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摘要

本篇出處 胸腔醫學 12:1 民86.03 頁10-16
篇名 復興鄉結核病的治療
作者 余明治 ; 索任 ; 林淑瑛 ; 吳英和 ; 李俊年 ; 林道平
中文摘要        山地鄉的結核病盛行率及死亡率,一直居高不下,故希望藉由桃園縣復興鄉結核病患的研究,探究問題所在。 本計劃根據全國結核病資料庫,選取於民國80年7月1日到83年6月30日間完成中心登記的所有復興鄉結核病患資料,並參考衛生所的結核病個案治療管理記錄卡及本局門診就醫記錄,進行資料收集和分析;並以桃園縣觀音鄉同時期的結核病患,做為對照組。總計復興鄉73位病患及觀音鄉53病患,進入研究。在復興鄉患中,男性48人(65.8%),女性25人(34.2%),平均年齡為41.9歲。33.3%有家族結核病史,23.8%有過去結核病史,27.5%有罹患結核危險因子,其中18.8%的病患有酗酒習慣。病患被發現的途徑方面,60.6%是經由防癆系統門診發現,16.7%為胸部x光巡迴檢查發現,僅18.2%為經醫院轉介發現。中心登記時的胸部x光檢查,50.7%為重度肺結核。治療方面,49.3%完成治療,50.7% 未完成治療,其中因結核病死亡者14.9%,不合作停案者35.8%。復興病患的年齡、酗酒習慣、發現途徑、胸部x光侵犯程度及治療結果皆與觀音鄉的病患,有顯著不同(P值<0.05)。過去結核病史及罹患結核病危險因子,特別是酗酒者,皆會明顯降低完治率(P值< 0.05)。故我們認為:病患服藥順從性不佳及無法早期發現,是山地鄉結核病盛行率及死亡率居高不下的主要原因。欲解決此問題,治標方面,必須早期發現病患,加強衛教,以增進病患藥順從性;並宜採直接觀察治療法,以提高完治率。而提整體生活條件、改變生活方式、增進醫學常識並充實醫療資源,才是真正最重要的努力方向。
英文摘要        The prevalence and mortality of tuberculosis (TB) in Taiwan aboriginal villages remain high. In order to investigate possible reasons for this, we enrolled from July 1, 1991, through June 30,1994, TB patients from Fu-Shing Shiang that were centrally registered into this study. We reviewed data from the National TB Date Base, medical records of the Taiwan Provincial Chronic Disease Control Bureau and the treatment and management cards of TB patients from the health station. TB patients registering during the same period at Guan-Yin Shiang were chosen as a control group. There were 73 patients from Fu-Shing Shiang and 53 patients from Guan-Yin Shiang included in the study. Among the Fu-Shing shiang patients, 48 (65.8%)were male and 25 (34.2%) were female. The mean age was 41.9 years. There were 33.3% with a family historyof TB, 23.8% with a past history of TB and 27.5% with risk factors for TB, including 18.8% who were alcoholics. The patient registry showed that 60.6% of patients were found at clinics of the official TB control sysytem, 16.7% by Mass-Miniature Radiography and only 18.2% from other medical resources. On chest X-rays, 50.7% had far-advanced pulmonary TB at diagnosis. Treatment was completed in 49.3% of patients. Of the 50.7% who did not finish their treatment, 14.9 % died of TB and 35.8% defaulted due to moncooperation. Age, alcohol use, the source of can finding, SEverity on chest X-rays and treatment cot come of Fu-Shing Shiang were all statistically difference (P valure < 0.05) form comparable data at Guarn-Yin Shiang. Those from Fu-Shing Shiage with a past history of TB and risk factors for TB, particularly alcohol abuse, had a significantly lower treatment completion rate (P valve < 0.05). From our analysis, major TB control problems of aboriginal villages are delay in detection and poor compliance with treatment. In order to reduce TB prevalence and mortality in this setting, police promoting early detection of TB and health education to reinforce patient compliance cannot to overemphasized. Directly observed therapy, the best strategy for increasing compliance, is recommended to increase treatment completion rate. However, attention to more fundamental issues, such as improving the quality of life, changing unhealthy life styles, enhancing health education and access to medical resources, are also required to solve the problem of TB in aboriginal villages.