【作者】 朱怿东； 周剑锋； 柴建农；

【Author】 ZHU Yidong;ZHOU Jianfeng;CHAI Jiannong;Department of Pediatrics,Changshu No.1 People’s Hospital;Changshu Traditional Chinese Medical Hospital;

【机构】 江苏常熟市第一人民医院儿科； 江苏常熟市中医院；

【摘要】 目的:探讨适合家长的、对无明显感染灶的儿童急性发热的评价方法。方法:制定儿童发热家长评价表,通过对家长及医师培训,结合发热危险度评分,比较应用评价表前后复诊、抗生素使用、居家治疗、输液等情况。结果:全程完成随访186例,既往共计发热336例次,使用过抗生素301例次(89.58%),居家治疗118例次(35.12%),门诊或住院输液218例次(64.88%)。未复诊者12例次(3.57%),复诊324例次(96.43%)。严重疾病19例次(5.65%),未有危重病例。纳入研究后发生发热事件592例次,仅电话告知发热消失未电话咨询或复诊者61例次(10.31%),仅电话咨询未复诊者105例次(17.74%),复诊426例次(71.96%)。儿童发热家长评价表应用前后未复诊患儿比例及复诊次数差异皆有统计学意义(p=0.000);使用过抗生素337例次(56.93%),居家治疗378例次(63.85%),门诊输液或住院输液214例次(36.15%),与进入研究前相比差异有统计学意义(p=0.000)。严重疾病65例次(10.98%),未有危重症发生。讨论:上世纪80年代Schmitt[6]将家长对儿童发热过度焦虑甚至恐惧定义为发热恐怖症(Fever phobia),三十多年来,各国家长对儿童发热依然存在过度恐惧而采取不适当的措施,包括过度就医、滥用抗生素和输液、不恰当使用退热药等[1,7-9]。我们根据相关文献和临床经验制定了儿童发热家长评价表,通过对家长进行充分培训,使家长基本掌握儿童发热的基本知识及正确处理方法。186例患儿纳入研究后,在592例次发热事件中,56.93%使用抗生素,36.15%输液,28.04%未复诊,63.85%居家治疗,与培训前相比差异有统计学意义(p=0.000),复诊次数差异有统计学意义(<0.05),提示我们的儿童发热家长评价表具有较好地指导家长处理无明显感染灶的急性儿童发热,通过适当的培训,家长可以掌握和运用,减少对发热恐怖,避免不必要的就诊。本组研究病例中,186例患儿入组前后928例次发热事件中,严重疾病在5.65%~10.98%,没有危重症病例发生,提示对于无明显感染源的3个月至5岁儿童急性发热,绝大部分为非严重疾病及非危重症疾病,因此,确当合理评估,结合医师的一对一指导(在基层医院更易实现),可减少门急诊就诊次数,减少不必要的输液和抗生素的应用,减少儿童院内感染。对复诊患儿结合发热危险度评分,分类处置,也能避免严重疾病的漏诊。更多还原

【Abstract】 Objectives:Investigate an evaluation method to fit family about acute fever in children without obvious focus.Methods:We instituted the Children Fever Family Evaluation Scales.We compared return visits,use of antibiotics,family therapy and transfusion before and after the application of Children Fever Family Evaluation Scales by training the doctors and families,combining the Fever Risk Scores.Results:336 fever events happened before use of Children Fever Family Evaluation Scales in 186 children.The antibiotics were prescribed in 301 person-time(89.58%),family therapy were used in 118 person-time(35.12%),transfusion were in observation ward or in hospital in 218 person-time(64.88%),12 person-time(3.57%) did not return visits,324 person-time(96.43%) returned visits. 19 person-time(5.65%) had serious diseases,no had critical illness.592 fever events happened after use of Children Fever Family Evaluation Scales in 186 children.The antibiotics were prescribed in 337 person-time(56.93%),family therapy were used in 378 person-time(63.85%),transfusion were in observation ward or in hospital in 214 person-time(36.15%).There were the significant differences between before and after use of the Scales in antibiotics,family therapy and transfusion(p=0.000).166 person-time(28.05%) did not return visits,426 person-time(71.96%) returned visits.There was the significant difference between before and after use of the Scales in visits(p=0.000).65 person-time(10.98%) had serious diseases,no had critical illness.Conclusions:The Children Fever Family Evaluation Scales may help parents handle the acute fever in children without obvious focus and decrease unnecessary visits,antibiotics and transfusions and ensure medical safety.更多还原