CAJ | 학술논문

目的评估陕西省成人急性腹泻诊治与Manatsathit工作组推荐的《成人急性腹泻诊治指南》(以下简称指南)的一致性.方法在陕西省10家医院各选择40例成人腹泻患者进行腹泻诊治的横断面多中心调查.组间差异计数资料比较采用x2检验,计量资料比较采用t检验.结果调查了400例患者,60.5％(242/400)为女性,平均年龄(38.4±17.5)岁.指南推荐脱水和血便患者应行粪便常规检查和培养.64例脱水患者中,仅有38例(59.4％)和13例(23.3％)分别行粪便常规检查和霍乱弧菌培养(x2=32.627、84.779,均P＜0.01).30例血便患者中,25例(83.3％)行粪便常规检查(x2=3.491,P=0.062),但仅3例(10.0％)行细菌培养(x2=49.091,P＜0.01).临床诊断细菌性痢疾30例(7.5％),急性感染性腹泻370例(92.5％).370例水样泻患者中,189例(51.1％)给予补液治疗,低于诊治指南的建议(x2 =239.600,P＜0.01).在216例补液患者中,按诊治指南应有144例(66.7％)给予口服补液盐(ORS),但仅有31例(14.4％)给予ORS(x2=122.700,P＜0.01),而诊治指南静脉补液应有72例,但有185例(85.6％)给予静脉补液(x2=122.700,P＜0.01).76例(19.0％)患者有抗菌药物应用指征,但有258例(64.5％)使用抗菌药物(x2=170.300,P＜0.01).结论陕西省各级医院在诊治成人急性腹泻方面与指南存在较大差距.广泛开展腹泻的诊治培训并出台国内的具体诊疗指南实有必要.
목적 평고합서성성인급성복사진치여Manatsathit공작조추천적《성인급성복사진치지남》(이하간칭지남)적일치성.방법 재합서성10가의원각선택40례성인복사환자진행복사진치적횡단면다중심조사.조간차이계수자료비교채용x2검험,계량자료비교채용t검험.결과 조사료400례환자,60.5％(242/400)위녀성,평균년령(38.4±17.5)세.지남추천탈수화혈편환자응행분편상규검사화배양.64례탈수환자중,부유38례(59.4％)화13례(23.3％)분별행분편상규검사화곽란호균배양(x2=32.627、84.779,균P＜0.01).30례혈편환자중,25례(83.3％)행분편상규검사(x2=3.491,P=0.062),단부3례(10.0％)행세균배양(x2=49.091,P＜0.01).림상진단세균성이질30례(7.5％),급성감염성복사370례(92.5％).370례수양사환자중,189례(51.1％)급여보액치료,저우진치지남적건의(x2 =239.600,P＜0.01).재216례보액환자중,안진치지남응유144례(66.7％)급여구복보액염(ORS),단부유31례(14.4％)급여ORS(x2=122.700,P＜0.01),이진치지남정맥보액응유72례,단유185례(85.6％)급여정맥보액(x2=122.700,P＜0.01).76례(19.0％)환자유항균약물응용지정,단유258례(64.5％)사용항균약물(x2=170.300,P＜0.01).결론 합서성각급의원재진치성인급성복사방면여지남존재교대차거.엄범개전복사적진치배훈병출태국내적구체진료지남실유필요.
Objective To evaluate the management of acute diarrhea in adult and to assess physician's adherence to guidelines recommended by Manatsathit working group.Methods A multicenter cross-sectional survey was carried out in 10 hospitals in Shaanxi Province with assignment of 40 patients each hospital.The difference of enumeration data between groups was analyzed using chi square test.Quantitative data were compared using t test.Results Data were collected from 400 patients.60.5％ (242/400) were female and mean age was (38.4 ± 17.5) years.In Manatsathit guideline,stool examination and stool culture for bacteria are recommended in patients with watery diarrhea with dehydration and in patients with bloody diarrhea.In this survey,of the 64 patients with dehydration,only 38 (59.4％) and 13 (23.3％) patients had done stool routine test and vibriocholera culture,respectively.Compared to Manatsathit guideline,the differences were obvious (x2 32.627 and 84.779,respectively; both P＜0.01).Of the 30 patients with bloody diarrhea,25 (83.3％) cases had stool examination done,which was roughly in line with Manatsathit guideline (x2 =3.491,P=0.062).However,stool culture for bacteria was performed only in 3 (10％) patients,which was significantly different with the guideline (x2 =49.091,P＜ 0.001).Overall,30 (7.5 ％) cases were diagnosed with acute bacillary dysentery clinically,and the remaining 370 (92.5％) were diagnosed with acute infectious diarrhea.Of the 370 patients with watery diarrhea,only 189 (51.1％) patients were prescribed with rehydration therapy,which was different with the recommendation of Manatsathit guideline (x2 =239.600,P＜0.01).Of the 216 patients who received rehydration therapy,144 (66.7％) cases should be prescribed with oral rehydration salts (ORS) and 72 cases should be prescribed with intravenous fluid replacement according to Manatsathit guideline.However,only 31 (14.4％) were prescribed ORS and up to185 (85.6％) patients received intravenous fluid replacement instead (bothx2 =122.700; both P＜0.01).On the basis of the guidelines,only 76 (19.0％) patients were eligible to use antibiotics.However,up to 258 (64.5％) patients were treated with antibiotics,which was absolutely against the recommendation of Manatsathit guideline (x2 =170.300,P＜0.01).Conclusions There are deep gaps between the clinical practice of treatment for acute diarrhea in adults in various levels of hospitals in Shaanxi Province and the recommendation of Manatsathit guideline.It is imperative to make domestic guidelines for adult acute diarrhea and to widely train physicians with algorithm for the management of adult acute diarrhea.