儿童哮喘相关教育的随机对照试验

Education on Asthma for Children and Caregivers:a Randomized, Controlled Trial

目的探讨哮喘相关教育对儿童哮喘的疾病状态和生活质量改善的有效性。方法对245例9～13岁活动期哮喘患者及照顾者进行哮喘相关教育,每例患者及照顾者教育3次,每次进行45分钟。干预分为3组:仅对患者进行教育(Ch组),仅对照顾者进行教育(Cc组),患者和照顾者均进行教育(Ch-Cc组)。教育进行3月后对患者哮喘急性发作次数,入院率,生活质量进行评估。结果各组教育后哮喘急性发作均有减少,但Cc组减少无显著差异。各组哮喘急性发作减少(人年)及95%可信区间(95%CI):Ch组-1.61,-2.87～-0.34;Cc组-0.88,-2.15～-0.40;Ch-Cc组-1.60,-2.88～-0.31。各组入院率均有减少,但Cc组减少无显著差异。各组入院率减少(人/年)及95%CI:Ch组-0.28,-0.51～-0.05;Cc组-0.17,-0.40～-0.07;Ch-Cc组-0.25,-0.49～-0.02。各组中试验后生活质量无显著改善。结论对儿童及照顾者进行哮喘相关教育可显著减少哮喘的急性发作和减少哮喘的住院治疗次数,但不能改善患儿的生活质量。但仅对照顾者进行教育,不能有效减少儿童哮喘的急性发作和入院率。

Objective To establish the efficacy in terms of morbidity and quality of life of a group education program on asthma aimed at children and caregivers. Methods An open, randomized, controlled trial was involved 245 children with active asthma aged 9 to 13 years and their caregivers. The intervention consisted of 3 educational sessions lasting 45 to 60 minutes each and was performed with 3 intervention groups： children alone, caregivers alone, and both children and caregivers. The outcome measures were difference between intervention and control groups in the rate of asthma attacks and hospital admission, as well as the quality of life of children and caregivers in the 6 months following the intervention. Results The rate of asthma attacks per patient-year decreased when the intervention was given only to children （mean difference,-1.61; 95% confidence interval [CI], （-2.87--0.34） or to both children and caregivers （-1.60; 95%CI,-2.88 to -0.31）. Hospital admissions per patient-year decreased in the intervention groups children alone（-0.28;95%CI,-0.51 to -0.05） and both children and caregivers （-0.25;95%CI,-0.49 to-0.02）.Education provided to caregivers alone was not associated with any changes in morbidity.No differences were observed in terms of quality of life between controls and any of the intervention groups. Conclusion Group education on asthma reduces morbidity but does not improve quality of life.The benefits are apparent when education is aimed at children but no additional benefits obtained if the intervention is also aimed at their caregivers.Finally, group education for adult caregivers alone is not effective.