目 錄

DOH95-DC-1108-03 15 95 9512 31

1882 3 24 (Dr. Robert Koch) 1944 Waksman (Streptomycin) 1952 Isoniazid (INH) 1960 Rifampin (RMP) 1970 INH+RMP 1980 INH+RMP+pyrazimide (PZA) INH+RMP [1,2] 1993 (Directly Observed Treatment, Short-course, DOTS, ) [3] 20 1 2003 881 2005 [3] 93 16,784 957 [4] 1

Find TB Cure TB 66.7 /10 2015 34 /10 [5] 1997 [6] [7] SARS 7 [8,9] 50% 65 [10] 倂 15% 2

[11,12] [13] [14] 2006 The Stop TB Strategy (Engage all care providers: public-public and public-private mix approaches and international standards for tuberculosis care)[15] [16] [16,17] Public-private Mix (PPM) 3

[18,19] (Basic Management Unit, BMU) [20] [21] [22] 4

(PPM for DOTS)[23] 5

1. 2. ( ) ( ) 1 2 3 4 6

1. 2. 1 7

3 4 5 DOTS 1. 8

2. [24] 3 2 1 6 Cronbach`s (2002) 0.75[24] 15 Cronbach`s 0.86 12 1 0-12 3. Likert Scale 4 CVI 0.80 20 Cronbach`s 0.96 9

1. 2. 3. 95 3 1 11 30 95 11 30 [25] 1. 2. ( ) 3. 4. 5. 6. 7. : 95 10

95 7 95 10 SPSS 11.3 t p <0.05 11

( ) 26 12

95 3 1 10 31 140 ( ) 9 101 62.5±24.0 82 58.6% 58 41.4% 10 7.1% 51 36.4% 40 28.6% 126 90.0% 93 (9 ) 47 ( 10 ) (P<0.05) 71 (76.3%) 56 (60.2%) 15 (16.1%) 22 (23.7%) 60% ( ) 11 (7, 63.6%) 7 (63.6%) 13

80.0±19.8 ( ) 129 13 (10.1%) 84 (65.1%) ( 1 7 )21 (16.3%) ( 10 X )11 (8.5%) 7 (5.5%) ( 93 26 (28.0%) (5 14 1, 5 1 倂 ) 29 (31.2%) ( ) 95 6 95 10 62 4 3 5 6 2 44 8.86 ± 2.52 10.25 ± 1.82 (p0.05) ( ) 56 55 54 4.3-4.6 / 14

( ) 15

40% 爲 却 [26] [16] [17,27] 7 4 1 2 16

(16.3%) ( 50% ) 却 50% 65 [10] 倂 30% [28] 23.7% (passive case finding) 17

(active case finding) 2006 The Stop TB Strategy [15] [15] (1)2003 SARS (2) [7](3) [7] 18

倂 (PPM for DOTS)[22] [15] The Stop TB Strategy 19

20

倂 21

1. American Thoracic Society, CDC, and the Infectious Diseases Society of America. Treatment of Tuberculosis. Am J Respir Crit Care Med 2003; 167:603-62. 2. 3. 2003 Tuberculosis. http://www.who.int/mediacentre/factsheets/fs104/en/ 4. http://www.doh.gov.tw/statistic/data/ /93/1.xls 5. http://www.cdc.gov.tw/index_news_info.asp?data_id=1691 6. Chiang CY, Chang CT, Chang RE, et al. Patient and health system delays in the diagnosis and treatment of tuberculosis in Southern Taiwan. Int J Tuberc Lung Dis 2005; 9:1006 1012. 7. Chiang CY, Enarson DA, Yang SL, et al: The impact of national health insurance on the notification of tuberculosis in Taiwan. Int J Tuberc Lung Dis 2002; 6:974-9. 8. 2005:S44 9. http://www.cdc.gov.tw/file/39045_6925694444.pdf 10. Ming-Chih Yu, Kuan-Jen Bai, Jer-Hwa Chang, et al. Age transition of tuberculosis patients in Taiwan, 1957-2001. J Formos Med Assoc 2006; 10: 25-30. 11. 12. 2004 22

2004; 23: 292-296. 13. 14. Center for Disease Control (Taiwan). Tuberculosis Annual Report, 2001. Cesta TG., Falter EJ. Case management: its value for staff nurses. Am J Nursing 1999: 99: 48-51. 15. World Health Organization. The stop TB strategy: building on and enhancing DOTS to meet the TB-related millennium development goals. http://www.who.int/tb/publications/2006/who_htm_tb_2006_368.pdf 16. 17. http://www.cdc.gov.tw/file/39045_6927083333.pdf 18. World Health Organization. Public-private mix for DOTS: practical tools to help implementation. http://whqlibdoc.who.int/hq/2003/who_cds_tb_2003.325.pdf 19. World Health Organization. Involving private practitioners in tuberculosis control: issues, interventions, and emerging policy framework. http://whqlibdoc.who.int/hq/2001/who_cds_tb_2001.285.pdf 20. World Health Organization. Compendium of indicators for monitoring and evaluating national tuberculosis programs. http://whqlibdoc.who.int/hq/2004/who_htm_tb_2004.344_chap1-2.pdf 21. World Health Organization: International standards for TB care: diagnosis, treatment, public health. http://www.who.int/tb/publications/2006/istc_report_shortversion.pdf 22. World Health Organization. Engaging all health care providers in TB control: guidance on implementing public-private mix approaches. http://whqlibdoc.who.int/hq/2006/who_htm_tb_2006.360_eng.pdf 23

23. World Health Organization. Expanding DOTS in the context of a changing health system.http://whqlibdoc.who.int/hq/2003/who_cds_tb_2003.318.pdf 24. (2002) 25. World Health Organization. Treatment of tuberculosis: guidelines for national programmes. http://whqlibdoc.who.int/hq/2003/who_cds_tb_2003.313_eng.pdf 26. http://www.cdc.gov.tw/file/38764_4477546296 950216.pdf 27. Lin RL, Lin FJ, WU CL, et al. Effect of a hospital-based case management approach on treatment outcome of patients with tuberculosis. J Formos Med Assoc 2006; 105:636-44. 28.Broekmans JF, Migliori GB, Rieder HL, et al: European framework for tuberculosis control and elimination in countries with a low incidence. Recommendations of the World Health Organization (WHO), International Union Against Tuberculosis and Lung Disease (IUATLD) and Royal Netherlands Tuberculosis Association (KNCV) Working Group. Eur Respir J 2002;19:765-75. 24

: 1. 2. : 1. 2. 25

(n=140) n=(140 n n=93 n% n=47 n% p 62.5±24.0 67.0±25.5 61.0±22.2 0.74 9 12 9 101 101 94 0.47 82 58.6% 5255.9% 3063.8% 58 41.4% 4144.1% 1736.2% 0.02* 21 15% 1415.1% 714.8% 51 36.4% 3133.3% 2042.6% / 28 20.0% 1415.1% 1429.8% / 40 28.6% 3436.5% 6 12.8% 0.00* 8 5.7% 1 1.1% 7 (14.9%) 126 90.0% 8793.5% 39 (83.0%) 6 4.3% 5 5.4% 1 ( 2.1%) 0.00* 13092.9% 9298.9% 37 (78.7%) 10 7.1% 1 1.1% 10 (21.3%) 0.61 32 22.9% 2324.7% 9 (19.1%) 91 65.0% 5862.4% 33 (70.2%) 7 5.0% 4 4.3% 3 ( 6.4%) 10 7.1% 8 8.6% 2 ( 4.3%) 0.67 10877.1% 7378.5% 3574.5% 32 22.9% 2021.5% 1225.5% 0.71 11985.0% 8389.2% 3676.6% 21 15.0% 1010.8% 1123.4% 0.12 11783.6 8086.0% 3778.7% 14 10.0 6 6.5% 8 17.0% 9 6.4 7 7.5% 2 4.3% * 26

(n=93) (%) 71 (76.3%) 43(60.6%) 28(39.4%) 56 (60.2%) 37(66.1%) 19(33.9%) 15 (16.1%) 6(40.0%) 9(60.0%) ( *)22 (23.7%) 14(63.6%) 8(36.4%) * 27

n=11 n / / 80.0±19.8 39 92 763.6% 436.4% 327.3% 436.4% 327.3% 19.1% 0 0% 11100% 0 0% 11100% 0 0% 00% 872.7% 327.3% 00% 981.8% 218.2% 11100% 0 0% 872.7 327.3 00 28

(n=129) (%) 13(10.1) 84(65.1) 77(59.7) 1 7(5.4) 0(0) 21(16.3) 17(13.2) 10(7.8) 7(5.4) 4(3.1) 11(8.5) 2(1.5) 2(1.5) 7(5.5) 29

(n=29) / (%) 8(27.6) 13(44.8) 2(6.9) 6(20.7) 30

(n=44) 31

(n=54 1. 24 26 4 0 0 0 4.4 2. 28 20 6 0 0 0 4.4 3. 33 16 5 0 0 0 4.5 4. 31 19 4 0 0 0 4.5 5. 31 20 3 0 0 0 4.5 6. 35 15 4 0 0 0 4.6 7. 18 12 7 0 0 17 4.3 8. 24 13 6 0 0 11 4.4 32

94 3 14 33

34

35

36

37

踨 踨 38

4,5,6 結核病知多少? 結核病是什麼? 1. 結核病是 結核菌 感染所引起的慢 性傳染疾病, 並不會遺傳 2. 結核病可分為肺結核及肺外結核兩 常見症狀有哪些? 咳嗽 咳痰 咳血 胸痛 夜間盜汗 食慾不振 疲倦 體重減輕 發燒等 大類, 其中以肺結核病患人數佔最多 咳嗽體重減輕 如何發現肺結核? 醫師將依臨床症狀 胸部 X 光檢查 痰 液抹片及培養檢查來診斷結核病 肺外結核包括 : 指肺部以外器官的結核病, 包含結核性肋膜炎 結核性腦膜炎 淋巴結核 喉頭結核 脊椎結核 腎結核 腸結核 輸卵管結核 骨結核 副睪丸結核等 肺結核如何傳染? 主要經由空氣傳染 : 如打噴嚏 咳嗽 大聲談話等方式 初期有時並無任何症狀, 但如果咳嗽超過三週, 應立到醫院接受檢查 哪些人最容易罹患結核病? 身體抵抗力降低時較容易罹患結核病, 如酗酒 糖尿病 塵肺症 愛滋病 營養不良 老年人 洗腎病患 曾經做過胃部切除 長期使用類固醇等 39 罹患結核病怎麼辦? 1. 遵照醫師指示規則服藥至少六個月 2. 依規定時間複查胸部 X 光 驗痰及臨床症狀改善判斷是否仍有傳染性 3. 一般只要規則服用抗結核藥物二星期, 即可依醫師指示出院並與家人同住, 但仍需繼續服藥, 並注意環境衛生

服用抗結核藥物有哪些副作用? 皮膚癢 起疹子 胃部不適 噁心 嘔吐 食慾不振 易疲倦 眼白變黃 視力模糊 紅綠燈看不清楚 關節痛 居家注意事項 1. 痰液應吐於衛生紙並丟於有蓋垃圾桶中, 或經由沖水馬桶沖掉 2. 經常打開窗戶, 維持室內空氣流通 3. 打噴嚏 咳嗽時應遮住口鼻 4. 飲食方面採取均衡飲食 當痰液培養沒有結核菌, 肺部病灶穩定 原來的開洞病灶癒合鈣化 纖維化 或完全消失, 才算完成治療 完成治療後, 仍需定期追蹤, 應至少第一年內每半年複查一次, 以後每年複查一次 肺結核病的家人需要檢查嗎? 由於是肺結核病是屬於傳染性疾病, 因此, 家屬都應該接受 X 光檢查, 以便早期發現 早期治療 5. 戒菸 戒酒 祝您早日康復! 24 小時諮詢專線 : 02-29307930 轉 52951 臺北醫學大學 市立萬芳醫院 40

2~4 5~7 8~12 13~14 ( ) X :10:00~12:00 :1:00~5:00 Rifater EMB INAH 1. 2... 1. 2. N95 3. 4. 5. 6. 20~30 130 / 1. 1. 1. 1~2 2.2. 10~14 ( ) 2. 41

1. 2. ( ) ) 4-5 (1) (2) (3) (4) (5) (6) (7) 6-8 4. 3. 42

)02-86621171 / 踨 (1) (2) ( ) ( ) / // / / / // / / 踪 ( ) 踨 ( ) ( 02-29307930 52958 43

/44/3 S872B029 12B 95-08-A 1. 1.1 1.2 2. 3. 3.1 3.2 3.2.1 3.2.2 3.3 3.4 3.5 3.6 3.7 4. 4.1 4.2 4.2.1 F872B002 4.2.2 4.2.3 4.2.4 S872B014 44

/45/3 S872B029 12B 95-08-A 4.2.5 4.2.6 5. : 5.1 F872B002 6. 45

1. 2. 3. 4. 1.2. 3. 4. 1. ( ) 2. 3. 4. 1. X 3. 2. 4. 1. 2. 3. 4. 1.2. 3. 4. 1. 2. 3. 4. 46

1. 2. 3. 1 2 4. 1. 2. 3. 1 2 4. 1. 2. 3. 4. 1. 2. 3. 4. 1. 2. 3. 4. 47

48

1. 2. 3. 4. 5. 6. 7. 8. 49

CVI 3-4/ 100% 1. 4.0 100% 2. 4.0 100% 3. 4.0 100% 4. 4.0 100% 5. 4.0 100% 6. 4.0 100% 7. 3.8 100% 8. 4.0 100% 50