Causes of Death of Notified Tuberculosis Patients from 2000-2004 in a Medical Center in Taipei

北部某醫學中心2000-2004年肺結核通報病例之死因分析

郭立國(Li-Kuo Kuo) ； 林榮祿(Rong-Luh Lin) ； 林芳杰(Fung-J Lin) ； 吳健樑(Chien-Liang Wu) ； 索任(Jen Suo)

《胸腔醫學》 22卷5期 (2007/10) Pp. 305-312

https://doi.org/10.29806/TM.200710.0001

摘要

前言：肺結核是臺灣最重要的傳染性疾病。雖然已經有有效藥物治療，在臺灣肺結核的死亡率和西方國家比較，仍顯偏高。如何降低肺結核死亡率，是政府和民間刻不容緩須解決的難題。因此我們分析本院過去五年內，本院通報且死在本院的肺結核病患，希望能明白造成肺結核病人死亡的真正原因，並思考因應之道。
方法：我們回溯性分析2000至2004年通報之肺結核確診死亡病患。依照肺結核對病人死亡之影響：分為肺結核為主要死因，或肺結核為共同死因，或肺結核與病人死亡不相關三組。再進一步分析其細因。
結果：一共有102位病患進入分析。其中有64位為治療過程中死亡，有38位肺結核是在死亡後診斷。這102位病人中，以肺結核為主要死因者有31位(30%)，肺結核為共同死因者有45位(44%)，肺結核與病人死亡不相關者有26位(26%)。在38位肺結核在死亡後診斷的病人中，有百分之六十七胸部X光呈現多肺葉浸潤，肺炎是死亡時最常見的診斷。
結論：本院死亡的肺結核病人中，以肺結核為共同死因者占較多數，而以肺結核為主要死因者占較少數。有三分之一病人，肺結核是在死亡後才診斷。這些病人X光大多有多肺葉浸潤。臨床提高警覺，輔以更快速的診斷方法，設法及早診斷，應可降低肺結核病人死亡率。

關鍵字

結核病 ； 死因分析

並列摘要

In Taiwan in 2003, the incidence of tuberculosis (TB) was 66.67 per 100,000 residents, with a mortality rate of 5.80 per 100,000 residents; this is still a very high mortality rate. A retrospective analysis of the causes of death of reported TB patients who died from 2000-2004 was performed; 102 patients with definitely active TB died during this period: 64 (63%) died of TB while on treatment, and 38 (37%) had a postmortem diagnosis of TB, based on positive culture reports. TB was considered to be the principal cause of death in 31 (30%) of the 102 patients, a contributing cause in 45 (44%), and unrelated in 26 (26%). Among the 38 patients with whom a postmortem diagnosis of TB was made, the mean hospital stay was 14.2 (range, 2 to 38) days. Severe pneumonia (53%) was the most commonly diagnosed cause of death in these patients, and multiple lobar infiltrates were the most common chest X-ray findings (67%).
In conclusion, TB was the principal cause of death in only 30% of TB patients who died, though TB was a contributory factor in most patients. One-third of patients had a postmortem diagnosis of TB. The presence of multiple lobar infiltrates should alert clinicians to the possibility of TB. More rapid and reliable diagnostic methods for TB are urgently needed.

並列關鍵字

tuberculosis ； cause of death