摘要
目的分析湖南省2004-2007年报告的30例不明原因肺炎病例相关信息,发现不明原因肺炎病例监测工作中存在的问题,为进一步做好监测工作提供参考。方法描述性流行病学。结果30例病例发病后,首诊时间为发病当天～病后6d,"发病-首诊"时间间隔中位数为1d;先后就诊(住院)医院数为1～7家;"发病-诊断为不明原因肺炎"时间间隔为病后1～33d,中位数7.5d;诊断为不明原因肺炎的医院级别分别为二级(6例)、三级(24例),二级、三级医院正确判定为不明原因肺炎病例的比例分别为24.0%、82.8%,三级明显高于二级医院(χ2=16.47,P=0.00)。医院内专家会诊结果为不明原因肺炎病例的当天,医院均向当地CDC和/或卫生行政部门进行了报告,但首次报告均为电话报告,最终只有11例进行了网络直报;排除SARS和人禽流感的20例病例"发病-排除诊断"时间间隔为病后4～53d,中位数11d,但16例仍未明确病原体。结论不明原因肺炎病例监测对湖南省3例人禽流感病例的及时发现有重要作用;但还存在很多困难和问题,如未很好地执行《方案》,医疗机构尤其市级以下专业人员培训不到位,基层对不明原因肺炎病例的排查存在难度等;建议加大培训力度,进一步提高医疗单位和疾控机构的检测能力,发现病例后科学、适度反应。
Objective To analyze the relative information about 30 pneumonia of unknown origin cases from 2004 to 2007 in Hunan Province, to find the problems of surveillance, and to provide scientific evidences for improving the surveil- lance. Method Descriptive epidemiological study was applied. Results The range of time interval of ＂onset first seeing doctor＂ was from 0 day to 6 days after they were ill, and the median was 1 day. The number of hospitals where the patients went to see doctor was from 1 to 7. The range of time interval of ＂onset making a diagnosis as pneumqnia of unknown origin case was from 1 day to 33 days after they were ill, and the median was 7.5 days. Six cases were diagnosed as pneu- monia of unknown origin cases in the second - level hospitals, and 24 cases were in the third - level ones, the ratios of correct diagnosis as pneumonia of unknown origin cases were 24.0 % and 82.8 %, the ratio of third- level hospitals was higher then that of second-level ones （χ^2= 16.47, P = 0.00）. The hospital reported to the local CDC and/or the local bureau of public health at the day when the case was diagnosed as pneumonia of unknown origin case, but the first report was by phone not by internet, and only 11 cases were reported by internet finally. The time interval of ＂onset excluded diagnosis of 20 cases which were excluded＇from SARS and human infection with avian influenza virus was from 4 days to 53 days after they were ill. and the median was 11 days,but 16 cases were unknown - etiological diagnosed. Conclusions It is very important to find 3 human cases with infected avian influenza virus for carrying on the surveillance of pneumonia of unknown origin cases in Hunan Province. But there are many questions and difficulties, such as the training for the clinicians especially in the low- level hospitals are not carried out well, the low - level specialist groups do not really make an excluding diagnosis. The results suggest that it is necessary to enhance the training for clinicians, improve the test ability of the hospitals and CDOs. and make scientific and reasonable response after finding the case.
出处
《实用预防医学》
CAS
2008年第5期1408-1411,共4页
Practical Preventive Medicine
关键词
不明原因肺炎
人感染高致病性禽流感
描述流行病学
Pneumonia of unknown origin cases
Human infection with avian influenza virus
Descriptive epidemiological study
