Frontières, Operations Center Brussels, Luxembourg.
出版信息
Public Health Action. 2011 Sep 21;1(1):2-5. doi: 10.5588/pha.11.0007.
SETTING
Zomba Central Hospital, Malawi.
OBJECTIVE
To determine diagnostic management and outcomes of pulmonary tuberculosis (PTB) suspects admitted to adult wards.
DESIGN
A retrospective, cross-sectional review of medical records of patients admitted to hospital between July and September 2010.
RESULTS
There were 141 PTB suspects. Sputum examination was requested and performed in 67 (48%) suspects, but none were smear-positive. Chest X-ray (CXR) was requested and performed in 26 (39%) suspects whose sputum smears were negative. Eleven suspects had a CXR suggestive of PTB: two were started on TB treatment and eight died before treatment started. Human immunodeficiency virus (HIV) status was known for 50 patients (35% of all suspects) on admission, all of whom were HIV-positive. HIV testing was requested for 37 patients, but was only performed in 12, five of whom were HIV-positive. Only one patient was referred for antiretroviral treatment. There were 41 (29%) deaths, eight of whom had probable TB and were not treated. In the remaining 33 patients who died, only nine (27%) had sputum smears examined and four (12%) had a CXR.
CONCLUSION
The study shows inadequacies in the diagnostic management of PTB suspects in the Zomba Central Hospital, but suggests opportunities for improvement.
背景
马拉维宗巴中心医院。
目的
确定入住成人病房的肺结核（PTB）疑似患者的诊断管理及治疗结果。
设计
对2010年7月至9月期间入院患者的病历进行回顾性横断面研究。
结果
共有141例PTB疑似患者。67例（48%）疑似患者接受了痰检，但均未痰涂片阳性。26例（39%）痰涂片阴性的疑似患者接受了胸部X光检查（CXR）。11例疑似患者的CXR提示为PTB：2例开始接受结核病治疗，8例在开始治疗前死亡。50例患者（占所有疑似患者的35%）入院时已知人类免疫缺陷病毒（HIV）状态，所有这些患者均为HIV阳性。37例患者被要求进行HIV检测，但仅对12例进行了检测，其中5例为HIV阳性。仅1例患者被转诊接受抗逆转录病毒治疗。共有41例（29%）死亡，其中8例可能患有结核病但未接受治疗。在其余33例死亡患者中，仅9例（27%）进行了痰涂片检查，4例（12%）进行了CXR检查。
结论
该研究表明宗巴中心医院对PTB疑似患者的诊断管理存在不足，但也提出了改进的机会。
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