北京市通州区痰涂片阳性肺结核病人实施全面监督化学疗法的研究

A study on fully supervised chemotherapy implemented in Tongzhou district,Beijing

目的 探讨通州区长期实施全监化疗的可行性。方法 对全区涂阳肺结核病人实施不住院全监化疗 ,建立健全三级防痨网 ,区、乡、村各级医生明确职责分工 ,区卫生局实施行政管理 ,各项工作实行质量控制监测。结果 1 979～ 1 997年对 1 64 8例涂阳病人中的 1 4 2 1例进行全监化疗 ,全监化疗率 86 2 % ,坚持监化率 90 4 % ,一年痰菌阴转率 95 3 % ,二年复发率 3 2 % ,人口传染源率从 1 980年的 81 /1 0万下降到1 997年的 2 .3 /1 0万 ,下降 97 2 % ,使 1 3万健康人避免了结核菌感染 ,保护劳动力创造产值 659万元 ,节约医药费 2 557万元。结论 通过制定统一的化疗方案和建立三级防痨网 ,以卫生行政管理手段保证三级防痨网稳定、高效地工作 ,可在通州区长期对涂阳病人实施全监化疗 ,并取得预期效果。

Objective To study the acceptability of fully supervised chemotherapy for smear-positive pulmonary tuberculosis in Tongzhou district,Beijing.Methods Domiciliary treatment for smear-positive pulmonary tuberculosis was implemented under fully supervised chemotherapy.Net work of health services has been organized at district,community and village three levels and supervised by Tongzhou District Bureau of Health.Results There were 1 648 case of smear-positive pulmonary tuberculosis registered during 1979～1997.The average coverage of DOTS for smear-positive cases was 86.2%,sputum conversion rate after complete the treatment was 95.3% and relapse rate during the 2 years was 3.2%.The prevalence of smear-positive cases decreased from 81/100 000 in 1980 to 2.3/100 000 in 1997 with 97.2% reduction rate.About 130 thousand population prevented from infection of tubercle bacilli.The value of output was created with RMB 6 590 thousand Yuan by protection of labors.Conclusion DOTS for smear-positive cases can be continuously and successfully implemented by network of three-level health service and supervision under administrative sectors.