儿童支气管哮喘规范管理疗效观察

目的:研究规范管理对儿童支气管哮喘的疗效。方法:对2006年1月～2007年1月支气管哮喘患儿56例实施系统的哮喘管理计划。结果:支气管哮喘患儿在管理后发作次数、肺功能测定指标、住院次数、平均诊疗费用均优于管理前。结论:规范的管理能减少支气管哮喘患儿发作次数、急诊次数,增强肺功能,减少社会及家庭经济负担。     

儿童哮喘区域性联合管理模式初探*

目的观察儿童哮喘区域性联合管理模式的成效。方法建立规范化的儿童哮喘诊疗管理方案和流程,并与周边3家社区医院组成医学联合体,对哮喘儿童进行区域性联合管理。根据对于随访和管理计划的依从性,将哮喘儿童分为管理组和失管理组,随访管理1年,观察治疗依从性、临床控制情况和医疗费用的差异。结果共入组哮喘儿童161例,其中管理组100例,失管理组61例。管理组中68%患者可完成执行80%以上的医嘱,显著高于失管理组;初诊时管理组的年哮喘发作次数和年住院天数高于失管理组,但纳入管理1年后均显著缩短;同时,肺功能指标FEV1和评价控制水平的ACT评分明显改善,药物总费用和就医成本均显著下降(P0.01)。结论儿童哮喘区域性联合管理模式可有效减少哮喘发作,提高长期治疗的依从性,并节约了医疗费用,值得在基层医院推广完善。     

北京市儿童哮喘对患儿和家庭影响及相关因素分析

目的了解北京市儿童哮喘患病对患儿学习、体育活动及家庭经济负担等的影响。方法采用横断面调查,以2010年第三次全国儿童哮喘流行病学调查中筛选的497名北京哮喘儿童为研究对象,通过统一的问卷调查收集患儿年龄、性别、哮喘发病及治疗对患儿和家庭的影响等信息,并分析其相关因素。结果 14.0%(41/292)的学龄期哮喘患儿因病缺课大于10 d/年,25.9%(75/290)的学龄期患儿完全不参加或只能参加部分体育活动;37.8%(184/487)的患儿家庭哮喘相关医疗总费用大于1万元,27.6%(135/488)的患儿一年最高医疗费用大于5 000元,2.5%(12/489)的患儿家庭不能承受医疗费用;儿童哮喘患病造成19.2%(92/478)的患儿家庭成员缺勤大于10 d/年。有序多分类logistic回归显示,患儿年龄、哮喘发作方式、发作强度和发作总次数是患儿因病缺勤、体育活动受限及家庭相关医疗费用、成员缺勤天数的影响因素(P0.05)。结论北京市儿童哮喘患病可以影响患儿的学习和生活,并给家庭造成一定的经济负担,可通过控制患儿病情、减少哮喘发作次数、控制发作强度来降低其不良影响。     

支气管哮喘患儿母亲的心理健康状况调查

<正>支气管哮喘(简称哮喘)是儿童常见的呼吸道疾病,严重影响儿童的身心健康,其慢性迁延的过程,对患儿及其家庭产生巨大的精神压力和经济负担。尽管世界各国对哮喘的诊疗日益重视,但从世界范围来看,哮喘发病率仍有不断上升的趋势[1]。目前关于患儿情绪心理与哮喘关系的研究较多,涉及家长情绪与哮喘的相关研究较少,特别是儿童哮喘对母亲情绪     

124例支气管哮喘患儿哮喘控制家庭干预情况分析

目的探讨成都儿童专科医院124例支气管哮喘儿童哮喘控制及家庭干预情况。方法选取2015-08/2017-03该院出院后的124例支气管哮喘儿童作为研究对象,随机分为观察组与对照组,各62例,观察组采用以家庭为中心的模式,医护及家长密切配合,积极参与治疗并定期追踪随访,对照组正常就诊随访,1年后观察两组患儿哮喘控制情况及其家庭干预效果。结果 (1)观察组完全控制率为45. 16%,高于对照组的25. 81%(P 0. 05);(2)观察组因哮喘加重住院、因哮喘加重急诊、因哮喘加重请假误课等均低于对照组(P 0. 05),平均住院天数、平均急诊次数低于观察组(P 0. 05),两组的平均误课次数差异无统计学意义(P 0. 05);(3)观察组坚持门诊随访、规律正确用药、参加哮喘防治讲座构成比依次是96. 6%、96. 6%和67. 2%,均高于对照组54. 5%、56. 4%和14. 5%(P 0. 05);(4)观察组家庭哮喘相关知识评分(34. 1±5. 4)分,采取干预措施评分(51. 5±8. 4)分,均高于对照组(32. 3±6. 2)分、(48. 3±7. 5)分(P 0. 05)。结论支气管喘儿童在予以家庭干预后哮喘控制效果明显,提高了家长对治疗的依从性,同时也提高了家长哮喘相关理论知识及干预能力,增强了自我护理能力。     

支气管哮喘患儿家长知信行问卷调查分析

目的 了解支气管哮喘(简称哮喘)患儿家长对哮喘认知情况.方法 对在我院儿科门诊就诊或病房住院的哮喘患儿家长进行问卷调查.结果 共调查68例患儿家长,49.4％的家长答对哮喘本质,52.33％的家长认为哮喘能够控制.79.92％的家长认为哮喘由感冒诱发.68.93％的家长认为长期吸入激素会对孩子的生长发育产生影响.9.62％的患儿使用过峰流速仪,2.88％的患儿使用过儿童哮喘控制测试量表.坚持规范吸入治疗的患儿占40.31％.80.33％的家长通过医院医生的讲解了解哮喘知识.在过去的1年内,67.35％的患儿有喘息发作,每人缺课(22.34±5.23)d,每个家庭误工(17.36±4.55)d.结论 哮喘患儿家长对于哮喘这种疾病的认识有较多不足之处,包括本质、触发因素、自我监测、吸入激素等方面,有待在今后的健康教育中进一步提高认识.     

儿童支气管哮喘社区干预效果研究

目的探讨社区综合管理模式对儿童支气管哮喘的干预效果,为社区防治儿童支气管哮喘提供依据。方法将108例儿童支气管哮喘患儿随机分为对照组和干预组,各54例,对照组采用被动式门诊管理,而干预组采用社区综合管理模式,比较两组的症状、生活质量、肺功能及疗效等指标。结果干预组干预前发作次数、急诊次数、缺课天数与对照组比较差别均无统计学意义（P〉．05）;而干预1年后,干预组的发作次数、急诊次数、缺课天数均明显小于对照组（P〈0.01）,说明干预组患儿经干预后病情有所减轻、生活质量有所提高。干预组干预前的FEV1、PEF％与对照组相比差别均无统计学意义（P〉0．05）;而干预1年后,干预组的FEV1、PEF％均明显高于对照组（P〈0．01）,说明干预组患儿经干预后肺功能指标有明显好转。干预组干预1年的总有效率为92．59％,明显高于对照组的66．67％（P〈0．01）,说明干预组经过干预后患儿的疗效明显得到提高。结论对儿童支气管哮喘患儿实施社区综合管理模式后,可明显降低患儿的发作频率,改善肺功能,提高疗效和生活质量。     

如何有效防治小儿哮喘？

哮喘是儿童常见的慢性呼吸道疾病，近年来其发病率在世界范围内呈上升趋势，发达国家儿童哮喘的患病率高达10％以上。2000年我国儿童哮喘的平均患病率为1．97％，比1990年上升了64．8％。由于哮喘常反复发作，难以根治，所以严重影响患儿的身心健康，也给患儿家长带来了沉重的经济负担和精神压力。然而，小儿哮喘也不是不可战胜的。只要了解哮喘的起因，掌握正确的预防和控制方法．就可以有效地减少哮喘的发病次数，缓解发病程度，逐渐摆脱哮喘的困扰。     

如何有效防治小儿哮喘?

哮喘是儿童常见的慢性呼吸道疾病,近年来其发病率在世界范围内呈上升趋势,发达国家儿童哮喘的患病率高达10%以上.2000年我国儿童哮喘的平均患病率为1.97%,比1990年上升了64.8%.由于哮喘常反复发作,难以根治,所以严重影响患儿的身心健康,也给患儿家长带来了沉重的经济负担和精神压力.然而,小儿哮喘也不是不可战胜的.只要了解哮喘的起因,掌握正确的预防和控制方法,就可以有效地减少哮喘的发病次数,缓解发病程度,逐渐摆脱哮喘的困扰.     

儿童哮喘控制现状及家长对疾病认知水平调查——西安地区单中心研究

目的 了解西安地区儿童哮喘控制现状及患儿家长对哮喘的认知水平,并分析其影响因素,为哮喘规范治疗和管理提供依据.方法 选取在西安交通大学医学院第二附属医院儿童哮喘门诊就诊且哮喘规范化治疗超过6个月的哮喘患儿,采用问卷调查方法,哮喘专科医生与患儿及其家长面对面沟通,可由父母共同参与完成,填写完成后由医生当场核查,并对数据进行统计分析.结果 收集的118例问卷显示:①患儿首次喘息发病年龄平均为5.1±3.7岁,首次喘息发作距确诊哮喘时间为2.3±1.6年;患儿中有55.1%合并过敏性鼻炎、50.0%有湿疹、28.8%有哮喘家族史;②患儿在三甲医院确诊哮喘占67.8%、二级及以下医院确诊占32.2%.89.0%的患儿在哮喘未发作时能够定期复诊,59.3%的患儿在过去12个月内有喘息发作,发作次数平均为4.2±2.5次.78.8%的患儿进行了肺功能检查,32.2%的患儿进行过敏原检测;③51.7%的患儿使用吸入激素与长效β2受体激动剂联合制剂,39.8%单独吸入激素,62.7%的家长选择喘息发作大于3次诊断为哮喘;④家长哮喘知识79.7%来自医生的讲解、44.9%为大众媒体宣传、29.7%为哮喘健康知识讲座.72.9%的家长最希望与医护人员一对一交流获得哮喘知识.结论 通过对儿童哮喘疾病的管理,可改善儿童哮喘的控制与家长对疾病的认知水平.     

Do Rural and Urban Children Have Comparable Asthma Care Utilization?

This study compares asthma-related health care visits and drug therapy for rural and nonrural Kentucky children with Medicaid health insurance in 1995. The 8,634 children with asthma had a mean age of 5.7 years. Ninety-two percent made at least one asthma office visit, and 13 percent were hospitalized. The urban and rural patterns of care for childhood asthma varied in some potentially important ways. Urban children were twice as likely as rural children to see an asthma specialist (5 percent vs. 2.5 percent, P < 0.05), 2.7 times as likely to receive asthma care in an emergency department (19 percent vs. 7 percent, P < 0.01) and 1.4 times as likely to receive oral steroids (16 percent vs. 12 percent, P = 0.04). If given inhaled anti-inflammatory medication, rural children were more likely to receive inhaled steroids while urban children were more likely to receive cromoglycates.     

儿童哮喘门诊192例患儿发病相关因素分析

目的 通过对哮喘患儿发病与治疗的相关因素进行性分析, 了解影响儿童哮喘发病因素和防治状况。方法 对宝鸡市人民医院儿童哮喘专病门诊2009年1月-2010年12月诊治的192例儿童哮喘病患儿临床资料进行回顾性分析。结果 192例哮喘患儿发病以冬季秋季节为主, 冬季42.18%、秋季36.45%, 诱因以吸道感染为诱因63.54%最多见。并过敏性鼻炎有过敏性鼻炎54.6%、有湿疹者50.5%, 家族中一、二级亲属中有哮喘病史28.6%。规范化管理后患儿家长哮喘健康知识掌握明显提高(P均<0.05)。结论 哮喘发病与季节、家族史及个人过敏史等多种因素有密切关系, 对患儿进行系统管理和健康教育是哮喘防治的关键。     

136例社区哮喘儿童系统管理体会

目的：探讨全球哮喘防治创议（GINA）系统管理社区哮喘患儿的效果。方法：对136例哮喘患儿（管理组）社区系统管理前后结果及对照组患儿的结果进行比较。结果：在系统管理前后，管理组对哮喘问卷知识的认识差异有统计学意义（P＜0.01）；管理组吸药技术正确率由指导1次的11.03%，上升至74.26%（指导3次）、94.12%（指导4次）；在系统管理6、12个月后，两组PEF＆gt;80%的比率比较差异有统计学意义（P＜0.01）；两组哮喘发作次数、急诊次数和住院次数比较差异均有统计学意义（P＜0.05）。结论：有效的哮喘防治知识学习班是教育患者的必要形式，正确使用吸药装置是保障疗效的重要环节，用峰流速仪监测PEF是评估和监测严重程度的最佳形式，采用社区与家庭相结合的社区系统管理是长期控制儿童哮喘行之有效的方式。     

儿童哮喘长期管理与控制中健康教育的效果评价

目的探索科学有效地管理对哮喘息儿哮喘控制的影响。方法按照全球哮喘防治的创议，通过举办哮喘知识教育讲座，课后哮喘知识问卷调查，建立个人档案，进行个体化管理，6岁以上患儿记录哮喘日记，使用峰流速仪监测病情变化，哮喘用药技巧培训与比赛，比较长期管理哮喘的模式实施前后患儿控制发作时静脉用药、雾化吸入及长期吸入疗法情况。结果健康教育后家长能够正确认识哮喘的本质，哮喘发作时选用静脉给药途径明显减少，选择雾化吸入治疗比例增高，哮喘用药技巧正确率明显增高，缓解期规则吸入激素治疗比例增高，复诊率增高。结论哮喘长期个体化管理对儿童哮喘的长期控制是有益的。     

Prognostic factors of severe asthma in Puerto Rico

Asthma in Puerto Rico is a serious Public Health Problem. This study extends our cross-sectional self-reported asthma prevalence survey of 3,000 volunteers. The purpose of the present study was to analyze the importance of known prognostic factors of asthma severity among 486 self-reported participants. Patients with more than one visit to the emergency room in the previous 12 months due to asthma exacerbations were classified as cases of "severe asthma", and those asthmatic patients who did not visit emergency rooms were classified as "non-severe asthmatic subjects". Severe cases and non-severe asthmatic subjects were compared regarding age, sex, family history of asthma, presence of household pets, and in the previous 12 months: history of hospitalization due to asthma, respiratory infections, tobacco smoking, exposure to passive smoking, and avoidance of passive smoking. Crude and logistic regression adjusted odds ratio was used as a measure of association between each prognostic factor, and the outcome namely severe asthma, while adjusting for all confounders simultaneously. The results clearly showed that previous hospitalizations due to asthma (OR = 7.3, p < 0.0001) and frequent of respiratory infection (OR = 2.5, p = 0.0003) were prognostic factors associated with increased asthma severity. A statistically significant, two percent less likelihood to have severe asthma for each year of age was found. Weak associations were found between asthma severity and male gender, family history of asthma, passive smoking, and presence of household pets. Avoidance of environmental tobacco exposure (passive smoking) was found to be an important and statistically significant protective factor associated with a 47% less likelihood for severe asthma. In conclusion, appropriate management of patients with history of hospitalization due to asthma is very important. The correct management of respiratory infection in asthmatic patients may result in a reduction of up to 60 percent of the odds of having asthma severe enough to require emergency treatment, and may reduced by 86.3 percent hospitalizations.     

贵阳地区400例哮喘患儿病情控制状况及影响因素分析

目的 了解贵阳地区哮喘患儿病情控制现状及影响哮喘控制的因素,为进一步加强儿童哮喘防治工作提供依据。方法 选取在贵州医科大学附属医院儿科哮喘门诊就诊的病程超过12个月的1~14岁哮喘患儿400例,采用回顾性调查的方法对其家长就哮喘控制状况及疾病认知情况进行问卷调查,以患儿近12个月有无哮喘发作为标准将其分为控制组和未控制组,对可能影响哮喘控制的相关因素进行多因素分析。结果 在过去12个月内,72.5%的患儿有过哮喘发作,35.5%的患儿有过因哮喘发作的急诊治疗,17.8%的患儿有过因哮喘发作导致的住院治疗。家庭经济收入、家长学历、家长认知水平、坚持规范用药、坚持定期复诊是哮喘患儿控制的保护因素;个人过敏史、哮喘家族史、被动吸烟史是哮喘患儿控制的危险因素。结论 贵阳地区哮喘患儿病情整体控制状况并不理想,与全国城市平均水平相比还存在一定的差距。家长对疾病的认知水平、治疗依从性及不良环境的接触等因素是影响哮喘控制的主要危险因素,认识并改善影响因素,有助于提高哮喘控制水平。     

西安地区118例哮喘患儿家长行为调查及其干预效果分析

【目的】 了解西安地区儿童哮喘患儿家长对哮喘认知水平和行为现状,采取有针对性的行为干预措施,并分析其效果,为哮喘规范治疗和管理提供依据。 【方法】 采用问卷形式进行调查,选取本院儿童哮喘门诊就诊且哮喘规范化治疗超过6个月的哮喘患儿。 【结果】 118例问卷显示:1)患儿一般情况:患儿首次喘息发病年龄平均为(5.1±3.7)岁,首次喘息发作距确诊哮喘时间为(2.3±1.6)年;患儿中有50.8%合并过敏性鼻炎、50.6％有湿疹、28.8％有哮喘家族史; 2)哮喘患儿家长行为:56.6%知道在哮喘急性发作时应该吸入速效β2受体激动剂治疗,96.6%在哮喘没有症状时会坚持用药。在选择哮喘长期治疗药物种类时,有51.7%选择吸入激素与长效β2受体激动剂联合制剂、39.6%单独吸入激素、20.6%口服白三烯拮抗剂、13.7%使用抗过敏药物。家长不愿意给患儿使用长期控制哮喘药物原因,60.3%是担心对生长发育产生影响、22.4%是担心对药物产生依赖;3)给予哮喘知识和行为低于平均得分的46例进行干预,干预后家长哮喘知识、态度和行为得分明显提高(P>0.01)。 【结论】 今后应做好哮喘患儿及家长的管理和宣教工作,提高家长的哮喘知识,改善其态度和行为水平,促进患儿的干预效果。     

Understanding frequent emergency room use by Medicaid-insured children with asthma: a combined quantitative and qualitative study

BACKGROUND: Medicaid-insured asthmatic children frequently use emergency rooms (ERs). The reasons are unclear and have predominantly been studied in inner-city populations. METHODS: We used billing data and focus groups to clarify reasons for frequent ER use by Medicaid-insured children with asthma living in rural areas and 23 towns in Kansas. RESULTS: High ER utilization was concentrated in a small percentage of provider practices and children with asthma. Parents expressed strong preference for primary care treatment, and identified real or perceived difficulties in using primary care as the principal reasons for ER use. Difficulties included trouble contacting primary care physicians or obtaining urgent appointments, limited continuity of care, practice systems poorly adapted to patient needs, a perception that physicians preferred patients to use emergency services, and difficulties in obtaining medications. Parents were not aware of preventive measures or case management but reported high interest in these. Parents did not recall provider discussion of asthma risk factors/preventive strategies during primary care visits, although all children with high ER utilization had multiple risk factors, including exposure to high levels of household smoking. CONCLUSIONS: Reducing ER utilization by Medicaid-insured asthmatic children depends on overcoming barriers to effective treatment in primary care and in greater attention to preventive services.     

Parental knowledge and misconceptions about asthma: a controlled study

We interviewed the parents of 128 asthmatic children about their knowledge and misconceptions of asthma. Two-third or more gave correct responses to questions on aetiology and pathogenesis, pathophysiology, symptomatology, precipitants and outcome of asthma. A control group of parents of 110 children admitted to the hospital with minor surgical complaints performed equally well on the knowledge questions, except for four sub-questions: (1) allergy as an aetiologic factor in asthma (64.5% vs 83.6%, P = 0.002), (2) constriction of airways as a bodily change during an asthmatic attack (75.4% vs 91.3%, P = 0.004), (3) cough as a symptom of asthma (82.7% vs 99.2%, P less than 0.001) and (4) change in weather (81.0% vs 95.5%, P = 0.002) or cold weather (60.9% vs 74.2%, P = 0.015) as triggers of asthma. However, a significant minority of both groups of parents were found to harbour misconceptions about asthma. Between 10-20% believed that poor care, inappropriate diet during pregnancy or premature birth can predispose a child to asthma. About one-third believed that bodily changes during an asthmatic attack include loss of control or paralysis of chest muscles, infection of lungs and compression of the lungs by the stomach. Also about one-third believed that swallowing a hard object or touching a poisonous plant can set off an asthmatic attack. Some 10% believed that diarrhoea is a symptom of asthma, while 50% regarded sore throat as a symptom. Up to 40% believed in restriction of outdoor play by asthmatic children.(ABSTRACT TRUNCATED AT 250 WORDS)     

1976～1999年中山市小儿肿瘤发病动态分析

目的 探讨中山市1976～1999年小儿肿瘤发病状况及其规律,为中山市小儿肿瘤防治提供科学依据；方法 搜集整理期间中山市肿瘤登记中的小儿肿瘤发病资料，计算并分析其发病数、发病粗率、中国及世界标化发病率等指标；结果 期间中山市小儿肿瘤发病粗率为74．5／10^6，世界标化发病率为74．3／10^6;虽然期间其总发病率无明显升降趋势，但部分病种如恶性淋巴瘤却有明显升降趋势；白血病、恶性淋巴瘤与脑肿瘤是其最常见小儿肿瘤；结论 期间中山市小儿肿瘤总发病率居1988～1992年国内城市试点小儿肿瘤发病率中等水平，居农村试点较高水平，说明中山市应加强小儿肿瘤防治工作。