【摘要】 目的 探讨基层医院儿童哮喘的管理模式。方法 应用全科医学的管理理念,对2000年1月～2002年10月儿童哮喘专科门诊的465例哮喘患儿进行管理,在对患儿按《全球哮喘防治创议》的基本原则和个体化原则相结合的专科治疗基础上,让患儿、家长及社区医生接受哮喘知识的健康教育。分析比较不同时期患儿、家长和社区医生对哮喘新知识的掌握情况,比较纳入管理前后患儿病情的差异。结果 2001年1月以后就诊的279例与2000年12月以前就诊的186例做比较,就诊前已诊断为哮喘的例数、吸入过气管扩张剂和吸人过皮质激素的例数分别占45.88％(128/279)、21.14％(59/279)、10.03％(28/279)和17.20％(32/186)、4.30％(8/186)、1.16％(3/186),差异均有显著性;使用过峰流速仪者仅分别为1.45％(1/69)和3.30％(4/121),差异无显著性。465例患儿纳入管理前后的年平均哮喘发作次数、因哮喘而住院的平均年人次数和峰流速达正常预计值人数分别为4.23±1.55、0.61±0.59、36/190和0.83±0.86、0.03±0.17、179/190,前后差异有极显著性。结论 运用全科医学管理理念对哮喘患儿进行系统管理,效果显著;但社会科普工作和社区医生的哮喘知识还需进一步加强和提高。更多还原

【Abstract】 Objective To explore management models for asthmatic children in primary hospitals.Methods A total of 465 children with asthma,all of whom were outpatients,were managed according to general medicine principles from January 2000 to October 2002.The children were divided into two groups,depending on whether they were enrolled in the management before or after January 2002 (before:after=186:279).Based on Global Initiative for Asthma and individual requirements,different treatment measures were applied,and all the patients,their parents and community health care workers received education of basic knowledge on asthma.The extent to which the knowledge was grasped by the study populations at different stages was analyzed,and difference in progression of the disease before and after the introduction of management was compared.Results There were significant differences (P<0.005 ) in previously confirmed cases on first visit [45.88% ( 128/279) vs 17.20% (32/168)],cases with inhalation of bronchial expanders [21.14 (59/279) vs 4.30% (8/186)] and cases treated with glucocorticoid [10.03 (28/279) vs 1.16% (3/186)] between two groups.While there was no significant difference in the use of Peak Flow Meter [1.45% (1/69) vs 3.30% (4/121),P>0.05].Of all 465 children,the mean frequency of asthma attack per year,asthma-based mean hospitalization per year and cases with normal predicted value of peak expiratory rate of flow were 4.23±1.55,0.61±0.59,36/190 and 0.83±0.86,0.03±0.17,179/190 before and after the introduction of the management respectively (P<0.01 ~ 0.001).Conclusions The significant impact of systematic management on asthmatic children has been found in this study,and efforts should be made to improve a better understanding of asthma among health care workers in communities.更多还原