“儿童哮喘健康之家”健康教育对学龄期患儿的干预效果评价

目的评价开展"儿童哮喘健康之家"健康教育活动对学龄期哮喘患儿的干预效果。方法将66例学龄期哮喘患儿分为干预组和对照组(延迟干预组)各33例,干预组患儿于2011.3.12-2011.6.12参加为期3个月的"儿童哮喘健康之家"健康教育活动,对照组患儿延迟到3个月后参加。采用一秒钟用力呼气量(FEV1)和最大呼气峰流速值(PEF)测定患儿的肺功能;Piers-Harris儿童自我意识量表(Children’s self-concept Scale,PHCSS)测评患儿自我概念水平;儿科哮喘生存质量调查问卷(PAQLQ)测评患儿生存质量。比较干预前后两组组内和组间各数值的变化情况。结果 3个月后干预组患儿的FEV1和PEF值有所提高(P<0.05),患儿的肺功能得到改善;干预前后,干预组患儿PHCSS得分和PAQLQ得分组内比较差异有统计学意义(P<0.01),而对照组患儿得分组内比较差异无统计学意义(P>0.05),同时,治疗后干预组患儿得分明显高于对照组患儿得分(P<0.01),干预组患儿的自我概念水平和生活质量明显提高,优于对照组患儿。结论 "儿童哮喘健康之家"健康教育活动适合学龄期儿童这一特殊群体,有利于改善患儿的肺功能状态,提高自我概念水平和生活质量,更好地控制哮喘发作,利于患儿的成长和自我发展。     

儿童哮喘症状控制分级治疗及规范化管理在临床实践中的意义

目的探讨儿童哮喘控制测试(C-ACT)、肺功能指标对儿童哮喘症状控制分级治疗及规范化管理疗效的评定。方法选择2016年12月-2018年12月期间在医院儿科门诊就诊的150例哮喘患儿,采用随机数表法分为常规组和标准组,每组各75例,两组患儿在入组时均处于非急性发作期,均给予糖皮质激素吸入治疗,常规组仅进行哮喘控制测试,不采用哮喘控制测试评分来调整药物治疗方案,标准组患儿采用哮喘控制分级评分来调整药物治疗方案,并给予规范化管理,定期对患儿哮喘急性发作情况、哮喘控制测试以及肺功能等情况进行专科回访,对比两组治疗后哮喘急性发作患儿例数、治疗后各时间段哮喘控制测试及肺功能情况。结果随访12个月,平均每个患儿每年随访2.5次,两组患儿共复诊375次,常规组患儿降级145次,升级35次,急性发作次数180次;标准组患儿降级70次,无升级,急性发作次数70次,标准组患儿降级、升级及急性发作次数均多于常规组,两组差异有统计学意义(P0.05);两组患儿治疗前、治疗1个月、治疗3个月、治疗6个月哮喘控制测试评分、FEV1以及MMEF差异无统计学意义(P0.05);标准组治疗9个月、治疗12个月哮喘控制测试评分、FEV1以及MMEF显著高于常规组,差异有统计学意义(P0.05)。结论儿童哮喘症状控制分级治疗及规范化管理可有效控制哮喘急性发作,促进患儿病情恢复。     

延续性护理干预对学龄期哮喘患儿病情控制的效果研究

目的 探讨延续性护理干预对学龄期哮喘患儿病情控制的效果研究。方法 选择2017年6月—2018年6月期间在某院就治的学龄期哮喘患儿88例,采用随机数表法分为2组,每组各44例。对照组患儿进行常规随访,观察组则实施延续性护理干预,为期6个月。评价2组疾病控制效果、家属疾病认知及患儿肺功能。结果 观察组患儿哮喘发作持续时间短于对照组,发作次数、再就医次数、再住院次数均低于对照组,家属疾病认知度高于对照组,差异均有统计学意义(P<0.05);护理6个月后,观察组一秒用力呼气容积占预计值百分比(FEV1%)为(88.6±6.5)、最大呼气流量占预计值百分比(PEF%)(85.9±6.4)高于对照组,差异有统计学意义(P<0.05)。结论 延续性护理干预能够提高学龄期哮喘患儿家属疾病认知,利于改善患儿肺功能,增强病情控制效果。     

鼻病毒感染诱发儿童哮喘急性发作时血清粘附分子水平及意义

【目的】 了解鼻病毒(rhinovirus,RhV)感染诱发儿童哮喘急性发作时血清可溶性细胞间粘附分子-1(solube intercellular adhesion moleculet,sICAM-1)水平变化及意义。 【方法】 用逆转录聚合酶链反应(RT-PCR)方法对哮喘急性发作儿童呼吸道RhV检测,筛选出39例RhV阳性患儿(研究组),正常儿童31例(对照组),采用 ELx800酶标仪酶联免疫吸附试验法检测两组儿童的血清sICAM-1水平。 【结果】 研究组sICAM-1水平结果为(229.57±59.19) μg/mL, 对照组sICAM-1水平结果为(198.92±49.74) μg/mL,两组比较差异有统计学意义(P<0.05)。 【结论】 鼻病毒感染诱发儿童哮喘急性发作时血清粘附分子表达水平升高,可能是导致哮喘儿童气道炎症和气道高反应的重要炎症因子之一。     

呼出气一氧化氮检测对儿童哮喘的临床意义

目的探讨呼出气一氧化氮(ENO)检测在儿童哮喘控制评估中的临床价值。方法 120例哮喘患儿,根据儿童哮喘控制测试(C—ACT)评分,分为哮喘未控制组(C—ACT<20分)50例和哮喘控制组(C—ACT≥20分)70例;120例哮喘患儿,根据2014版GINA指南分为重度组38例、中度组46例及轻度组36例、30例健康儿童为对照组。所有研究对象均进行ENO和肺功能(FEV1%、PEF%)检测,分析ENO水平与FEV1%、PEF%的相关性。结果哮喘控制组、非控制组及对照组3组组间ENO水平比较差异均有统计学意义(F=90.72,P<0.05);重度组、中度组、轻度组及对照组4组纽间ENO水平差异具有统计学意义(F=1123.78,P<0.05);哮喘非控制组、控制组、重度组、中度组和轻度组ENO水平与肺功能FEV1%和PEF%均无相关性(r值介于-0.097^-0.027,均P>0.05)。结论 ENO是气道炎症反应的良好指标,可作为监测儿童哮喘严重程度及控制状况的指标。     

哮喘患儿嗜酸性粒细胞、IL-4及IFN-γ检测的临床意义

目的 探讨哮喘患儿诱导痰中嗜酸性粒细胞与哮喘发病的关系, 血清中IL-4和IFN-γ水平变化在哮喘患儿中的意义, 完善儿童哮喘临床诊断方法。方法 选取2011年2月-2012年6月在本院儿科住院的急性发作期哮喘患儿69例, 及同期在院体检的健康者42例为对照, 对两组受试者进行肺功能测试、痰液的诱导和处理, 计数嗜酸性粒细胞百分率、采用酶联免疫吸附实验法(ELISA)检测血清中IL-4和IFN-γ水平。结果 与正常对照组相比, 哮喘组FEV1%和FEV1占预计值%等肺功能指标明显降低(P<0.05), 而嗜酸性粒细胞百分率明显提高(P=0.009);哮喘组IL-4水平明显高于对照组(P=0.012), IFN-γ水平明显低于对照组(P=0.020), 差异均有统计学意义(P<0.05)。结论 嗜酸性粒细胞增加、IL-4水平明显升高、IFN-γ水平降低与儿童支气管哮喘的发生与发展有密切关系, 可以结合肺功能指标更好地完善儿童哮喘的临床诊断方法。     

中性粒细胞与淋巴细胞比值在儿童支气管哮喘急性期的临床应用价值

目的探讨中性粒细胞/淋巴细胞比值(NLR)在儿童支气管哮喘急性期的变化及临床意义。方法选取儿童支气管哮喘者240例,其中哮喘急性发作期114例,哮喘临床缓解期126例,同时选取130例健康体检儿童作为对照组;根据急性发作期病情严重程度,将哮喘急性发作期患儿分为轻度发作组(n=48)、中度发作组(n=36)和重度发作组(n=30),记录患者一般临床资料,并抽取空腹血标本测定血常规,计算NLR,对所有研究者进行肺功能检测。结果与对照组和哮喘临床缓解组相比,哮喘急性发作组患儿中性粒细胞计数(NC)和NLR均升高,淋巴细胞计数(LC)降低,差异均有统计学意义(P 0. 05),而对照组和哮喘临床缓解组间无明显差异;重度发作组NLR高于轻度发作组和中度发作组,并且中度发作组NLR也高于轻度发作组(P 0. 05); Pearson相关分析提示,在哮喘急性发作期患儿中,NLR与FVC、FEV1及FEV1占预计值百分比均呈负相关(r值分别为-0. 196、-0. 208、-0. 219,P 0. 01); Logistic回归模型矫正一些危险因素后,NLR仍然是儿童哮喘急性发作的危险因素(OR=2. 743,95%CI:2. 001～4. 381,P 0. 05)。结论儿童哮喘急性发作者NLR升高,NLR与儿童哮喘急性发作及病情严重程度密切相关。     

脉冲振荡肺功能在儿童哮喘治疗中的监测意义

【目的】探讨脉冲振荡（impulse oscillometry，IOS）肺功能在儿童哮喘治疗中的监测意义。【方法】应用Master Screen系列肺功能测定系统，对不同病组哮喘患儿（发作组42例，缓解组34例）及正常对照儿童（32例）进行IOS测试，其中学龄期患儿（发作组36例，缓解组30例）及正常对照儿童（30例）同时进行常规肺功能（pulmonary function test，PFT）测试。【结果】IOS及PFT测试，发作组与缓解组比较，除R20外，其它各指标差异皆有显著性；缓解组与对照组比较，R5-R20、Fres、FEF25～75差异有显著性（P〈0.05或〈0．01）。发作组R5—R20异常率达95.24％，FEF50异常率达91．67％，缓解组R5-R20异常率达76．47％，FEF75达66.67％。发作组Zrs与FVC；R5-R20与FEF25～75；Fres与FEV1．0皆呈负相关（r=-0．39～-0．64），X5与FEF50、FEF75呈正相关（r均=0．41，P〈0．05）。【结论】IOS和PFT之间有良好相关性，IOS可作为儿童哮喘（尤其是学龄前儿童）治疗评价中的最佳监测指标。     

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。     

血清硒水平与儿童哮喘关系的病例对照研究

【目的】评估血清硒水平与儿童哮喘之间的相关性。【方法】随机选取本院就诊的82名哮喘儿童,并1∶1配比健康儿童,分别测定其血清硒水平。【结果】哮喘组儿童血清硒水平显著低于对照组[(62.1±10.1)vs(75.3±11.2)μg/L](P0.05);而硒缺乏患病率则高于对照组(47.6%vs31.7%)(P0.05)。不同哮喘发作程度的儿童其血清硒水平以及硒缺乏患病率均差异无统计学意义(P0.05)。儿童血清硒水平与哮喘发作次数曾明显负相关(r=-0.436,P0.001),而与儿童的年龄、身高以及体重等指标并无显著相关性(P0.05)。【结论】血清硒可能与儿童哮喘的发生发展有关;硒缺乏可能是儿童哮喘的危险因素。     

Occupational asthma in the city of São Paulo, 1995-2000, with special reference to gender analysis

BACKGROUND: Occupational asthma (OA) is the leading occupational respiratory disease in the area of S?o Paulo Municipality. Understanding its characteristics can provide useful information for better interventions. METHODS: From a joint registry of OA from five outpatient public clinics for occupational respiratory diseases, data on occupation, with job titles corrected by an expert evaluation, agents, exposure and symptom duration, and spirometry were analyzed by gender. Data on employment for S?o Paulo Municipality were used to calculate expected ratios for men/women in broad economical sectors. RESULTS: Three hundred and ninety four OA cases were reported with a ratio of men/women of 1.5. Women had significantly shorter exposure duration (5.6 +/- 5.2 vs. 8.9 +/- 9.0 years, P = 0.0005), shorter symptoms duration (2.6 +/- 3.7 vs. 3.2 +/- 3.5 years, P = 0.1270), and higher prevalence of previous atopy (27.0 vs. 18.4%, P = 0.0485). The main occupations related to OA cases were cleaning activities, working in plastics manufacture and in chemical and pharmaceutical plants. Women reported significantly more exposures to cleaning products, biologic agents, and textile fibers, whereas men reported more exposures to isocyanates, metal dusts and fumes, oil mists, wood dusts and anhydrides. Women presented an increased risk of OA in the service sector (odds ratio (OR) = 1.77, confidence interval (CI) = 1.61-1.96). CONCLUSIONS: Cleaning services was the main reported occupation and cleaning products the main reported agents. Women had significantly shorter exposure duration possibly due to difference in exposures, previous atopy, and behavior. There was an excess of cases of women in the service sector.     

Isocyanate Medical Surveillance: Respiratory Referrals From a Foam Manufacturing Plant Over a Five‐Year Period

This study assesses the causes of medical surveillance changes leading to specialist referral from one isocyanate‐using company where 39 workers (about 20% of all employees) were referred to a hospital occupational clinic during a 5‐year period for concerns regarding their surveillance respiratory questionnaire or spirometry results. The respiratory assessment determined that the questionnaire had detected 5 workers with non‐occupational asthma, 2 with possible occupational asthma (OA), and 1 with subsequently confirmed OA, while no additional asthmatics were detected by spirometry without questionnaire findings. The surveillance questionnaire in this study was sensitive but not specific (no additional compensation claims for OA were made during this time period): workplace spirometry, however, did not add to the detection rate of asthma. Am. J. Ind. Med. 35:87–91, 1999. © 1999 Wiley‐Liss, Inc.     

Occupational exposures associated with work-related asthma and work-related wheezing among U.S. workers

BACKGROUND: National estimates of occupational asthma (OA) in the United States are sparse. METHODS: Using data from the Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994, we analyzed associations between occupation and work-related asthma and work-related wheezing among U.S. workers. RESULTS: This study identified several occupations that were at risk of developing work-related asthma and/or wheezing, with cleaners and equipment cleaners showing the highest risks. Other major occupations identified were farm and agriculture; entertainment; protective services; construction; mechanics and repairers; textile; fabricators and assemblers; other transportation and material moving occupations; freight, stock, and material movers; and motor vehicle operators. The population attributable risks for work-related asthma and work-related wheezing were 26% and 27%, respectively. CONCLUSIONS: This study adds evidence to the literature that identifies work-related asthma as an important public health problem. Several occupations are targeted for additional evaluation and study. Of particular interest are cleaners, which are being increasingly reported as a risk group for asthma. Future intervention strategies need to be developed for effective control and prevention of asthma in the workplace.     

Characteristics of work related asthma: results from a population based survey

Objectives

Many risk factors for asthma have been investigated, one of which is the workplace. Work related asthma is a frequently reported occupational respiratory disease yet the characteristics which distinguish it from non‐work related asthma are not well understood. The purpose of this study was to examine differences between work related and non‐work related asthma with respect to healthcare use and asthma control characteristics.

Methods

Data from the Massachusetts Behavioral Risk Factor Surveillance System for 2001 and 2002 were used for this analysis. Work related status of asthma was determined by self‐report of ever having been told by a physician that asthma was work related. Healthcare measures evaluated were emergency room visits and physician visits for worsening asthma and for routine care. Characteristics of asthma control evaluated were frequency of asthma symptoms, asthma attacks, difficulty sleeping, and asthma medication usage in the last 30 days and limited activity in the past 12 months.

Results

The prevalence of lifetime and current asthma in Massachusetts were 13.0% and 9.2%, respectively. Approximately 6.0% (95% CI 4.8 to 7.3) of lifetime and 6.2% (95% CI 4.7 to 7.8) of current asthma cases were work related. In the past 12 months, individuals with work related current asthma were 4.8 times (95% CI 2.0 to 11.6) as likely to report having an asthma attack, 4.8 times (95% CI 1.8 to 13.1) as likely to visit the emergency room at least once, and 2.5 times (95% CI 1.1 to 6.0) as likely to visit the doctor at least once for worsening asthma compared to individuals with non‐work related asthma.

Conclusions

Work related asthma is associated with increased frequency of asthma attacks and use of healthcare services. A better understanding of factors that contribute to differences in healthcare use and asthma control is needed to improve prevention and control strategies for individuals suffering from the disease.     

Acute Asthma Exacerbations and Air Pollutants in Children Living in Belfast,Northern Ireland

The incidence of childhood asthma, a common condition, is on the rise worldwide. Despite reductions in the emission of urban smoke, traffic pollution is now a major worldwide problem. Belfast, Northern Ireland, is an old industrial city with major pollution problems. In this study, the authors investigated the rates of acute asthma admissions to Belfast's major children's emergency department. The admissions were studied, relative to day-to-day fluctuations in thoracic particulate matter, sulfur dioxide, nitrogen dioxide, nitric oxide, oxides of nitrogen, ozone, carbon monoxide, benzene, temperature, and rainfall. Daily admissions for acute asthma at the emergency department of the Royal Belfast Hospital and average daily pollution were recorded for the 3-yr period between January 1, 1993, and December 31, 1995. The authors used Poisson regression to assess independent association(s). Individually, small associations were seen for thoracic particulate matter (relative risk = 1.10), sulfur dioxide (relative risk = 1.09), nitrogen dioxide (relative risk =1.11), nitric oxide (relative risk = 1.07), oxides of nitrogen (relative risk = 1.10), carbon monoxide (relative risk = 1.07), and benzene (1.14); no associations were noted between meteorological factors (temperature and rainfall) or ozone and asthma emergency-department admissions. The authors adjusted for the aforementioned parameters, and benzene level was the only variable associated independently with asthma emergency-department admissions in children. Benzene may be a more reliable method of measuring exposure to vehicle exhaust emissions than measurements of other pollutants.     

江苏地区尘螨暴露、尘螨过敏在外源性哮喘中的作用

1992年7月至1993年4月于江苏地区用病例对照研究的方法着重对尘螨暴露、尘螨过敏与外源性哮喘的联系进行非条件Logistic回归分析。以对象床褥上鸟嘌呤含量为尘螨暴露水平的指标,血清中尘螨特异性IgE为尘螨过敏的指标。结果表明:尘螨暴露、尘螨过敏、双亲过敏史和出生于高螨密度月份均与外源性哮喘发生有显著联系。尘螨暴露的人群归因危险度百分比(PAR%)达70.29%。据此,对外源性哮喘的防治提出了建议。     

Classifying asthma severity: prospective symptom diary or retrospective symptom recall?

We used an observational within-subject control study at an inner-city school to compare asthma severity classification obtained by retrospective symptom recall with that obtained by a prospective symptom diary. The prospective symptom diary identified a higher proportion of persistent asthmatics than the retrospective symptom recall.