75岁以上肺结核合并慢性疾病患者双重督导管理探讨.docVIP

75岁以上肺结核合并慢性疾病患者双重督导管理探讨 作者：顾裕，赵鑫泉，王永革，王彩兰 【摘要】 目的 探讨高龄肺结核合并慢性疾病的个体化治疗及双重督导管理模式的有效性和安全性。方法 对43例75岁以上肺结核患者（双重管理组），在标准方案和符合化疗机制的基础上，根据患者病情、用药史、药物不良反应、药敏结果、合并疾病等，选用个体化抗结核联合用药。在对结核病进行督导用药的同时对合并糖尿病、慢性阻塞性肺疾病、高血压及心脑血管疾病者从健康教育、合理用药、定期复查等方面进行双重督导管理。以2002、2003年42例未进行双重督导管理的75岁以上肺结核患者资料作对照（对照组）。结果 双重管理组合并慢性疾病38例，在治疗过程中因恶性肿瘤死亡1例，合并肺部感染死亡1例，未愈1例,治愈率92.11%；治愈疗程5～12个月〔平均（8.21±2.13）个月〕；对照组合并慢性疾病35例,脑血管疾病死亡2例，恶性肿瘤死亡2例，冠心病死亡1例，未愈2例，拒绝治疗2例，治愈率74.29％,治愈疗程5～12个月〔平均（7.84±2.15）个月〕。2组比较，双重管理组治愈率提高（P＜0.05），而疗程无显著差异（P＞0.05）。药物不良反应双重管理组31.58％、对照组57.14％，2组比较有显著差异（P＜0.05）。结论 75岁以上高龄肺结核合并慢性疾病的个体化治疗和双重督导管理，提高了治疗的效果和安全性。 【关键词】 结核，肺；老年；管理；合并疾病 Abstract : Objective To explore the safety and efficacy of dual management and individualized treatment of elder tuberculosis patients with chronic diseases. Methods 43 cases of lung tuberculosis over 75 years old were enrolled in the study as dual management group. Individualized therapy was given on the basis of standard regime according to the patient′s condition and treatment history, such as side effects, drug resistance test and combined diseases. During the period of directly observed treatment short-course (DOTS), the combined chronic diseases, such as diabetes, COPD, hypertension and cardiovascular and cerebrovascular diseases were also treated. The dual management included health education, regular treatment and periodic follow-up, etc. Another 42 cases of old tuberculosis were taken as control. Results In the dual management group (n=38), 1 patient died of cancer, 1 died of pulmonary infection, 1 failed the care . The cure rate was 92.11% and the course averaged 5-12 (8.21±2.13) months. In the control group (n=35), 2 patients died of cerebrovascular disease, 2 died of cancer, 1 died of coronary heart disease, 2 failed the care, 2 refused treatment. The cure rate was 74.29%, the course averaged 5-12 (7.84±2.15) months. The difference in cure rate was significant between the two groups (Plt;0.05).