摘要
目的调查广州市新型冠状病毒肺炎(COVID-19)境内确诊病例发病—确诊时间间隔,并对时间间隔较长的个案分析其原因。方法收集广州市COVID-19疫情初期(均为境内病例)确诊病例流行病学资料,对病例发病至确诊时间间隔进行描述性分析。结果截至3月14日,广州市COVID-19确诊病例共347例,1月24日后,病例发病至确诊间隔时间均数为(4.4±0.2)d和中位数为4(2.0,6.0)d,较之前均数为(8.3±1.7)d和中位数为8(3.0,13.0)d明显降低。主动防控发现方式病例发病至确诊时间间隔均数(4.1±0.3)d和中位数3(1.0,6.0)d均小于患者自主就医方式均数为(5.9±0.3)d,中位数为6(3.0,8.0)d,不同发现来源病例从发病—确诊时间间隔差异有统计学意义(P<0.01)。50~<60年龄段时间间隔中位数6(2.0,9.0)d最大,80岁以上年龄段时间间隔均数为(7.3±2.0)d最大。导致发病至确诊时间间隔延长,主要原因在于首诊医疗机构仅对患者对症治疗、患者自行用药以及实验室核酸检测结果假阴性等。结论发病至确诊时间间隔与防控级别呈现相关性;主动防控模式有助于快速发现病例;应重点加强中老年人健康宣教力度。医疗机构强化首诊负责制,综合症状、流行病学史和病原学检查做出诊断。实验室结果的利用要结合采样规范、采样次数及采样部位。
Objective To investigate the time interval from the onset to the diagnosis of the domestic cases of COVID-19 in Guangzhou,and we analyze the causes of cases with long time intervals.Methods We collected epidemiological data of all the confirmed domestic cases in the early stage of COVID-19 in Guangzhou.Descriptive analysis was used to the time interval from the onset to the diagnosis.Results After January 24 th,the time interval from the onset to diagnosis,the mean was(4.4±0.2)days and the median was 4(2.0,6.0)days,was significantly lower than before,the mean was(8.3±1.7)days and the median was 8(3.0,13.0)days.The mean(4.1±0.3)days and median 3(1.0,6.0)days in the time interval in the active prevention and control discovery mode were smaller than that in the self-seeking medication mode,the mean was(5.9±0.3)days and the median was 6(3.0,8.0)days,the difference in the interval from onset to diagnosis was statistically significant(P<0.01).The median 6(2.0,9.0)days was largest in 50-<60 age group,and the mean(7.3±2.0)days was the largest in the age group over 80.The only symptomatic treatment in first visit,self medication,and the false negative of the laboratory nucleic acid testing results leaded to longer time intervals.Conclusion prevention and control mode had contributed to detect cases quickly.Public health education should be strengthened especially for the elderly.And we should strengthen the responsibility system of the first-visited medical institutions.The diagnosis needed to be combined with symptoms,epidemiological investigation and etiological examination.The use of laboratory results should be combined with sampling technology specification,sampling times and sampling locations.
作者
李海麟
罗雷
景钦隆
郑睦锐
LI Hai-lin;LUO Lei;JING Qin-long;ZHENG Mu-rui(Guangzhou Center for Disease Control and Prevention,Guangzhou,Guangdong 510440,China)
出处
《中国热带医学》
CAS
2021年第4期354-358,共5页
China Tropical Medicine
