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研究生:鄭心宜
研究生(外文):ZHENG, XIN -YI
論文名稱:東部某醫學中心2011-2015年結核病病人死亡相關性因素探討
論文名稱(外文):The Correlation Factors of Tuberculosis Deaths in a Medical Center in Eastern Taiwan
指導教授:章淑娟章淑娟引用關係
指導教授(外文):CHANG, SHU-CHUAN
口試委員:李仁智彭少貞
口試委員(外文):LEE, JEN-JYHPERNG, SHOA-JEN
口試日期:2019-01-17
學位類別:碩士
校院名稱:慈濟大學
系所名稱:護理學系碩士班
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:2019
畢業學年度:107
語文別:中文
論文頁數:102
中文關鍵詞:結核病個案管理致死率
外文關鍵詞:tuberculosiscase managementfatality rate
相關次數:
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目的:本研究的目的在探討結核病病人死亡相關因素與預測因子,分析病人人口學特性、疾病嚴重度、共病、藥物副作用等因素與死亡之間的差異性。期能盡早發現並提供照護,以降低結核病病人死亡。
研究方法:本研究採病歷回溯性研究設計,以某醫學中心2011-2015年治療的結核病病人為研究對象,回溯病歷收集相關資料後,以SPSS 20.0版for Windows進行統計分析,以邏輯斯迴歸分析進行死亡相關因子的風險預測。
研究結果:本研究結果發現年齡>=65歲比<65歲增加2.07倍死亡風險(p=.007);男性死亡風險是女性的2.19倍(p=.008);共病結果顯示共病越多,死亡風險越高(p=.001);而治療期間有發生肝炎副作用者較無肝炎副作用增加1.91倍死亡風險(p=.012),且有喝酒史發生肝炎副作用的風險是無喝酒史的1.80倍,具顯著差異(p=.001),有肝病病史者發生肝炎副作用風險是無肝病病史的3.56倍,具有顯著差異(p<.001);而無發生皮膚過敏死亡風險是皮膚過敏的5.35倍(p=.006)。而教育程度、初次痰液塗片結果、初次痰液塗培養結果部分雖也具有死亡風險,但經調整其他變項後則與死亡不具顯著差異。而居住在花蓮非山地鄉死亡風險是山地鄉的2.22.倍(p=.005),結果發現>=65歲者、初次痰塗片陽性、初次痰培養陽性、有癌症病史、有肝病病史都是居住在非山地鄉比例高於山地鄉,這可能是導致本研究非山地鄉死亡風險高於山地鄉之因素。
研究建議:有喝酒史或肝病病史者,會增加治療期間發生肝炎副作用的風險,肝炎副作用會增加死亡風險,故建議在病人治療期間,應確實依疾病管制署建議進行肝炎監測,而個案管理師也應將酒精影響肝炎的風險納入衛教中,以期降低個案因肝炎而影響藥物使用及治療療程。

Purpose: The purpose of this study is to explore the death-related factors and
predictive factors of tuberculosis patients, and to analyze the differences in their death
due to the demographic characteristics of patients, disease severity, co-morbidity, drug
side effects and other factors. It is hoped that early detection and care can be provided
to reduce the death of tuberculosis patients.
Research Method: This study adopted retrospective chart review study design. TB patients treated in a medical center from 2011 to 2015 were taken as research objects. After collecting the relevant data from retrospective cases, SPSS 20.0 for Windows was used for statistical analysis, and logistic regression analysis was used for the risk
prediction of death-related factors.
Research Results: The results of this study showed that the risk of death was 2.07
times higher for the age of >=65 than the age of <65 (p=.007); the risk of death for men was 2.19 times higher than that for women (p=.008); the results of co-morbidity indicated that the more co-morbidity, the higher the risk of death (p=.001). And, the risk of death for patients with hepatitis side effects during treatment was 1.91 times higher than that without hepatitis side effects (p=.012), and the risk of hepatitis side effects with drinking history was 1.80 times higher than that without drinking history, with significant difference (p=.001). The risk of hepatitis side effects for patients with liver disease history was 3.56 times higher than that without liver disease history, with significant difference (p<.001); the risk of death without skin allergy was 5.35 times than that with skin allergy (p=.006). However, although the education level, the results of initial sputum smear and the results of initial sputum smear culture also had the risk of death, there was no significant difference in death after other variables were adjusted. The death risk of patients living in non-mountainous villages in Hualien County was 2.22 times (p=.005) higher than that of those living in mountainous villages. The results showed that the proportions of the first sputum smear positive, the first sputum culture positive, the history of cancer, the history of liver disease and the age were higher for the patients living in non-mountain townships than those living in mountainous villages, which may be the factor leading to the higher death risk of the patients in non-mountainous villages than that of those in mountainous villages in this study.
Research Suggestions: The risk of side effects of hepatitis during treatment will
increase for those with a history of alcohol consumption or liver diseases, and the side
effects of hepatitis will increase the risk of death. Therefore, it is suggested that
hepatitis monitoring should be carried out in accordance with the recommendations of
Centers for Disease Control, and case managers should also incorporate the risk of alcohol related hepatitis into health education, so as to reduce the impact of hepatitis on drug use and treatment in all cases.

第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究目的 2
第三節 研究問題 2
第四節 研究假設 2
第五節 名詞界定 3
第六節 研究概念與架構 6
第二章 文獻查證 7
第一節 結核病概論 7
一、結核病歷史 7
二、結核病病理機轉 7
三、結核病治療的演進 8
第二節 結核病流行概況 8
第三節 結核病治療結果概況 10
第四節 影響結核病死亡之因素 12
第三章 研究方法 35
第一節 研究設計 35
第二節 研究場所 35
第三節 研究變項與測量工具 36
第四節 研究流程 43
第五節 統計分析 43
第六節 研究對象與權益保護 44
第四章 研究結果 44
第一節2011年至2015年研究對象治療結果及死亡個案存活時間 45
第二節 研究對象之人口學屬性、疾病嚴重度、共病、藥物副作用以及治療結果 46
第三節 死亡與人口學屬性、疾病嚴重度、共病、藥物副作用各類別變項之差異性 62
第四節 以二元邏輯斯迴歸分析進行各類別變項與死亡風險之差異性 68
第五節 影響肝炎副作用之風險因素 73
第五章 討論與結論 75
第一節 結核病治療結果 75
第二節 結核病病人開始治療至死亡的存活時間 76
第三節 死亡個案人口學屬性探討 77
第四節 死亡個案疾病嚴重度探討 80
第五節 死亡個案共病探討 82
第六節 死亡個案藥物副作用探討 84
研究限制與建議 86
參考文獻 87

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