目的 加强基层医院犬伤门诊建设与管理，进一步规范狂犬病暴露预防处置工作。方法 收集2009－2019年期间嘉兴市疾病预防控制中心（CDC）犬伤门诊资料，运用Excel 2007软件处理监测资料并进行回顾性分析，提出狂犬病暴露预防处置中存在的问题。结果 嘉兴市CDC犬伤门诊暴露人数呈逐年递增趋势，11年共接诊暴露者66 059例，男女性别比为0.93：1。7－8月为暴露高峰，82.50%的暴露者在24 h内及时就诊。Ⅲ级暴露者中人狂犬病免疫球蛋白联合注射率由2009年的10.02%逐年上升至2019年的63.42%，平均注射率为41.91%。存在犬伤门诊硬件设施落后，专职执业医师配备不足，问诊信息不详尽，知情同意不到位，暴露处置欠规范，暴露者依从性不高，重症患者转送机制不畅通，信息化管理薄弱，以及对暴露者的健康教育以及心理辅导缺位等问题。结论 嘉兴市CDC由原来的狂犬病暴露预防处置承担单位转型为对基层医院的技术管理和指导单位，基层医院需加强犬伤门诊基础建设，配备足够数量的具有相应资质的犬伤门诊专职医务人员，加强信息化建设，优化犬伤门诊服务制度。
Objective To strengthen the construction and management of the outpatient service of rabies in primary hospitals, and to further standardize the prevention and disposal of rabies exposure. Methods The data of rabies exposure in the outpatient service of Jiaxing Center for Disease Control and Prevention (Jiaxing CDC) were collected from 2009 to 2019, and Excel 2007 software was used to perform a retrospective analysis of the data. The problems in the prevention and disposal of rabies exposure were put forward. Results In the outpatient service of Jiaxing CDC, the number of individuals with rabies exposure was increasing year by year, and 66 059 individuals with rabies exposure were received in the past 11 years, with a male/female ratio of 0.93:1. The peak of rabies exposure was in July and August, and 82.50% of the exposed individuals attended the hospital within 24 hours. The rate of combined injection of rabies immunoglobulin increased from 10.02% in 2009 to 63.42% in 2019 among the individuals with grade Ⅲ exposure, and the mean injection rate was 41.91%. There were several problems in the outpatient service of rabies, such as old hardware facilities, insufficient number of full-time medical practitioners, a lack of detailed inquiry information, inadequate informed consent, a lack of standard exposure treatment, low compliance of individuals with exposure, poor transfer mechanism of severe patients, weak information management, and a lack of health education and psychological guidance for individuals with exposure. Conclusion Jiaxing CDC has transformed from the unit undertaking the prevention and disposal of rabies exposure to the unit of the technical management and guidance of primary hospitals. Primary hospitals need to strengthen the infrastructure of the outpatient service of rabies, equip enough qualified full-time medical staffs, improve information construction, and optimize the outpatient service system for rabies.
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