医院主动管理模式和患者自我管理模式对哮喘控制和肺功能的对比研究

目的 对比研究医院主动管理模式和患者自我管理模式对哮喘控制和肺功能的作用，提高哮喘管理水平。方法 2009年7-12月连续入选门诊中度哮喘患者40例，按随机数字表法分为医院主动管理组（A组）和患者自我管理组（B组），每组20例，分别以医院主动管理模式和患者自我管理模式给予规范化治疗患者1年。对比研究两组患者急性发作次数、急诊就医次数、住院次数、肺功能、圣乔治呼吸质量问卷(SGRQ)等指标。结果 研究结束时，A组依从性良好19例，疗效满意度评分为(9.300±0.801)分，完全控制13例，部分控制6例，未控制1例；B组依从性良好11例，疗效满意度评分为( 7.800±1.542)分，完全控制6例，部分控制8例，未控制6例。A组患者的依从性、疗效满意度评分和哮喘控制情况优于B组（P＜0.01或＜0.05）。A组第1秒用力呼气容积和最大呼气峰流速分别为(2.56±0.30)L、(6.26±0.39) L/s，明显高于B组的(2.38±0.31)L、(5.83±0.52)L/s，而A组SGRQ为(21.55±6.35)分，明显低于B组的(29.80±12.04)分，差异均有统计学意义(P＜0.05或＜0.01)。结论 医院主动管理模式在患者依从性、哮喘控制、肺功能和呼吸质量改善等方面的效果均优于患者自我管理模式，积极推广医院主动管理模式有利于提高我国哮喘防治水平。

Hospital initiative management or patients self management in asthma control and pulmonary function:a study in contrast

Objective To compare the effect of hospital initiative management or patients self management in asthma control and pulmonary function, and improve the control level of asthma. Methods Forty moderate asthma patients enrolled successfully from July to December in 2009 were divided into 2 groups by random digits table:hospital initiative management group (group A) and patient self management group (group B) with 20 cases each, and received the asthma treatment with hospital initiative management or patient self management for 1 year. The acute attack time, emergency visit time, hospitalization time,pulmonary function and Saint George respiratory questionnaire (SGRQ) were compared between two groups.Results After 1 year management, there were 19 patients in good compliance, satisfaction score was (9.300 ± 0.801 ) scores, 13 total control, 6 partial control and 1 uncontrol in group A, while there were 11 patients in good compliance, satisfaction score was (7.800 ± 1.542) scores, 6 total control, 8 partial control and 6 uncontrol in group B. The compliance, satisfaction and control in group A were much better than those in group B (P＜0.01 or ＜0.05). The forced expiratory volume in 1 second (FEV1)(2.56 ±0.30) L]and peak expiratory flow (PEF)(6.26±0.39) t/s]were elevated while SGRQ(21.55 ±6.35) scores]in group A were better than those in group B(2.38 + 0.31 ) L, (5.83 ± 0.52 ) L/s, (29.80 ± 12.04) scores](P ＜ 0.05 or ＜ 0.01 ). Conclusion The compliance, asthma control, pulmonary function and respiratory quality are improved by hospital initiative management, so it is helpful to promote this management model in China via a close cooperation between general hospital and community hospital.