大连市实施肺结核归口管理的作法与成效

目的　探讨归口管理在结核病控制中的作用。方法 在卫生行政部门的干预下，依据《大连市结核病防治管理办法》开展归口管理工作。对转诊发现的涂阳病例全部予以全程监督化疗。结果 综合医院可疑肺结核报卡由1997年448张上升至2000年2533张。肺结核截留率由1997年74.0%下降至2000年2.8%。1997～1999年登记的新发涂阳病例中转诊发现分别占65.9%、88.0%、90.7%，新发涂阳登记率较归口前上升显著。新发涂阳病人登记满一年转归队列分析，1997～1999年初治涂阳治愈率分别达93.9%，95.3%，94.9%。结论 1 病人发现水平与归口管理力度呈正比。2 综合医院可疑者转诊是发现新发涂阳病例的主要途径。3 归口管理与DOTS是保证新发涂阳病人高发现，高治愈的有效措施。

The situation andeffectiveness of pulmonary tuberculosis convergence case-management in Dalian

Objective　To explore the role of convergence case-management in tuberculosis control.Methods　Start the work of convergence case-management according to ‘The Management Methods of Prevent and Treatment Tuberculosis in Dalian’ under administrative intervention. All cases with smear positive were treated by the directly observed chemotherapy.Results　The report cards of suspicious pulmonary tuberculosis cases increased from 448 pieces in 1997 to 2533 in 1999. The retain rate declined from 74.0% in 1997 to 2.8% in 1999. In 1997～1999, the proportion of the transfer finding cases in the new smear-positive case was 65.9%, 88.0% and 90.7% respectively. The annual register rate of new smear-positive was markedly increased than that before conduct the work of convergence case management. In 1997～1999, The cure rate of new smear-positive case was 93.9%, 95.3% and 95.0% respectively. Conclusion　1. The level of cases finded is in direct proportion to the convergence case-management. 2.Convergence case-management plays a major role in the new smear-positive case finding. 3.Convergence case-management and DOTS is a useful measure to improve case finding rate and cure rate of new smear positive cases.