提高肺结核病人发现率的措施研究

目的 探索提高肺结核病人发现率的新途径，加速病人发现工作进程。方法 在2002年度肺结核病人发现工作较差的40个县（市），每个县（市）选择1家门诊量最大的综合医院和结核病防治中心（疾病预防控制中心）作为研究项目实施单位。由结核病防治中心对综合医院门诊、放射科、检验科、保健科等相关专业人员进行业务技术培训。并就病人就诊、痰涂片检查、诊断、登记、报告、转诊和落实免费治疗等工作规范进行管理。结果 2003年10月-2004年9月期间。40个县（市）综合医院门诊各相关科室均建立了病人登记、报告和转诊工作制度，设立了相对独立的痰结核菌检验室，对肺结核可疑症状者查痰率达到51．0％，涂阳检出率为15．5％，病人转诊率为30．1％。40个县（市）累计发现新涂阳肺结核病人12193例，是2002年的2．1倍（12193／5836），是项目实施前一年同期（2002年10月。2003年9月）的1．5倍（12193／8228）。病人发现率由2000年的41．4％提高到86．2％，其中综合医院对项目县（市）涂阳病人发现占11．4％。结论加强结核病防治中心与综合医院合作，特别是加强肺结核病人和肺结核可疑症状者的转诊和追踪调查，能够快速地提高病人发现的数量和质量。但必须建立健全结核病防治法律法规，完善对综舍医院的补偿机制，加强对相关专业人员的培训，才能使综舍医院在结核病防治工作中发挥更大的作用。

Study on enhancement of TB case detection rate through strengthening the collaboration between general hospital and TB control center

Objective To explore the new approach to increase case detection of tuberculosis and realize the targets declared by WHO. Methods One TB dispensary (Center for Disease Control and Prevention, CDC ) and one general hospital in each county among 40 counties where the case detection rate was low in 2002 are involved in this project. Work procedures regarding case check, diagnosis, registration, notification, and referral are established in both TB dispensary and hospital. TB staff is responsible for training , technical guidance, supervision, and laboratory quality control of hospital. It is requested that hospital should offer TB suspects sputum smear examination free of charge, and refer the TB patients diagnosed to TB dispensary for further therapy and management. Results A series of systems regarding case registration, notification, and referral have been set up at outpatient departments a-mong 40 county hospitals. A relatively separate laboratory for sputum smear has also been established and launched at each hospital. 51.0% of TB suspects received sputum smear examination in hospital, among which 15.5% are smear positive. 30.1% of TB patients are referred to TB dispensary. From Oct. 2003 to Sept. 2004, 12193 new smear positive TB cases are detected in 40 counties, which is 2.1 times as many as the number of cases detected in 2000. Case detection rate is increased from 41.4% to 86.2% . 11.4% of case detection in the county is attributed to hospital. Conclusion To strengthen the cooperation between TB dispensary and hospital, especially to strengthen the referral and tracing of TB patients and suspects, can notably accelerate case detection of TB. However, relative laws and regulations on TB control must be issued by government and implemented thoroughly. The personnel in hospital should be trained again and again. In this way, general hospital will play more and more roles in TB control and prevention.